Missouri Health Insurance Marketplace Guide

You can buy individual and family health insurance from Missouri’s Marketplace if:⁴

• You live in Missouri. 
• You are lawfully present in the U.S.
• You don’t have Medicare.
• You are not incarcerated.

Eligibility for financial assistance with your Marketplace coverage will depend on your income. In addition, to be eligible for financial assistance in the Marketplace:

• You must not be eligible for affordable employer-sponsored health coverage.
• You must not be eligible for Medicaid/CHIP (MO HealthNet).
• You must not be eligible for premium-free Medicare Part A.⁵
• If married, file a joint tax return.⁶
• Not be able to be claimed by someone else as a tax dependent.⁶

In Missouri, the open enrollment period to sign up for 2027 ACA-compliant individual and family health plans is expected to run from November 1, 2026 until January 15, 2027.

HHS had planned to shorten the enrollment window, ending it in mid-December, but a federal judge vacated that rule change in June 2026. However, HHS appealed that ruling in July 2026.⁷ So as of early August 2026, there was still some uncertainty in terms of when open enrollment will end.

Consumers should plan to enroll by December 15, regardless. That might end up being the final day of open enrollment. But if not, it will be the last day to pick a plan with a January 1 effective date.

Outside of open enrollment, you can still make plan changes or enroll in the Marketplace if you qualify for a special enrollment period (SEP). Most SEPs require a qualifying life event, such as involuntary loss of coverage, marriage, or having a baby.

But if you’re an Alaska Native or American Indian, you can enroll anytime.⁸

Medicaid enrollment is also open year-round, for people who are Medicaid-eligible.

In Missouri, you have a few options to enroll in a Marketplace health plan:

• Directly through HealthCare.gov – the ACA exchange
• By phone at (800) 318-2596
• By contacting agents, navigators, certified application counselors or an approved enhanced direct enrollment entity.⁹
• By mailing in a paper application
  

Many people use the ACA Marketplace, including early retirees not yet on Medicare, self-employed people, and those who work for small businesses without health benefits.

In Missouri, you can find affordable health plans through the ACA Marketplace’s website: HeathCare.gov.

Under the ACA, you may qualify for income-based subsidies called Advance Premium Tax Credits (APTC). These credits lower your premiums.

During the open enrollment period for 2026 coverage, 87% of the people who enrolled in coverage through Missouri’s exchange were receiving premium subsidies, saving an average of $638 per month. The average after-subsidy premium for subsidy-eligible enrollees was about $90/month.¹⁰

But as described below, 2026 premium subsidies don’t cover as much of enrollees’ total premiums as they did in 2025, and fewer people are eligible for these subsidies. This is because Congress allowed federal subsidy enhancements to expire at the end of 2025.

If your income isn’t more than 250% of the federal poverty level, you may also receive cost-sharing reductions (CSR), as long as you enroll in a Silver-level plan.¹¹ CSRs reduce your out-of-pocket costs when you use your health insurance. 

Source: CMS.gov ¹⁰

Missourians may also find affordable coverage through Medicaid if eligible. Missouri expanded Medicaid eligibility guidelines in 2021, under the terms of a voter-approved ballot measure that implemented the ACA’s Medicaid expansion. This allows adults younger than 65 to enroll in Medicaid with a household income up to 138% of the poverty level (note that a work requirement will apply starting in 2027). Learn more in our Missouri Medicaid guide.

Short-term plans are also a low-cost option for people who are not eligible for employer plans, Medicaid, Medicare, or subsidies through the exchange. However, short-term health insurance is not regulated by the ACA, so the policies generally do not cover pre-existing conditions, do not cover all of the ACA’s essential health benefits, and are only designed to provide temporary coverage.

Six insurers (with varying coverage areas) will offering coverage through Missouri’s Marketplace for 2027.¹

• Blue Cross Blue Shield of Kansas City
• Celtic Insurance Company (Ambetter)
• Healthy Alliance Life Insurance Company (Anthem)
• Medica Insurance Company
• Oscar Insurance Company
• United Healthcare Insurance Company

There were eight participating insurers in 2026,¹² but Cox Health Plans will no longer offer on-exchange plans in 2027 (off-exchange Cox plans will be available in some counties),¹³ and Medica appears to be consolidating its two entities into one for 2027.¹⁴

There were nine participating insurers in 2025, but Aetna exited the market at the end of 2025, as was the case in all states where Aetna offered Marketplace insurance.

Ten insurers offered Missouri Marketplace plans in 2023,¹⁵, but Cigna exited Missouri’s individual insurance market at the end of 2023.¹⁶ (Cigna is exiting the Marketplace in all remaining states at the end of 2026, but this does not affect Missouri, as Cigna plans are no longer available there.)

The following average rate changes have been proposed for 2027 in Missouri, amounting to a weighted average rate increase of about 12.5%, before any subsidies are applied.¹⁷

Source: Missouri Department of Insurance¹

The proposed rate changes apply to full-price premiums. Since most people on Missouri’s exchange receive premium tax credits, they don’t pay the full price. If you qualify for subsidies, your net rate change depends on changes in your plan rates and your subsidy amounts.

Unfortunately, the federal subsidy enhancements that had been making Marketplace coverage much more affordable since 2021 expired at the end of 2025. Because Congress did not extend those subsidy enhancements, subsidies do not cover as much of the premiums as they did in 2025, and the “subsidy cliff” has returned. This has made coverage much less affordable than it was in 2025, and that will continue to be the case in 2027 (although enrollees will not see the sort of “sticker shock” for 2027 that they experienced for 2026).

A note about rate review in Missouri: Prior to 2017, Missouri did not have an effective rate review program, but that changed in 2017 (as of 2026, only three states — Oklahoma, Tennessee, and Wyoming — do not have an effective rate review program and thus rely on the federal government for this).¹⁸

Since 2017, under the terms of SB865, the Missouri Department of Insurance has taken an active role in reviewing insurers’ proposed rate changes.¹⁹ State regulators determine whether the proposed rates are justified, although they are not allowed to prevent an insurer from implementing a rate change, even if the state does not consider it to be justified (this is the same as the federal rate review process).

For perspective, here’s a summary of how unsubsidized premiums have changed over the years in Missouri’s individual/family health insurance market:

• 2015: Average increase of 9%²⁰
• 2016: Average increase of 14%²¹
• 2017: Average increase of 25.5%²²
• 2018: Average increase of 40%²³
• 2019: Average increase of 1.6%²⁴
• 2020: Average decrease of 2%²⁵
• 2021: Average increase of 4.7%.²⁶
• 2022: Average increase of 2.3%.²⁷
• 2023: Average increase of 11%²⁸
• 2024: Average increase of 4.6%²⁹
• 2025: Average decrease of 1.7%³⁰
• 2026: Average increase of 23.1%³¹

365,734 people selected plans through the Missouri exchange during the open enrollment period for 2026 coverage.¹⁰

The 2025 enrollment had been a significant new record high (see graph below). But enrollment declined significantly in 2026, because the expiration of federal subsidy enhancements made coverage much less affordable. 

Source: 2014,³² 2015,³³ 2016,³⁴ 2017,³⁵ 2018,³⁶ 2019,³⁷ 2020,³⁸ 2021,³⁹ 2022,⁴⁰ 2023,⁴¹ 2024,⁴² 2025⁴³ 2026¹⁰

Usually, when a state expands Medicaid, Marketplace enrollment drops. That’s because people with income between 100 and 138% of the federal poverty level transfer from Marketplace plans to Medicaid.

But Missouri’s Marketplace enrollment grew in 2022 and 2023 despite the 2021 expansion of Medicaid in Missouri. This growth was likely because of the subsidy enhancements under the American Rescue Plan and the Inflation Reduction Act, which made subsidies larger and more widely available.⁴⁴ (Unfortunately, those subsidy enhancements expired at the end of 2025, making coverage much less affordable in 2026.)

The enrollment growth in 2024 and 2025 was also driven by the “unwinding” of the pandemic-era Medicaid continuous coverage rule. CMS reported that by April 2024, more than 124,000 Missouri residents had transitioned from Medicaid (MO HealthNet) to a Marketplace plan.⁴⁵

HealthCare.gov
The official federal website where you can sign up for health insurance plans through the ACA Marketplace. 

Missouri Department of Insurance
Oversees and regulates health plans, brokers, and agents.

MO HealthNet
Missouri’s Medicaid.

Missouri State Health Insurance Assistance Program (Missouri SHIP)
Helps Missourians with Medicare benefits.

Medicare Rights Center
National resource with a website and call center to provide information and help for people on Medicare.