Health insurance in Missouri
- Missouri’s enrollment is through the federally facilitated exchange at HealthCare.gov.
- Open enrollment for 2019 coverage in Missouri ended on December 15, but enrollment is still possible for residents who have qualifying events.
- Short-term health plans are available in Missouri with initial plan terms up to six months.
- Four insurers are offering individual market plans for 2019.
- The average individual-market rate increase for 2019 is about 1.6 percent.
- About 243,000 Missourians enrolled in 2018 coverage through the Missouri exchange.
- Missouri continues to reject ACA’s Medicaid expansion.
- Slightly less than 20 percent of Missourians are enrolled in Medicare.
Missouri’s health marketplace
Open enrollment for 2019 coverage ended on December 15, but enrollment is still possible for residents who have qualifying events.
Medica announced in late June that it would join the Missouri exchange in the Kansas City area and offer plans for 2019. That means four individual market insurers – Medica, Anthem, Ambetter and Cigna – are offering 2019 plans.
The Missouri Department of Insurance has created a map that shows the coverage areas of the four individual market insurers for 2019 (plans are available both on and off-exchange).
The average rate increase in Missouri’s individual market is 1.6 percent for 2019. But the average benchmark premium is decreasing by 5.3 percent in 2019 in Missouri. Premium subsidies are based on the cost of the benchmark plan relative to the plan you select, so subsidies will be a little smaller in 2019, due to the lower benchmark plan costs. That makes it particularly important for people to shop around during open enrollment, which continues until December 15, 2018.
Missouri enrollment in qualified health plans
During the ACA’s 2014 open enrollment period,152,335 Missourians selected a qualified health plan (QHP) from the state’s Obamacare exchange. That was 23.2 percent of the estimated eligible market according to the Kaiser Family Foundation. Nationally, 28 percent of the estimated eligible market enrolled in QHPs during 2014 open enrollment. Eighty-five percent of Missouri residents who enrolled in a QHP qualified for subsidies that made their premiums more affordable.
As in most states, Missouri’s exchange enrollment picked up by 2016. At the end of the 2016 open enrollment period, there were 290,201 Missouri residents enrolled in private plans through the exchange.
Enrollment declined in 2017, however, by almost 16 percent. 244,382 people enrolled in coverage through the Missouri exchange between November 1, 2016 and January 31, 2017 (the 2017 open enrollment period) including new and renewing enrollees.
Nationwide, HealthCare.gov enrollments declined by about 5 percent, although state-run exchanges saw a small increase in enrollment for 2017. The Trump Administration cut back on advertising and outreach for HealthCare.gov in the final week of 2017 open enrollment, and the uncertainty surrounding the future of the ACA is also linked to the drop-off in enrollment.
In 2017, 243,382 people purchased private plans through the Missouri exchange during open enrollment for 2018 coverage.
Read more about Missouri’s health marketplace.
Missouri still has not expanded Medicaid
Missouri has not expanded Medicaid under the Affordable Care Act (ACA). Non-disabled adults without children are not eligible for Medicaid regardless of how low their income is, and parents with dependent children are only eligible with incomes that don’t exceed 22 percent of the poverty level. Only Texas and Alabama have lower Medicaid eligibility caps, at 18 percent.
If Missouri were to expand Medicaid, FamiliesUSA estimates that 293,000 people would be newly eligible for coverage. Federal funding continues to be available for states that wish to expand Medicaid now.
Because subsidies are only available in the exchange for people whose household incomes are at least 100 percent of poverty, there are 87,000 people in Missouri who are in the coverage gap and have no realistic access to health insurance. They aren’t eligible for Medicaid or for subsidies to offset the cost of private insurance.
Read more about Medicaid in Missouri.
Short-term health insurance in Missouri
Missouri does not follow the new federal regulations on short-term health plans. Instead, state regulations limit short-term health plans to terms of no more than six months. The state does not limit renewals of short-term plans.
Missouri lawmakers had considered a bill to extend short-term plans, but it did not pass.
Read more about short-term health insurance in Missouri.
Missouri and the Affordable Care Act
Missouri resisted the implementation of the Affordable Care Act, opting for a federally facilitated exchange and declining Medicaid expansion. The state favored Trump in the 2016 presidential election, with 57.1 percent of its voters choosing the Republican candidate, who campaigned on a promise to repeal Obamacare.
Yet, despite Trump’s popularity in Missouri, the Show Me State has seen healthcare access improvements on par with the national average since the Affordable Care Act took effect. Missouri did not accept federal funding to expand Medicaid, so the impact on the state’s uninsured rate has not been as dramatic as it would have been if Medicaid had been expanded. But HHS reported that 203,000 people in Missouri gained health insurance coverage from 2010 to 2015 as a result of the ACA.
How has Obamacare helped Missouri?
Missouri is among states less accepting of the Affordable Care Act. And, like other states that have not embraced the ACA (i.e., have not implemented a state-run marketplace or expanded Medicaid, or have only implemented one of those measures), it has seen more gradual reductions in its uninsured population.
Missouri’s uninsured rate, according to U.S. Census data, was 13 percent in 2013. It fell gradually over the next three years, to 11.7 percent in 2014 and 9.8 percent in 2015, and to 8.9 percent in 2016. But it increased slightly in 2017, to 9.1 percent (there was a nationwide uptick in the uninsured rate in 2017, after the Trump Administration took office; the national uninsured rate went from 8.6 percent in 2016 to 8.7 percent in 2017).
In 2018, more than 188,000 Missouri residents received premium subsidies to offset the cost of their individual market health insurance. The subsidies averaged $592/month, which covered the vast majority of the average pre-subsidy premium ($644/month).
In addition, people with pre-existing conditions no longer face exclusion riders, higher-than-standard rates, or declines in the individual market, nor do they face pre-existing condition waiting periods on employer-sponsored health insurance plans. This is all a result of the ACA and its landmark health care reforms.
Missouri and the Affordable Care Act
Missouri has balked at the Affordable Care Act. It refused to implement a state-run marketplace, rejected Medicaid expansion, and passed a law to restrict consumer assistance; however, a court ruling blocked enforcement of the law.
In the 2010 U.S. Senate vote on the ACA, Sen. Claire McCaskill, a Democrat, voted “yes,” while Sen. Christopher Bond, a Republican, voted “no.” Republican Sen. Roy Blunt has replaced Bond in the Senate.
Blunt voted against the ACA as a U.S. representative from Missouri in 2010, and has consistently voted against the ACA and similar reform measures, and in favor of bills that would unravel the ACA.
McCaskill has defended the ACA, but she lost her re-election bid in 2018 to Josh Hawley, so both of Missouri’s senators will be Republicans as of 2019. Hawley campaigned on a promise to protect people with pre-existing medical conditions, but as Missouri’s Attorney General, he joined in a lawsuit that would gut the ACA, including its pre-existing condition protections. Hawley claimed that his plan in supporting the lawsuit is to overturn the ACA and replace it with a new health care bill once he’s in the Senate. It’s notable, however, that none of the GOP bills that were considered in 2017 to repeal the ACA would have adequately protected people with pre-existing conditions.
Missouri’s U.S. representatives voted 6-3 against the ACA in 2010. Missouri has since lost a House seat, and as of 2018, Republicans have a 6-2 majority. All of Missouri’s House incumbents were re-elected in the 2018 election.
Republicans hold strong majorities in both the Missouri House and Senate. Former Governor Jay Nixon, a Democrat, supported a state-run health insurance marketplace. However, state legislators did not authorize a state-run marketplace and, in fact, passed legislation to prevent Nixon from doing so by executive order. Similarly, Nixon supported Medicaid expansion, but a majority of state legislators did not.
In 2016, Former US Navy SEAL Eric Greitens (a former Democrat, now a Republican), won the gubernatorial election in Missouri, and took office in January 2017 (Nixon was term-limited and couldn’t run). Greitens opposed Medicaid expansion because of the cost to the state (states are gradually paying a slightly larger percentage of the cost each year until they reach 10 percent in 2020; the 90/10 split will remain in effect from that point onward).
Greitens was only in office until mid-2018, when he resigned amid multiple scandals. Lieutenant Governor Mike Parson assumed the governor’s office at that point, and the next election will take place in 2020. One of Parson’s first acts as governor was to eliminate Medicaid funding for preventive care obtained at Planned Parenthood.
Does Missouri have a high-risk pool?
Prior to 2014 and the ACA’s reforms to the individual health insurance market, coverage was medically underwritten in nearly every state, including Missouri. Since a review of medical history was part of the application process, people with pre-existing conditions often found themselves unable to purchase comprehensive coverage in the private market.
The Missouri Health Insurance Pool (MHIP) was created in 1991 to provide health insurance for people who were denied coverage in the private market because of their medical history. But medical history is no longer an eligibility factor for private health insurance, making high-risk pools largely unnecessary now that the ACA has been implemented.
In 2013, the Missouri legislature passed SB262, which allowed MHIP to cease operations on January 1, 2014, and transition members to coverage in the private market instead.
Medicare enrollment in the state of Missouri
Missouri Medicare enrollment reached 1.2 million in 2018, a little more than 19 percent of the state’s population and slightly higher than national enrollment (18 percent). About 82 percent of Missouri Medicare beneficiaries qualify based on age alone, while 18 percent are on Medicare as the result of a disability.
Missouri’s Medicare recipients can select a Medicare Advantage plan instead of Original Medicare, although there are pros and cons to both options. 34 percent of Missouri’s Medicare beneficiaries selected Medicare Advantage over traditional Medicare in 2018, slightly lower than the 36 percent who did so nationwide.
According to 2016 data, Original Medicare spent an average of $9,521 per beneficiary in Missouri – very close to the national average of $9,533.
You can read more about Medicare in Missouri in our state guide.
State health insurance legislation
Here’s a summary of other recent Missouri legislation related to health reform: