TABLE OF CONTENTS
In Missouri, there are many health insurance options available. Your options include employer-sponsored insurance plans, Medicaid, Medicare, and private individual or family health insurance.
Read this guide to see your health insurance options and learn how to select insurance that best suits your needs.
If you’d like to enroll in a health insurance plan via Missouri’s Health Insurance Marketplace, you can do so by visiting HealthCare.gov. Once there, you can create an account to view and compare plans. After you’ve signed up for your account, you can complete an application for health insurance coverage. Using the information you provide on this application, HealthCare.gov will check your eligibility for Medicaid and the premium tax credit. With a completed application, HealthCare.gov provides you with a list of qualifying plans. You can compare details, such as premiums and deductibles, as well as copay requirements. The website allows you to compare up to three plans side by side so you can view costs and coverage details on a single screen. Once you’ve selected a plan, you can continue the enrollment process at HealthCare.gov. Insurance companies that offer family health insurance plans for Missouri residents include:
The enrollment process for families and individuals is similar. Just as when you purchase insurance for yourself, it’s essential to consider the needs of family members when selecting insurance for your spouse or dependents. As you compare plans, keep each family member’s medical needs and anticipated coverage requirements in mind. Additionally, consider your budget and preferred plan type. Consider different plans for yourself or other family members if certain members need a significantly higher level of care than others. For example, if one member is diabetic and needs regular specialist care and expensive injectable medications, and the rest of the family is healthy, not everyone needs to be on the same plan. Consult with a broker or independent health insurance agent to find the best combination of coverage that has the most cost-effective outcome.
When you’re shopping for individual health care coverage, you can often tailor add-ons and deductibles to suit your needs and budget. If you’re looking to pay low monthly premiums and don’t anticipate high coverage needs, consider speaking to your insurance provider about increasing your annual deductible. Be careful here because a lower premium doesn’t always mean a higher deductible and vice versa. Look for out-of-pocket expenses, such as copays, coinsurance, and maximum out of pockets. You’ll also want to consider the type of network of providers that you have access to on the plan you select:
When you’re shopping for affordable health insurance for more than just yourself, it’s essential to carefully weigh your costs as well as your family’s health conditions or insurance needs. It might be best to purchase a more expensive plan with lower deductibles and copays for families whose members have chronic health conditions or ongoing medication needs. Just as with individual insurance, it’s essential to consider the type of health insurance plan you want. If you have a family member who requires specialist treatment, purchasing a PPO plan that enables you to visit healthcare providers outside your network without a referral is often the smartest choice. If you choose to purchase an HMO plan, make sure the providers you like to go to are in-network and will accept the plan. HMO plans are typically very limited in their area of service with little to no flexibility when it comes to selecting specialists.
Four tiers of health insurance plans are recognized in the Health Insurance Marketplace: Bronze, Silver, Gold, and Platinum. Tiers are ranked by the copay amount or the coinsurance amount. Each of these tiers usually includes different plans, including HMOs and PPOs, from various providers and networks:
|Average premium in Missouri||2020||2021||2022||2023|
|Most affordable Bronze plan||$380||$358||$343||$385|
|Most affordable Silver plan||$506||$470||$445||$472|
|Most affordable Gold plan||$510||$464||$435||$562|
Missouri offers MO HealthNet, Missouri’s Medicaid program if you meet low-income requirements and are in a qualifying category. Medicaid covers the cost of necessary healthcare services and is provided jointly by the state and federal governments.
MO HealthNet is Missouri’s program for Medicaid and Medicare. It’s available to households with low income in the following categories:
You can only qualify for Medicaid with low or very low income. For a single person, the maximum annual income for Medicaid eligibility is $18,075 per year, while a family of four’s household income needs to be below $36,908. In addition to the standard MO HealthNet managed care and fee-for-service plans, another option is available to seniors. The Missouri Care Options program expands the coverage offered by traditional Medicaid to help seniors who require long-term care. Covered services include homemaker services, personal care, adult daycare, and nursing services. This program is entitlement-based, meaning that all eligible and qualified seniors may access it. To apply for MO HealthNet coverage, visit MyDSS online and complete the appropriate benefits application.
MO HealthNet waivers help seniors, disabled persons, and those facing mental health problems access additional care that’s not traditionally covered by Medicaid programs. There are two types of waivers in Missouri:
While 1115 demonstration waivers provide coverage for experimental and pilot programs that support Medicaid objectives, 1915(c) waivers ensure that seniors and those with disabilities can access home and community-based services, thus delaying or negating the need for institutional care. Missouri’s waivers include:
If you’re 65 or older or have a qualifying disability, you have several Medicare options available.
Original Medicare plans feature two main parts: Part A and Part B. While Part A covers inpatient care, Part B provides primary care, preventive care, and other outpatient medical services. The Medicare Part A deductible for inpatient hospital stays is $1,600 in 2023. Medicare Part B enrollees pay a standard monthly premium of $226 for 2023. These plans don’t cover prescription medications, but you can purchase additional supplemental coverage called Medicare Part D, which covers the cost of medications.
MORx is Missouri’s state pharmacy assistance program. It provides coverage for prescription medications for seniors who are members of a Medicare Part D plan. This plan coordinates with Medicare Part D and pays 50% of the beneficiary’s out-of-pocket costs after using their Part D plan. This program doesn’t cover the cost of Part D premiums.
You may also want to consider Medicare Advantage. With Medicare Advantage Plans, you can access additional benefits, including Medicare Part D, medical transportation, and alternative care options. As of 2023, there are 135 Medicare Advantage Plans available in the state, however, you can only select a plan that’s available in your county.
You must be a legal United States.S. citizen or lawful permanent resident who is at least 65 years old or have a qualifying disability to qualify for Medicare coverage.
If you start receiving your Social Security or Railroad Retirement Board benefits at least four months before you turn 65, you’ll be automatically enrolled in Medicare. Otherwise, you must fill out an application online or contact your local Social Security office. You can enroll in Medicare during the following periods:
In Missouri, CLAIM operates as the SHIP program. It provides insurance counseling for Medicare and Medicaid recipients throughout the state, providing help with benefits coordination, Medicaid spend down, applications, and claims.
Short-term health insurance plans are available in Missouri. These plans provide coverage for a limited time, typically anywhere from 90 days up to six months. Short-term health insurance is designed to provide insurance when there are gaps in your coverage, such as between jobs or under a waiting period at the beginning of group or individual coverage. Because the coverage offered by short-term plans is limited and temporary, premiums are usually affordable. You shouldn’t expect adequate coverage from a short-term health insurance plan if you have chronic health conditions or expensive prescription medications, and there’s no coverage for preexisting conditions.
MO HealthNet is the name for Missouri’s Medicaid program. It provides coverage for low-income individuals and families throughout the state and is jointly paid for by Missouri and the federal government.
Although there aren’t any state laws that require you to carry health insurance in Missouri, the Affordable Care Act (ACA) does require all U.S. citizens to carry insurance. Previously, those who didn’t carry insurance were subject to tax penalties. However, this penalty has been reduced to $0 and this rule is no longer enforced.
While there’s no requirement to use Missouri’s Health Insurance Marketplace when shopping around for coverage, it’s recommended. If your household income is low enough, you may qualify for premium tax credits. These credits are only provided to those who apply using the marketplace.
Several life events qualify you for special enrollment periods, meaning you can enroll in a health insurance plan outside of the annual open enrollment period. These life events include:
The most popular form of cost-sharing plans are faith-based plans. In a faith-based plan, members share health care costs with other members. You don’t need to be a member of a particular denomination (or even religious), to participate in a plan. While these plans can be relatively low-cost, most faith-based plans don’t conform to Affordable Care Act standards and don’t cover pre-existing conditions, mental health care, or pregnancy.
Health spending accounts (HSAs) and flexible spending accounts (FSAs) aren’t meant to cover significant health care expenses. If you’re hospitalized or experience a medical emergency, most HSAs and FSAs don’t include enough coverage to pay your full costs. While it’s not required, having a health insurance policy in addition to your HSA or FSA is recommended.
Short-term disability coverage works to cover non-medical expenses when you’re out of work due to illness or injury for a short period of time. Because health insurance doesn’t cover expenses such as food, rent/mortgage, and other bills, it’s best to consider short-term disability on top of your health insurance policy.
Just like short-term disability coverage, long-term disability insurance can help cover your household costs when you’re out of work for an extended period of time due to illness or injury. Long-term disability coverage works best when combined with an affordable health insurance policy that covers medical bills.
MORx covers 50% of out-of-pocket costs paid for prescription medications when a member has Medicare Part D. The plan covers generic prescriptions and brand name prescriptions when a generic replacement isn’t available. Prescriptions are only covered up to 31 days at a time.
MORx doesn’t pay for any compound medications or over-the-counter drugs, such as vitamins, minerals, or cold medications.
You’ll qualify for MORx after you’ve met your Medicaid spend-down requirement at least once during the calendar year. Once the spend-down requirement has been met once, MORx benefits will begin.