Missouri health insurance

Eight individual market insurers will offer plans on- and off-exchange for 2021; short-term coverage is now available with plan terms up to six months.

Health insurance in Missouri

This page is dedicated to helping consumers quickly find health insurance resources in the state of Missouri. Here, you’ll find information about the many types of health insurance coverage available. You can find the basics of the Missouri health insurance marketplace and upcoming open enrollment period; a brief overview of Medicaid expansion in Missouri; a quick look at short-term health insurance availability in the state; statistics about state-specific Medicare rules; as well as a collection of health insurance resources for Missouri residents.

Missouri’s health insurance marketplace

Missouri utilizes the federally facilitated marketplace, which means residents enroll through HealthCare.gov if they want a plan through the exchange.

Open enrollment for 2021 health plans runs from November 1, 2020 to December 15, 2020 in Missouri. Outside of that window, Missouri residents can still enroll or make changes to their coverage if they experience a qualifying event.

Three insurers – Oscar Health, SSM Health Insurance, and Cox Health Systems joined the exchange for 2020 – bringing the number of insurers to seven. And for 2021, Blue KC (BCBSKC) is returning to the northwestern part of the state, offering on-exchange and off-exchange plans in 30 counties (the same service area they covered prior to 2018; Blue KC left the ACA-compliant individual market at the end of 2017). So there are eight insurers offering individual market plans in Missour, on- and off-exchange, for 2021 (expected coverage area map here).

The existing seven insurers have proposed an overall average rate increase of 4.7 percent for 2021. In addition to Blue KC’s return to the exchange, Medica and Anthem are also expanding their coverage service areas for 2021.

Read our overview of the Missouri health insurance marketplace – including news updates and exchange history.

Missouri enrollment in qualified health plans

As in most states, Missouri’s exchange enrollment peaked in 2016, when 290,201 Missouri residents enrolled in private plans through the Missouri health insurance marketplace. Enrollment declined in 2017, 2018, and again in 2019, when just 220,461 people enrolled.

Enrollment dropped again in 2020, with 202,750 people enrolled in plans through the health insurance marketplace during the Missouri open enrollment period 2020.

Missouri has a robust small group health insurance market (covering people employed by businesses with up to 50 employees). All new small group plans are fully compliant with the ACA, but they are purchased directly from the health insurance companies, as opposed to through the exchange (health insurance companies in Missouri no longer provide exchange-certified small business plans).

Read more about Missouri’s health insurance marketplace.

Medicaid expansion in Missouri

In 2020, Missouri voters went to the polls to support expansion of Medicaid eligibility in Missouri. In the August 2020 primary, about 53 percent of voters said Yes to a Medicaid expansion amendment.

When the Medicaid eligibility expansion takes effect in Missouri, an estimated 230,000 Missourians will be newly eligible for coverage. Until the expansion takes effect, there are 113,000 low-income residents still caught in a coverage gap, with no realistic access to the health coverage they need.

Read more about Medicaid expansion 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 insurance 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’s uninsured rate, according to U.S. Census data, was 13 percent in 2013. It fell gradually over the next three years, reaching 8.9 percent by 2016. But it had increased to 9.4 percent in 2018 (there has been a nationwide uptick in the uninsured rate under the Trump administration took office).

In 2020, almost 166,000 Missouri residents were receiving premium subsidies to offset the cost of their individual market health insurance coverage. The subsidies averaged $563/month, which covered the vast majority of the average pre-subsidy premium costs ($631/month).

In addition, people with pre-existing conditions no longer face exclusion riders, higher-than-standard rates, or declined applications 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 (until voters took the issue into their own hands), 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 defended the ACA, but she lost her re-election bid in 2018 to Josh Hawley, so both of Missouri’s senators are now Republicans. 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 was to overturn the ACA and replace it with a new health care bill once he was 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, and no GOP lawmakers have since proposed anything close to comprehensive protections for people with pre-existing conditions (there is no way to adequately protect people with pre-existing conditions unless you have market-wide community rating, coverage for essential health benefits on all plans, guaranteed-issue coverage, and subsidies to make coverage affordable; the ACA can be improved, but its existing consumer protections cannot be eliminated without harming 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 2020, Republicans have a 6-2 majority.

Republicans hold strong majorities in both the Missouri House and Senate, and are generally opposed to Obamacare. 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. Greitens opposed Medicaid expansion because of the cost to the state (states pay 10 percent of the cost, while the federal government pays 90 percent).

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?

The Missouri Health Insurance Pool (MHIP) was created in 1991 to provide health insurance for people who were denied coverage in the private individual insurance 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 coverage and enrollment in Missouri

Missouri Medicare enrollment reached 1,247,001 by August 2020. You can read more about Medicare plans most popular in Missouri in our state guide – which includes details about Medicare Advantage, Medigap, and Medicare Part D.

Missouri health insurance resources

State health insurance legislation

A summary of recent Missouri legislation related to healthcare reform is available at the bottom of this page.


Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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