Missouri offers Marketplace plans from seven insurers in 2020. Premiums have decreased, so finding affordable coverage may be easier than ever before.
Missouri Health Insurance Overview
About 5.9 million people call the Show-Me State home.1 Most residents get health insurance through an employer while one in three gets them through government programs. Just under 4% of the population have Obamacare health insurance through the Marketplace.2 The majority of residents with Marketplace coverage get subsidies from the federal government to help offset the cost of coverage. Other residents with low income qualify for Medicaid.
Missouri and the Affordable Care Act
Fewer Missouri residents are uninsured since the Affordable Care Act (or Obamacare) took effect in 2013. The uninsured rate has decreased every year since and dropped to 9% in 2018.3
Missouri is among 14 states that haven’t expanded Medicaid. Under the ACA, states can expand Medicaid to childless, able-bodied adults under 65 who earn up to 138% of the federal poverty level. Missouri currently has 124,000 uninsured residents who could access health insurance if the state extended eligibility for Medicaid.
Missouri’s Marketplace Enrollment
Missouri uses the federal exchange at HealthCare.gov for enrollment in ACA qualified health plans. More than 220,000 residents signed-up for individual and family coverage for the 2020 enrollment season, which ended on December 18, 2019.4 The next enrollment season starts on November 1, 2020. You may be able to shop for 2020 plans before November 1 if you have a qualifying life event.
Buying Missouri Health Insurance for Individuals, Families, and Self-Employed Entrepreneurs
Obamacare offers private health insurance to individuals, families, and self-employed entrepreneurs with no employees. The latter includes freelancers or independent contractors.
If you buy an Obamacare plan, insurers can’t deny you coverage due to your health or a preexisting condition. You also get guaranteed coverage that includes essential health benefits, such as maternity care, hospitalization, and free preventive services. If any children enroll, the policy must provide them vision and dental benefits.
Plans are available in four metal levels: bronze, silver, gold, and platinum. Each level covers a percentage of your medical expenses from 60% to 90%. Bronze plans offer the lowest monthly premiums but higher costs when you get care. Platinum plans are the reverse: they have higher premiums but lower costs when you get care.
Health Insurance Costs in Missouri
Missourians who enrolled in 2020 health insurance through the state’s Marketplace paid an average of $483 per month (for a silver plan). This amount dropped from $499 in 2019. Marketplace premiums peaked at $529 a month in 2018.
In 2019, 87% of Missourians with Marketplace coverage received subsidies to lower their premiums. Another 61% received cost-sharing reductions on silver plans, which helped reduce their out-of-pocket expenses.
The average subsidy received in 2019 was $578 per month.5 You qualify for Obamacare subsidies if you earn between 100% and 400% of the federal poverty level. This ranges from $12,760 to $51,040 per year for a single adult in 2020.
Health Insurance Companies in Missouri
Three new insurers joined Missouri’s Marketplace for 2020: Cox Health Systems, SSM Health, Oscar Health.6 The new entrants make up a total of seven Missouri health insurance companies offering individuals and family plans:
- Ambetter (Celtic)
- HALIC (Anthem)
Missouri’s Medicaid Program for Low-Income Adults and Children
Missouri’s Medicaid program, MO HealthNet, enrolled about 885,000 people as of October 2019.7 You may qualify for benefits if you earn $16,612 or less as a single adult. The income limit rises by about $5,878 for each additional person in your household.8
MO Health Net offers coverage through two programs: Managed Care and Fee-for-Service. You get comprehensive health benefits, such as hospital care, doctor visits, emergency care, and prescription drug coverage.
Managed Care Program is available to:
- Kids under 19 (provided through MO HealthNet for Kids)
- Pregnant women and newborns
Fee-for-Service Program is available to:
- People with disabilities
- Blind and visually-impaired adults
- Women with breast or cervical cancer
Missouri Medicare Coverage for Seniors and People Under 65 With Disabilities
You may know Medicare as a health insurance program for seniors turning 65. But younger people who collect Social Security Disability Insurance (SSDI) benefits also qualify for it. Among Missouri’s roughly 1.2 million7 Medicare enrollees, four out of five are age 65.9
Close to 7 out of 10 enrollees in Missouri have Original Medicare, which is the traditional program run by the federal government.10 The rest have private Medicare Advantage plans, which include all the benefits of Original Medicare and often come with prescription drug coverage.
Drug coverage is also available through standalone Part D prescription drug plans, which are often paired with Original Medicare. You may also add a Medicare Supplement (called Medigap) plan to help pay for some or all of your Original Medicare out-of-pocket costs.
Short-Term Health Insurance in Missouri If You’re In Between Jobs or a Coverage Gap
Missouri allows the sale of short-term health insurance plans, but only with coverage for up to six months.
You may consider buying a Missouri short-term health plan if you need basic health coverage temporarily. Losing coverage through a job, spouse, or parents’ health plan are among the reasons why some choose this type of coverage.
Short-term health plans usually cost less than comprehensive health insurance under the Affordable Care Act (ACA). But they have a downside: they don’t have to follow ACA rules to cover preexisting conditions or include essential health plans.
Before you buy a short-term health policy, be sure to ask questions to understand its limitations. You should also compare your Missouri health insurance options to choose the coverage that is right for you.