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Healthcare Advisor

Dr. Noor Ali is a licensed medical doctor and surgeon with an established national health insurance consulting practice serving clients in 34+ states.

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.

What to know about health insurance in Missouri

  • Marketplace plans: If your employer doesn’t provide health insurance, or if you require more coverage than what your employer-sponsored plan provides, you can purchase an individual health insurance plan.
  • Open Enrollment: Missouri’s Health Insurance Marketplace usually accepts enrollments November 1 to December 15. In 2021, you can enroll before August 15 due to the COVID-19 pandemic. If you qualify for special enrollment, you may be able to enroll after this date.
  • Special Enrollment: A Special Enrollment Period is available if you’ve experienced a major life event.
  • Health Insurance Marketplace: You may qualify for a premium tax credit when enrolling in a plan through the Health Insurance Marketplace. This credit is based on household income. The lower the annual household income, the greater the tax credit or subsidy.
  • Premium tax credit: If you don’t qualify for the premium tax credit, you can still purchase health insurance from the marketplace at a higher cost. Alternatively, you can purchase health insurance directly from a private health insurance company.
  • Coverage types: 52% of Missouri’s residents are enrolled in employer health plans. 14.4% are insured by Medicaid, 16.4% are insured by Medicare, and 5.7% are enrolled in non-group insurance plans. Just 1.3% are enrolled in military plans while 10% of Missouri’s residents don’t have health insurance.

How do I enroll in Missouri's health insurance marketplace?

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 will provide you with a list of qualifying plans. You’ll be able to 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:

  • Anthem Blue Cross and Blue Shield
  • Ambetter from Home State Health
  • Blue Cross and Blue Shield of Kansas
  • Medica
  • Cox Health Plans
  • Cigna Health Care
  • Oscar Insurance Company
  • WellFirst Health

How do I enroll in Missouri individual and family insurance?

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 a spouse or your 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.

Insurance for individuals in Missouri

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 does not 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:

  • Preferred Provider Organizations (PPOs) give you access to healthcare providers both in and out of the network with little to no restrictions.
  • Health Maintenance Organizations (HMOs) are typically less expensive than PPOs; however, they don’t usually cover any out-of-network visits unless you receive a referral and may require you to live within their service area to receive coverage. Additionally, you are assigned a Primary Care Provider who acts as the gatekeeper to your health plan.
  • You can also consider Point-Of-Service (POS) plans, which combine the low cost of HMOs with the flexibility of PPOs.

Insurance for families in Missouri

When you’re shopping for 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.

How much does health insurance cost in Missouri?

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 2018 2019 2020 2021
Most affordable bronze plan $389 $394 $379 $347
Most affordable silver plan $495 $479 $467 $467
Most affordable gold plan $730 $657 $593 $530

  • Bronze plans are those with the least expensive premiums, but it’s also essential to keep in mind that these plans often have higher deductibles and 40% copay requirements for all medical services. While these plans are great if you’re in good health and simply need coverage for emergencies, they’re not ideal if you have chronic health problems or require extensive coverage. As of 2021, the least expensive bronze plan costs $347 monthly.
  • Silver plans are generally more expensive than bronze plans; however, they also have lower copay amounts and deductibles. Silver plans sometimes come with additional savings if your income qualifies and can sometimes cost less than bronze plans. Silver plans come with a 30% copay. As of 2021, the least expensive silver plan was $467 monthly before income-based savings.
  • Gold and platinum plans carry the highest monthly premiums and the lowest deductibles and copays. Gold plans include a 20% copay, while platinum plan copays are just 10%. These are the best plans if you have high coverage needs. As of 2021, the most affordable gold plan was $530 monthly.

What kind of low-income health insurance is available in Missouri?

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.

Medicaid in Missouri

MO HealthNet is Missouri’s program for Medicaid and Medicare. It’s available to households with low income in the following categories:

  • Seniors aged 65 and older
  • Pregnant women
  • Blind and visually impaired persons
  • Uninsured women
  • Women with breast or cervical cancer
  • Disabled persons
  • Children aged 18 and younger

You can only qualify for Medicaid with low or very low income. For a single person, the maximum annual income for Medicaid eligibility is $17,131 per year, while a family of four’s household income needs to be below $35,245. 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.

Medicaid Waivers

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:

  • 1115 demonstration waivers
  • 1915(c) waivers

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:

  • Adult Day Care Waiver
  • Aged and Disabled Waiver
  • AIDS Waiver
  • Brain Injury Waiver
  • Community Support Waiver
  • Comprehensive Waiver
  • Independent Living Waiver
  • Medically Fragile Adult Waiver
  • MO Children with Developmental Disabilities Waiver
  • Partnership for Hope Waiver
  • Structured Family Caregiving Waiver

What are Missouri’s Medicare options for seniors and people with disabilities?

If you’re 65 or older or have a qualifying disability, you have several Medicare options available. Medicare plans feature two main parts: Part A and Part B. While Part A covers inpatient care, Part B provides primary care, preventative care, and other outpatient medical services. 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 does not cover the cost of Part D premiums.

You may also want to consider Medicare Advantage (MA). With MA plans, you can access additional benefits, including Medicare Part D, medical transportation, and alternative care options.

Eligibility You must be a legal U.S. citizen or lawful permanent resident who is at least 65 years old or have a qualifying disability to qualify for Medicare coverage.
Enrollment Initial enrollment: You become eligible for Medicare at the age of 65 and have a seven-month Initial Enrollment period during which you’re eligible to apply for benefits. That period begins three months before the month you turn 65, includes the month of your birthday, and ends three months after turning 65. If you don’t enroll in Part B coverage, you’ll face a late enrollment penalty.
Open enrollment: The Open Enrollment Period is annually from October 15 to December 7. During Open Enrollment, you can make changes to your plan.
Medicare/Medicaid Dual Eligibility You may be dually eligible for both Medicare and Medicaid. When this happens, most healthcare costs are covered in full by combining benefits.

Medicare Resources

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.

Are there short-term health insurance plan options in Missouri?

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 should not expect adequate coverage from a short-term health insurance plan if you have chronic health conditions or expensive prescription medications, and there is no coverage for preexisting conditions.

Missouri Insurance FAQs

Is MO HealthNet the same as Medicaid?

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.

Does Missouri require residents to carry health insurance?

Although there aren’t any state laws that require you to carry health insurance in Missouri, the Affordable Care Act does require all U.S. citizens to carry insurance. Previously, those who did not carry insurance were subject to tax penalties; however, this penalty has been reduced to $0 and this rule is no longer enforced.

Do I have to use the Health Insurance Marketplace when buying health insurance in Missouri?

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.

How can I qualify for the Health Insurance Marketplace Special Enrollment Period?

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:

  • Loss of health coverage due to job loss or changes in eligibility
  • Getting married or divorced
  • Adding a child to your family
  • A death in the family
  • Changes in residence
  • Changes in income
  • Release from prison or jail

What types of alternative health insurance plans (like cost-sharing plans) are available in Missouri?

In Missouri, some you may qualify for cost-sharing or health-share insurance. With these plans, members share costs such as deductibles and copayments by pooling funds to cover expenses. This model often works like a reimbursement program. Please note that since this is legally not health insurance, health sharing companies are not obligated to pay claims.

Do I need health insurance if I have an HSA or FSA?

Health spending accounts and flexible spending accounts aren’t meant to cover significant healthcare 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.

Do I need short-term disability coverage in Missouri if I have health insurance?

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.

Do I need long-term disability coverage in Missouri if I have health insurance?

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 a health insurance policy that covers medical bills.

What does MORx Cover?

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 does not pay for any compound medications or over-the-counter drugs, such as vitamins, minerals, or cold medications.

Can I use MORx if I’m on Medicaid?

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.

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