Missouri Health Insurance

Overview

If you live in Missouri and either buy your own health insurance or are currently uninsured, this guide is for you. It will help you:

  • Determine whether you may qualify for a credit to help you pay for health insurance under the Affordable Care Act (also known as Obamacare)
  • Compare private health plans using U.S. News & World Report's health insurance ratings for Missouri

If you are enrolling for an Obamacare subsidized insurance plan through Healthcare.gov or a broker, the official deadline to sign up for health coverage in 2014 was March 31st. If you signed up by March 31, you would be covered by May 1 and avoid paying a penalty for not being insured.

* Note that federal officials let you get qualified coverage after March 31 IF you started an application by March 31 and finish by April 15.

Do I Qualify for a Tax Break on Health Insurance?

Use the calculator below to determine whether you qualify to receive a tax credit (called a subsidy) that you can use to pay for health insurance. The calculator will also help steer you toward health insurance options that may be best for your needs.

What Plan Type is Right For Me?
How Many Need Coverage
Total Annual Income
 
 

You may qualify for Medicaid, a free, state-sponsored health insurance program. Call 800-318-2596 or go to the Health Insurance Marketplace website to find out if you can enroll in Medicaid.

You qualify for a subsidy (tax credit) that will save you money if you buy a plan on Missouri's new insurance marketplace, called Health Insurance Marketplace. Plans should be offered there starting October 1, 2013. While your subsidy will cover part of the monthly premium for any of the marketplace's plans, a plan that's in the "silver tier" probably offers the best deal. That's because you also qualify for a second subsidy that increases the value of benefits you'd get from any silver plan.

You qualify for a subsidy (tax credit) that will save you money if you buy a health plan on Missouri's new insurance marketplace, called Health Insurance Marketplace. Plans should be offered there starting October 1, 2013. Your subsidy will cover part of the monthly premium for any of the marketplace's plans, known as Qualified Health Plans.

You don't qualify for a subsidy. You can either buy a plan on the Health Insurance Marketplace website or click the button below to compare U.S. News-rated plans in your state's private insurance market. Plans on Health Insurance Marketplace will generally offer more health coverage than plans in the private market, but they also tend to cost more in monthly premiums. The Health Insurance Marketplace website should offer plans beginning October 1, 2013.

Any children in your household may be eligible for Medicaid. Call 800-318-2596 or go to the Health Insurance Marketplace website to find out if your children are Medicaid-eligible.

See Plans

If You Qualify: Plans That Cost Less

Under the Affordable Care Act, you might qualify for a subsidy to help pay for your health insurance. If you qualify, the subsidy can be used to reduce the cost of your monthly premium or can be taken as an annual tax credit. To take advantage of a subsidy, you must choose a health plan that has been approved by the federal government and the government of Missouri. These plans, known as Exchange Plans, meet a set of standards that aim to eliminate benefit loopholes to make sure that people with pre-existing conditions are not being denied coverage. 

Note: you had until March 31 to enroll for coverage for the rest of 2014 (enrolling on March 31 would cover you starting May 1). If you missed this date, with few exceptions, you will pay a penalty.

If You Don't Qualify: Private Plans

If you don’t qualify for a subsidy, you can still choose among the Health Exchange Plans, or consider one of the many private health insurance plans available in Missouri’s private marketplace. We have rated these private plans on a 1-star to 5-star basis, with 5-star plans providing the most comprehensive coverage.  What’s the biggest difference between a private market health plan and a government-approved one? The trade-off is usually cost. Insurance companies can charge less for private plans with less-extensive network coverage or fewer benefits, which makes more-affordable options available to you.

Do I Have To Buy Health Insurance?

You may have heard that everyone in Missouri must have health insurance in 2014 or pay a penalty – Obamacare's so-called “individual mandate.” With a few exceptions, this is true. For 2014, not carrying insurance will cost $95 per adult plus $47.50 per child (up to $285 per family) or 1 percent of your family’s income, whichever is more. 

U.S. News generally recommends getting health insurance of some kind, even if it is only catastrophic coverage. That's because unexpected medical expenses can easily bankrupt anyone who is uninsured.

Where To Buy Health Insurance

Missouri's Official Marketplace

Health Insurance Marketplace is Missouri’s official portal for buying an Obamacare Health Exchange Plan under the Affordable Care Act. To sign up online for coverage on Health Insurance Marketplace, be prepared to fill out a form that could take 30 minutes or longer. To complete the process quickly, have this info handy:

  • Social security numbers for everyone in your household
  • Your employer’s name and address
  • Your most-recent pay stub or recent records of your wages
  • Information about other types of income you receive, such as alimony, unemployment benefits or a pension

 

Insurance Companies and Brokers

Some people prefer to buy health insurance directly from an insurance company or through a broker. Thanks to strict regulation, you'll pay the same price for a plan regardless of where you buy it – whether on the Health Insurance Marketplace website, through a broker or directly from an insurer – and regardless of whether you sign-up via phone, online, or by filling out paper forms.

U.S. News & World Report has teamed up with eHealth.com, an online broker licensed to sell health insurance, to help you buy the health plan you want. The eHealth customer service team can answer questions, determine whether you're eligible for a subsidy and help you apply for insurance.

Qualified Plans on Health Insurance Marketplace

Beginning October 1, 2013, each state was required by law to have a new online marketplace where residents can buy health insurance. In these marketplaces, most states will offer five tiers of Obamacare Health Exchange Plans: platinum, gold, silver, bronze and catastrophic. Platinum plans will offer the highest level of coverage but tend to cost more in monthly premiums. Bronze plans will cover only a bare minimum of health care expenses but tend to have low premiums. If you are relatively healthy and want to pay less up front, consider a lower-tier plan such as bronze or silver.

You should also look at a Health Insurance Marketplace plan if you are lower-income, because the government will give financial help on a sliding scale to pay for premiums, and better benefits if you select a silver-tier plan. If you have not already done so, we can tell you if a Health Insurance Marketplace plan makes sense given your income on the State Overview tab, under the heading, "Do I Qualify For a Tax Break?"

Read ACA and Health Insurance: Which "Metal" Tier is Right for You? for more advice on choosing between metal tiers.

Participating Companies

Anthem Blue Cross Blue Shield. Anthem offers PPO exchange plans in Catastrophic through Gold tiers. However, its exchange plans do not include the BJC hospital network, the largest health care provider in Missouri, reported the St. Louis Post-Dispatch. The BJC hospital network is comprised of 13 hospitals in Missouri and southern Illinois, including the Barnes-Jewish Hospital and St. Louis Children’s Hospital. Boone Hospital Center, as a part of the BJC network and Lake Regional Medical Center in Osage Beach are also not included within the Anthem network, according to The Columbia Daily Tribune. In addition, its network does include the University of Missouri Health Care, Moberly Regional Medical Center, Audrain County Medical Center or St. Mary’s Health Center. 

Blue Cross and Blue Shield of Kansas City. As Missouri’s largest insurer, the company is affiliated with the Blue Cross and Blue Shield Association, the oldest U.S. health insurance system. The Blue Cross and Blue Shield Association offers coverage in all 50 states, Washington, D.C., and Puerto Rico and has 37 Blue Cross and Blue Shield companies that serve over 100 million members (one third of all Americans), according to the company. Nationally, Blue Cross and Blue Shield companies have contracts with over 96 percent of hospitals and 91 percent of providers. Missouri residents who buy a Blue Cross and Blue Shield exchange plan may not have access to the entire network of doctors and hospitals. BCBSKS offers PPO exchange plans in Bronze through Gold tiers.

Coventry Health and Life. In 2012, Coventry was acquired by Aetna, one of the largest U.S. insurance companies, and is now a subsidiary of the company. Coventry has more than 5 million members in all 50 states. BJC, Missouri’s largest hospital network system, comprised of 13 hospitals, is included within Coventry’s PPO exchange network, reports the St. Louis Post-Dispatch. Its network includes the following hospital systems: BJC, Mercy Health, SSM Health Care, St. Anthony’s Medical Center and St. Luke’s Hospital. Coventry Health offers PPO exchange plans in Catastrophic through Gold tiers.

Coventry Health Care. A subsidiary of Coventry Health, Coventry Health Care offers PPO exchange plans in Catastrophic through Gold tiers.

Need More Help?

The Missouri Department of Insurance exists to help residents resolve issues with their insurance company, locate a doctor or other provider within their network, appeal a denial of service, and resolve billing problems with insurers and providers. The office can be reached at 800-726-7390 or emailed at consumeraffairs@insurance.mo.gov. Residents can file an insurance complaint online by mail.

Health Insurance Guide

U.S. News offers information on how to buy health insurance and publishes plan ratings for every state. If you’re over 65, see the guide to Medicare plans. Otherwise, start by looking up the Health Insurance Guide for your state.

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2014-05-01