- Individuals -

What plans are available in Missouri?

What plans are available in Missouri? image

There are four possible levels of health plans that will be offered by private health companies. 

  •  bronze — These plans pay 60 percent of medical expenses.
  •  silver — These plans pay 70 percent of medical expenses.
  •  gold — These plans pay 80 percent of medical expenses.
  •  platinum — These plans pay 90 percent of medical expenses.

Health Plan Information For Individuals and Families

An Excel file lists all health plans available in Missouri, where the federal government is operating the marketplace. This tool allows you to filter plans by categories. Plans are priced partly on geographic location, so be sure to choose the right county to see plans and prices available in a given area. 

These examples offered in the file are for comparison purposes only. When an individual provides household and income information on the marketplace application, the applicant’s specific age, household makeup and smoking status will be used to determine premium costs. For more information, visit HealthCare.gov. For questions, call toll free 800/318-2596. This is a 24-hour hotline that handles consumers’ questions.

IMPORTANT NOTE: The prices here don’t reflect the lower costs an applicant may qualify for based on household size and income. Many people who apply will qualify for reduced costs through tax credits that are automatically applied to monthly premiums. These credits will significantly lower the prices shown for a majority of those applying. Final price quotes are available only after someone has completed a marketplace application. 

View Health Plans Available In Missouri

View Premium Estimates

Find Assistance In Your Area

Licensed Navigators In Missouri

How Does This Affect Me?

How Does This Affect Me? image

In Missouri, 16 percent of residents are uninsured — that’s 799,257 individuals. Many of these uninsured may qualify for tax credits to purchase health coverage in the marketplace. If you are one of the uninsured, the health plans in the marketplace offer you the opportunity to purchase health insurance at an affordable price to meet your health care needs.

You can get insurance through the exchange if you:

  • live in the United States
  • are a U.S. citizen or national (or lawfully present)
  • currently are not incarcerated

What Do I Need To Know?

What Do I Need To Know? image

Health plans in the marketplace will offer comprehensive coverage, from doctors to medications to hospital visits. You can compare all your insurance options based on price, benefits, quality and other features that may be important to you, in plain language that makes sense.

All plans offered through the Missouri Health Insurance Exchange will meet the Affordable Care Act’s definition of a qualified health plan (QHP). The plans, certified by the exchange, will be offered by level of coverage for essential health benefits (EHB) to allow consumers to compare plans on an “apples to apples” basis. These plans also follow established limits on cost-sharing (like deductibles, co-payments and out-of-pocket maximum amounts) and meet other requirements.

How Much Will This Cost?

The amount will vary, based on the type and level of health plan you select.

The federal government will provide tax credits for qualified individuals who purchase insurance through the exchange.

Individuals and families earning between 133 percent and 400 percent of the federal poverty level (income between $29,725 and $89,400 for a family of four in 2011) will qualify for sliding scale premium tax credits.

Individuals and families earning between 100 percent and 250 percent of the federal poverty level (income between $22,350 and $55,875 for a family of four in 2011) will qualify for cost-sharing tax credits.

If you're curious about your marketplace costs, check out these resources.

Keep in mind that this is just an estimate, and your actual costs may be higher or lower. When open enrollment begins Nov.15, you’ll be able to see exactly what you’ll pay for specific plans, including any savings you qualify for based on your income.

These three scenarios illustrate the cost of health insurance under the Affordable Care Act for families in different circumstances, both before and after premium subsidies (in the form of a tax credit).

Health Insurance Marketplace Basics

This video series, part of Cover Missouri's project to help consumers understand how to get, use, and keep health insurance is a great place to start if you want to learn more about the health insurance marketplace and how to get covered.

Cover Missouri has also made a series of brief fact sheets available that each cover a topic that consistently came to their attention and can impact daily work with assisting consumers.

5 Steps to Staying Covered

To help consumers better understand the renewal process, CMS released the 5 Steps to Staying Covered – to make it as simple as possible for them to choose the plan that best fits their needs and budget.  The consumer tested 5-step process includes:

1) Review: Plans change, people change – review your coverage and look for a letter from your plan about how your benefits and costs may change next year,

2) Update: Starting November 1, log in and update your 2016 application - make sure your household income and other information is up-to-date for next year,

3) Compare: Compare your current plan with other plans that are available in your area,

4) Choose: Select the health plan that best fits your budget and health needs, and

5) Enroll: The marketplace opens on November 1, make sure to review, update, compare and choose by December 15 to have any changes take effect on January 1.  Contact your plan after you’ve enrolled and make sure you pay your first month’s premium.

Seven Things You Can Do Now

Also, this handy checklist outlines seven things you can do now.

  1. Learn about different types of health insurance. Through the marketplace, you’ll be able to choose a health plan that gives you the right balance of costs and coverage.
  2. Make a list of questions you have before it’s time to choose your health plan. For example, “Can I stay with my current doctor?” or “Will this plan cover my health costs when I’m traveling?”
  3. Make sure you understand how insurance works, including deductibles, out-of-pocket maximums, co-payments, etc. You’ll want to consider these details while you’re shopping around. Visit "Insurance Basics" to learn more about how insurance works.
  4. Start gathering basic information about your household income. Most people will qualify to get a break on costs, and you’ll need income information to find out how much you’re eligible for.
  5. Set your budget. There will be different types of health plans to meet a variety of needs and budgets, and breaking them down by cost can help narrow your choices.
  6. Find out from your employer whether they plan to offer health insurance, especially if you work for a small business.
  7. Explore current options. You may be able to get help with insurance now, through existing programs or changes that are in effect already from the new health care law. Use our resources to get information about health insurance for adults up to age 26, children in families with limited incomes (CHIP) and Medicare for people who are over 65 or have disabilities.

Source: Healthcare.gov

Additional Resources

Additional Resources image

Healthcare.gov – Use this interactive tool to find a health insurance plan that fits your needs. Also, create an account to prepare for open enrollment in the state's federally-administered health insurance markeplace. Missourians will use the site to apply for coverage, compare plans and enroll.

Marketplace.cms.gov -  Offers a wide variety of tools and resources to help you help people prepare to apply, enroll, and get coverage.

CoverMissouri.org - This site offers Missourians an overview of the state's health insurance marketplace and the most current information about resources available in Missouri.

Health Coverage for Adult Children - A campaign from the AARP using a little humor as moms encourage their kids to get health insurance (also in Spanish).

Premium Assistance Calculator - This tool from the Kaiser Family Foundation allows individuals to estimate their premium subsidies and costs for purchasing health insurance through the exchange.

Protect Yourself From Fraud - Missouri Attorney General Chris Koster and the Missouri Hospital Association have teamed up to educate Missourians about possible scams surrounding the new federal health insurance exchange plans. In addition, this tipsheet lists ways to help consumers protect themselves from fraud in the marketplaces. 

The Enroll UX 2014 Project - Missouri is participating in the “Enroll UX 2014” project. Enroll UX 2014 has developed an online application and enrollment process for health coverage that meets the requirements of the health reform law.

Zane Benefits - This guide provides an overview of the Missouri health insurance exchange, including the history of the exchange, how the exchange will operate and exchange information for Missouri residents and small businesses.