The Missouri Health Insurance Marketplace
In Missouri, the health insurance exchange offers individual and small group coverage to numerous residents at an affordable cost. While the marketplace is federally-run, each carrier selling coverage is a familiar Missouri insurer. Before the health law, Missouri health plans were only reasonably priced for healthy individuals, and now everyone in the state has access to coverage they can afford. Subsidized individual health plans sold on the exchange are especially beneficial to those who have been enrolled in a risk pool, uninsured, or whose income is just over the Medicaid limit, as these plans are guaranteed issue and benefit-rich. The Affordable Care Act established the Missouri marketplace, in which insurers sell reduced-cost insurance plans covering various benefits. The health law also requires each resident to have coverage, and the exchange is the optimal solution for many individuals.
Insurers selling plans on the exchange factor in tax credits to reduce premiums and cost sharing for qualifying applicants. Many individuals applying for health plans on the Missouri exchange qualify for discounted rates and medical expenses, including those who earn between 100-400 percent of federal poverty. Another perk of exchange plans is coverage for various categories of care called essential health benefits. This includes services such as maternity care, doctor’s office visits, prescription medications, and emergency room care. Exchange policies are sold by a handful of national carriers serving Missouri’s private individual market.
Marketplace plans are a wonderful, affordable addition to Missouri insurance products for individuals, families and small businesses. For assistance and guidance with these plans and tax credits, contact a licensed agent at 888 803 5917.
Each comprehensive plan on the Missouri individual exchange belongs to a “metallic” tier to help you more easily identify coverage levels. These tiers indicate how much your plan pays for covered healthcare services and about how much you are expected to pay. Bronze and silver plans also have lower monthly premiums, while gold and platinum plans are more costly as they provide better coverage.
For young, healthy Missouri residents under age 30, catastrophic plans are a less expensive alternative to these four plan types. Such plans won’t pay for most types of care, but if you rarely see the doctor, it may be helpful. Catastrophic plans also help you evade the penalty for being uninsured. These plans cover four office visits and preventive care in full, and emergency care at deductible. While they are inexpensive, these plans also cannot be used with subsidies. Use the cost comparison tool below to view estimates of your rates.
Premium Tax Credit
Marketplace plans offers financial assistance to residents with household income between 100 and 400 percent of poverty. If you have income closer to the poverty line, you’re likely eligible for a larger discount, covering a portion of both cost sharing and premiums. While it doesn’t offer the best coverage, some applicants can even qualify for a zero-premium bronze plan after their subsidy is factored in. Marketplace applicants in Missouri earning between 100 and 250 percent of federal poverty qualify for a cost sharing subsidy to help pay for coinsurance, copays and deductibles. If you earn up to 400 percent of FPL, the government will provide you with a premium tax credit.
Tax credits are estimated by considering your total family income, and the second lowest-cost silver plan in your area as a percentage of your income. Your subsidy amount is determined by how much of the premium needs to be paid after you pay up to the premium share limit for your income level. The table below indicates the premium share thresholds for subsidy-eligible income groups.
A variety of Missouri participate in the exchange, selling subsidized individual and small group plans. Different companies are available in different areas, with about 1-3 carriers per region. You may find that the insurers’ provider networks are smaller than usual, which is typical of marketplace plans. Making provider networks smaller makes it feasible for insurers to sell these subsidized plans. Before you apply, please verify that your doctors are included in your future plan’s network. If not, you may check which plans outside the marketplace can connect you with your providers of choice. The following carriers sell plans on the marketplace in Missouri. Use the tool below or call us to find out what plans are in your area at 888 803 5917.
- Anthem Blue Cross and Blue Shield
- Blue Cross and Blue Shield of Kansas City
- Coventry Health and Life
- Coventry Health Care of Kansas
To simplify shopping for health plans on the marketplace, each insurer is required to cover ten types of benefits, providing a general idea of what you can expect. Copays, coinsurance and other costs vary between plans and companies, as do the specifics of covering the ten essential health benefits. Certain services, such as preventive immunizations or exams, are covered in full, and others, like ER visits and hospital care, require some amount of cost sharing. Always read the fine print of your plan, notably the outline of benefits, to confirm a particular service is covered.
Essential Health Benefits include:
- Preventive, wellness, and chronic disease management services
- Office visits
- Laboratory tests
- Prescription medications
- Maternity and newborn care
- Emergency care
- Pediatric care, including dental and vision
- Rehabilitative and habilitative services and devices
- Mental health and substance abuse services, including behavioral health care
Small Business Health Options Program
In addition to individual market coverage, the exchange offers small group plans through the Small Business Health Options Program (SHOP) at a reduced rate for qualifying businesses. Missouri’s small business owners across the state can insure their workers for a lower rate if they have less than 25 full-time workers who earn $50,000 per year per person. The Small Business Health Care Tax Credit is offered to employers who meet these criteria, and those who employ up to 49 workers may qualify for a plan through the SHOP. The highest tax credit an employer can receive covers half of their premium contribution, which is given to companies with 10 or fewer workers with annual income up to $25,000 each.
How to Apply
You can apply for Missouri marketplace plans by contacting a licensed insurance agent at 888.803.5917. Additionally, you can locate a facility where navigators are staffed, including local hospitals and nonprofit organizations. HealthCare.gov is the federal website for the exchange, but as it’s helpful to receive professional assistance when selecting an annual health plan, consulting an agent is advantageous. Our agents are licensed to sell non-marketplace individual health plans throughout the state, and have also been certified to enroll Missouri residents in subsidized exchange plans. Before applying, no matter how you do so, it’s best to research your coverage options and secure a health plan you can get the most out of — and afford.
Compare Missouri Marketplace Plans
Below is a cost comparison tool providing a closer look at the marketplace policies. These rates are calculated by average premiums released by insurers on the exchange. If you’re interested in one of the plans you find in your results, or for a more precise quote of exchange plans and subsidy eligibility, call an agent at 888 803 5917.
*The above disclaimer pertains to the creator of this comparison tool, not East Coast Health Insurance, a licensed broker of insurance products.