missouri guide to health insurance

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Missouri health insurance exchange

Four insurers join MO exchange

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Missouri will join the national trend of expanded competition on the health insurance marketplace when the 2015 open enrollment period begins on Nov. 15. Preliminary filings indicate that the number of insurance companies offering policies in Missouri through HealthCare.gov will double — going from four in 2014 to eight in 2015. While the U.S. Department of Health and Human Services (HHS) has announced the number of insurers, they have not released the names of the companies.

Dan Mendelson, CEO of Avalere Health, told CNBC the growing participation by insurers is good news for consumers: “The exchanges are a robust commercial market — viable in the short run and very strategic for a future that has more individual choice.”

2015 insurers, premiums to be announced

Missouri residents may have to wait until open enrollment begins on Nov. 15 to see which insurers are participating and to get a look at 2015 premiums.

While not confirmed by state or federal officials, four insurers so far have indicated they plan to participate in the Missouri marketplace for 2015. Those carriers are Anthem Blue Cross Blue Shield of Missouri, Cigna, Coventry Healthcare, and UnitedHealthcare.

In many states, the department of insurance reviews rates and has authority to push back on increases proposed by insurers. However, Missouri does not have a rate review law, so HHS reviews proposed insurance rates for plans in the state.

HSS has not yet released 2015 marketplace premiums information for the five states for which it conducts rate review: Alabama, Missouri, Oklahoma, Texas and Wyoming.

The Consumer Council of Missouri filed suit against HHS, seeking information about which plans will participate in the 2015 marketplace, the rates they will charge, and the justification for the rates.

SHOP exchange

Missouri small businesses (those with 50 or fewer employees) will be able to shop for health insurance through HealthCare.gov beginning in late October. Missouri is one of five states that will get early access to the federal Small Business Health Options Program (SHOP) online portal. Small employers in other states that use HealthCare.gov will get access starting Nov. 15.

The launch of the online portal was delayed while fixes were made to the marketplace used by individuals. However, small employers were able to enroll in a SHOP plan through a broker or via a paper application while the fixes were underway.

For the 2015 coverage year, Missouri’s small employers can offer their employees a choice of several health plans within a single metal level through the SHOP’s “employee choice” option. Missouri is among 14 states using the federal exchange to implement employee choice for the upcoming year.

How many people enrolled in 2014?

More than 152,000 Missourians purchased health insurance through the marketplace during 2014 open enrollment. That’s 23.2 percent of the estimated eligible market according to the Kaiser Family Foundation. The national average was 28 percent.

In addition to those purchasing private insurance plans, 45,513 people qualified for either Medicaid or the Children’s Health Insurance Program (CHIP).

Among Missouri residents who purchased health insurance, 85 percent qualified for financial assistance, which matches the national figure. A report released in June by HHS showed the average monthly premium, after tax credits, for Missouri consumers was $59. Fifty-seven percent of enrollees pay $50 or less per month after subsidies.

Twenty-one percent of Missouri residents selected a bronze plan (20 percent nationally), 63 percent selected a silver plan (65 percent nationally), 13 percent selected a gold plan (9 percent nationally), 0 percent selected a platinum plan (5 percent nationally) and 3 percent selected a catastrophic plan (2 percent nationally). Twenty-nine percent of Missouri enrollees were between the ages of 18 and 34.

History of the Missouri marketplace

Legislation to establish an exchange was introduced, but failed to pass, in both 2011 and 2012. Despite the lack of legislative authorization, some initial workgroups were established. In 2011, Gov. Jay Nixon established the Health Insurance Exchange Coordinating Council, which did some initial scoping and planning. Also in 2011, the Senate created the Interim Committee on Health Insurance Exchanges to explore Missouri’s options to establish a state-based exchange.
Members of the interim Senate committee refused to authorize the use of federal grant money. In April 2012, the Missouri legislature rejected a $50 million grant to upgrade the state’s Medicaid information system as some legislators believed the system be used as a springboard to building a state-run exchange.

In May 2012, the Missouri legislature approved a ballot measure that to prevent the executive branch from authorizing a state-based health insurance exchange without legislative or popular approval — even though Gov. repeatedly stated his administration would not authorize an exchange by executive order. Voters passed the ballot measure in November 2012, and state defaulted to the federally operated exchange.

Missouri requires training and licensing for navigators that go far beyond federal standards. Legislation also prohibits navigators from providing “advice concerning the benefits, terms and features of a particular health plan, or offer advice about which exchange health plan is better or worse for a particular individual or employer.” Several health care advocacy groups challenged the restriction on providing advice, saying that is the core function of navigators. In January, a federal judge agreed and issued a temporary injunction to halt enforcement of the law.

Missouri health insurance exchange links


State Exchange Profile: Missouri
The Henry J. Kaiser Family Foundation overview of Missouri’s progress toward creating a state health insurance exchange.

Missouri Department of Insurance
Assists people insured by private health plans, Medicaid, or other plans in resolving problems pertaining to their health coverage; assists uninsured residents with access to care.
(800) 726-7390 / consumeraffairs@insurance.mo.gov