Short-term health insurance in Missouri

Short-term plans duration in Missouri

Until October 2018, federal rules limited short-term health insurance plan duration to no more than three months, and prohibited renewals. But the Trump administration changed the rules to allow much longer short-term plans, unless states have their own restrictions.

Missouri regulations limit short-term healthcare plans to no more than six months in duration. But the state does not limit the renewability of short-term plans.

The Trump Administration’s new rules for short-term plans are clear in noting that states may continue to impose tighter regulations than the new federal rules. So short-term health insurance plans in Missouri are limited to a maximum initial term of six months, despite the fact that the federal government would allow the plans to have initial terms of up to 364 days.

However, the Missouri Department of Insurance confirmed that the state does not limit renewals, and defaults to the federal rules for the total duration (including renewal periods) of a short-term plan. So an insurer is within the bounds of the law to offer a plan that could be renewed for up to 36 months (the limit in the federal rules), as long as each term isn’t more than six months. There are several insurance companies that take this approach in Missouri, offering enrollees up to 36 months of coverage with one application.

Missouri’s short-term health insurance regulations

Lawmakers in Missouri considered HB1685 in 2018, which would have defined short-term healthcare coverage as a policy with a duration of less than one year. The House passed the measure, but it didn’t reach a full vote on the Senate floor before the session adjourned.

Missouri insurance statutes generally exclude short-term plans from laws mandating specific benefits. The state’s filing guidance for short-term plans notes that any plans with terms in excess of six months will be subject to all state mandates.

Which insurers sell short-term plans in Missouri?

As of late 2020, there were at least eight insurance companies that provide short-term health insurance policies in Missouri:

• Blue KC (Blue Cross Blue Shield of Kansas City)
• Companion Life
• Cox Health Systems
• Everest Reinsurance
• Independence American Insurance Company
• National General (National Health Insurance Company)
• UnitedHealthcare (Golden Rule)
• United Security Health and Casualty

The benefits and coverage specifics vary from one insurer to another, as does the availability of renewals (some insurers only offer up to six months of coverage, without the option to renew). Because there are fewer restrictions on short-term plans, insurers have more leeway in their plan designs. This results in a lot of coverage options, but it’s important to carefully read the policy descriptions for any plans you’re considering, to make sure you understand what is and isn’t covered.

Who can buy short-term health insurance in Missouri?

Short-term health insurance in Missouri can be purchased by applicants who pass the underwriting guidelines the insurers use. This typically means being under 65 years old (some insurers put the age limit at 64 years) and in fairly good health.

Short-term health insurance policies typically include blanket exclusions for any pre-existing condition that the applicant may have, so they are not adequate for residents of the Show Me State who need certain medical care for long term or ongoing conditions.

If you’re in need of health insurance coverage in Missouri, your first step should be to see whether you’re eligible to enroll in an ACA-compliant major medical plan (ie, an Obamacare plan). Open enrollment for these plans runs from November 1 to December 15 each year, with coverage effective January 1 (this enrollment window applies in Missouri’s marketplace/exchange and also outside the exchange).

You may be able to enroll in an ACA-compliant plan outside the open enrollment period, if you experience a qualifying event that triggers a special enrollment period.

ACA-compliant plans are purchased on a month-to-month basis, so you can enroll in one even if you’re only going to need it for a few months before another policy takes effect. And depending on your income, you may qualify for a premium subsidy (premium tax credit) that will make the monthly premiums much less costly than you may have been expecting. For 2021 coverage, a single individual can earn more than $51,000 and still qualify for a premium tax credit, and a family of four can earn up to $104,800 and still be subsidy-eligible.

But if you’re not able to enroll in an employer-sponsored plan or an ACA-compliant plan, or you just cannot afford the premiums, a short-term plan will likely be a better option than remaining uninsured, despite its limitations. And even though there are no premium subsidies for short-term health insurance plans, the monthly premiums tend to be quite affordable, due to the plan limitations and the use of medical underwriting.

When should I consider short-term health insurance in Missouri?

These are times when you may need to consider a short-term health insurance plan:

• You missed open enrollment for ACA-compliant coverage and do not have a qualifying event that would trigger a special enrollment period.
• You’re newly employed and will soon be covered by your employer’s health plan, but they have a waiting period of up to three months before you’re eligible for coverage.
• You’ll soon be enrolled in Medicare, but do not have any other coverage options in the meantime. If your Medicare won’t take effect until after the start of the coming year, you can enroll in an ACA-compliant health plan during the autumn open enrollment period (November 1 – December 15), with coverage effective January 1, and then cancel it when your Medicare coverage takes effect.
• You’ve already enrolled in an ACA-compliant plan, but have to wait up to several weeks before it takes effect. You can use a short-term plan to bridge the gap until your new coverage is in force.
• You’re not eligible for Medicaid or a premium subsidy for marketplace coverage, making an ACA-compliant plan unaffordable. People who are ineligible for premium subsidies include:
  • Those who earn over 400% of the poverty level. (For 2021 coverage, that amounts to $51,040 for a single person. If your ACA-specific modified adjusted gross income is just a little above the subsidy-eligible threshold, there are steps you can take to reduce it).
  • People caught by the ACA’s family glitch, which happens when an employer will provide affordable coverage to employees, but the cost to add family members to the employer’s plan is unaffordable (unfortunately, the family is still not eligible for premium subsidies in the marketplace).
  • People who aren’t lawfully present in the U.S. and thus are not able to enroll in a plan through the exchange/marketplace at all.

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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.