Missouri Health Insurance Marketplace

Category: State Guides Originally Posted: December 11, 2014 by HealthCare.com Staff Last modified: July 21, 2015

With most of the Affordable Care Act’s major provisions now in effect, the nation’s health insurance marketplace has undergone a significant transformation. Obamacare impacts individuals, families and small business owners alike. Most Americans are required to have minimum essential coverage unless they qualify for an exemption; however, the law is designed to make healthcare insurance more accessible and affordable with income-based financial assistance and one-stop shopping via state-based and federally facilitated exchanges. Meanwhile, the private marketplace remains a place to shop for quality, affordable health insurance plans that meet ACA requirements.

The following guide offers a glimpse at the various types of ACA-compliant health insurance in Missouri, including individual and family health plans, small group health plans, coverage for high-risk applicants, mini-COBRA continuation coverage, Medicaid, and CHIP.

Health and healthcare in Missouri

Missouri placed 36th in United Health Foundation’s 2014 America’s Health Rankings.1 Its strengths include a high rate of high school graduation, lower prevalence of low birthweight than most other states, and small disparity in health status by educational attainment. Challenges Missouri faces include a high prevalence of smoking, low immunization coverage among children, and high cardiovascular and cancer death rates.

Missouri individual and family health insurance

Missouri’s Obamacare health insurance exchange is federally facilitated. Those who need individual and family coverage may buy it through the federal Health Insurance Marketplace and may be eligible for income-based premium tax credits and cost-sharing subsidies when they do. Individuals who go without health insurance may face a tax penalty known as the shared responsibility payment.

Missouri residents can also buy qualified health plans away from the Obamacare exchanges in the private marketplace. Websites such as HealthCare.com can help consumers find affordable coverage that meets their healthcare needs. Check out HealthCare.com’s tax subsidy calculator to see if you qualify for a tax credit. If you do, visit Missouri’s Health Insurance Marketplace to apply for health insurance coverage.

The U.S. Department of Health and Human Services reported that 152,335 individuals in Missouri selected a marketplace plan through the exchange from Oct. 1, 2013, through April 19, 2014.2 In 2015, the number of individuals in Missouri enrolled in a marketplace plan increased to 253,430 during the open enrollment period.3

Missouri’s health insurance exchange: healthcare.gov
Missouri department of insurance: insurance.mo.gov

Missouri small group health insurance plans

Small businesses with 50 or fewer employees can find group coverage options through the SHOP portal, which is accessed through the federal Health Insurance Marketplace website. Small businesses that use SHOP and have 25 or fewer employees may qualify for a Small Business Healthcare Tax Credit.

Self-employed individuals with no employees must apply for an individual health insurance plan on or away from Missouri’s federally facilitated exchange.

Missouri state COBRA variations for small groups

The Consolidated Omnibus Reconciliation Act (COBRA) allows those employed by businesses with 20 or more employees to continue their group health insurance plan for a limited time should they lose coverage due to qualifying events such as termination of employment due to reasons other than gross misconduct, a reduction in work hours, divorce or legal separation, and loss of dependency status. To learn more about the federal COBRA program, visit dol.gov/ebsa/cobra.html.

In some states, those who work for a small business and lose health insurance coverage due to a qualifying event may be eligible for health insurance continuation through mini-COBRA or a similar state continuation program. In a few states, these programs may also be extended to those who work for larger companies and exhaust their federal COBRA continuation coverage limit. Mini-COBRA generally works like the federal COBRA continuation coverage, but its terms may vary.

Missouri’s small group COBRA continuation variations are as follows4:

Mini-COBRA option Yes
Eligible group sizes 2-19
Maximum continuation period – standard 18 months
Maximum premium Increase 102 percent
State legislation reference MO Stat. Sec. 376.428
Additional notes Missouri’s mini-COBRA law is identical to the federal COBRA law.

Missouri high-risk pools

It used to be that health insurance companies could deny applicants or charge them more based on health history and preexisting conditions. When the Affordable Care Act was passed in 2010, many states created federally funded preexisting condition insurance programs or accepted federal funding to assist with similar high-risk pool programs they already operated.5

The Affordable Care Act prohibits this practice for health insurance plans considered minimum essential coverage with effective dates beginning Jan. 1, 2014, and later. As such, the PCIPs and state high-risk pools created to provide health insurance for those once considered uninsurable are being phased out.

Missouri Medicaid

Medicaid is a state health insurance program for low-income individuals under age 65, pregnant women, children, disabled individuals, and seniors over age 65; it is partially funded by the federal government. In 2014, states were given the option to accept additional federal funding and expand their Medicaid program eligibility to those who make up to 133 percent of the federal poverty level (effectively 138 percent due to how it is calculated, according to HealthCare.gov).6

Missouri did not expand Medicaid to low-income adults without dependents in 2014.7 In 2014, a coverage gap was created in states where Medicaid was not expanded. This coverage gap includes those whose incomes are too high for Medicaid but too low to receive federal premium and cost-sharing assistance when shopping the state’s federally facilitated health insurance exchange.

The information below is specific to Missouri’s Medicaid program:

Medicaid expansion No
Governing agency Centers for Medicare & Medicaid
Administrator Missouri Department of Social Services
Where to apply mydss.mo.gov/CitizenPortal/application.do
Additional application options 888-275-5908 — MO HealthNet Service Center
Phone number 888-275-5908 — MO HealthNet Service Center
More information dss.mo.gov/mhd/
Open-enrollment period Year-round in all states
Eligibility Determined by the Missouri Department of Social Services’ Family Support Division

Missouri CHIP

The Children’s Health Insurance Program is a partnership between the states and federal government. CHIP provides health insurance to uninsured children who meet certain eligibility guidelines.

The information below is specific to Missouri’s health insurance program for low-income children:

Program name MO HealthNet for Kids
Website dss.mo.gov/mhk/
Where to apply mydss.mo.gov/CitizenPortal/application.do
Additional application options dss.mo.gov/mhk/appl.htm
Phone number 888-275-5908 — MO HealthNet Service Center
  • Children who are under 19 years old, apply for Social Security number, live in Missouri and intend to remain there, are U.S. citizens or qualified non-citizens, and have a countable family income that meets guidelines
  • Parents must cooperate with Child Support
  • Enforcement in the pursuit of medical support

1 United Health Foundation. 2014 America’s Health Rankings Annual Edition. “Annual State Health Rankings.” http://www.americashealthrankings.org

2 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2014/.

3 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2015/.

4 Missouri Department of Insurance. “Accident and Health FAQ.” http://insurance.mo.gov/consumers/faq/lhfaqs.php.

5 National Conference of State Legislators. Coverage of Uninsurable Pre-Existing Conditions: State and Federal High-Risk Pools. Updated April 2014. http://www.ncsl.org/research/health/high-risk-pools-for-health-coverage.aspx.

6 Centers for Medicare & Medicaid Services. “Medicaid Expansion & What It Means for You.” HealthCare.gov. N.D. https://www.healthcare.gov/what-if-my-state-is-not-expanding-medicaid/.

7 Centers for Medicare & Medicaid Services. “Missouri.” http://www.medicaid.gov/medicaid-chip-program-information/by-state/missouri.html.

8 Missouri Department of Social Services. “MO HealthNet for Kids.” http://dss.mo.gov/fsd/mchild.htm.