Frequently asked questions about health insurance coverage options in Missouri
Missouri utilizes the federally facilitated marketplace, which means residents enroll through HealthCare.gov (or an approved enhanced direct enrollment entity) if they want a plan through the exchange. Ten insurance companies provide private individual/family health plans through Missouri’s exchange in 2023.
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).
The open enrollment period for individual/family coverage runs from November 1 to January 15 in Missouri. Outside of that window, plan changes and new enrollments are allowed if you qualify for a special enrollment period.
Most special enrollment periods need a qualifying life event, although there are some (such as the enrollment opportunity for Native Americans, or for people earning under 150% of the poverty level) that do not require a specific qualifying event.
If you have questions about health insurance enrollment opportunities, you can learn more in our guide to open enrollment and guide to special enrollment periods.
In Missouri, consumers may be able to buy affordable individual and family health insurance by enrolling through the ACA marketplace (HealthCare.gov). Ninety-one percent of the people enrolled through Missouri’s exchange in 2022 were receiving premium subsidies that offset a large portion of their premium costs.
Missourians may also find affordable coverage through Medicaid if they’re eligible. See Medicaid eligibility guidelines in Missouri.
For people who aren’t eligible for an affordable employer-sponsored plan, Medicaid, Medicare, or a premium subsidy through the exchange, short-term health insurance is a lower-cost coverage option in Missouri. Several insurers offer short-term plans in Missouri, but it’s important to understand the drawbacks of these plans; they are intended to serve as a temporary bridge between other plans, and not as a long-term substitute for ACA-compliant health coverage.
For 2023, UnitedHealthcare rejoined the marketplace, after previously exiting at the end of 2016. There are a total of ten insurers offering plans:
- Aetna
- Anthem
- Cigna
- Ambetter/Celtic (Centene)
- Medica
- SSM/WellFirst
- Cox
- Oscar
- Blue KC (Blue Cross Blue Shield of Kansas City)
- UnitedHealthcare (new for 2023)
The overall average rate change for 2023 amounted to an increase of about 11% in Missouri’s individual/family health insurance market.
The year before, for 2022 coverage, Missouri’s exchange insurers implemented rate changes that ranged from a 7% decrease to a 15% increase.
Read more about rate changes over time in Missouri’s marketplace.
257,629 people enrolled in private plans through Missouri’s exchange/marketplace during the open enrollment period for 2023 coverage.
Enrollment grew in 2023 and also in 2022, despite the fact that Missouri’s Medicaid expansion took effect in the fall of 2021.
When a state expands Medicaid, marketplace enrollment tends to drop, as people with income between 100% and 138% of the poverty level shift from subsidized marketplace coverage to Medicaid. But even with the expansion of Medicaid starting in the fall of 2021, enrollment in Missouri’s marketplace plans still grew for 2022, and grew again in 2023. The enrollment growth is likely due to the American Rescue Plan’s subsidy enhancements, which have made subsidies larger and more widely available.
Missouri resisted the implementation of the Affordable Care Act, opting for a federally facilitated exchange and rejecting Medicaid expansion for the first several years (it took effect in late 2021; versus 2014 in many states; by early 2023, nearly 312,000 people were covered under Medicaid expansion in Missouri). The state favored Donald Trump — who campaigned on a promise to repeal Obamacare — in both the 2016 and 2020 presidential elections.
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% in 2013. It fell gradually over the next three years, reaching 8.9% by 2016. But it had increased to 9.4% in 2018 and to 10% in 2019 (there was a nationwide uptick in the uninsured rate under the Trump administration).
In 2022, more than 216,000 Missouri residents were receiving premium subsidies to offset the cost of their individual market health insurance coverage. The subsidies averaged $548/month, which covered the vast majority of the average pre-subsidy premium costs ($632/month). Subsidies became larger starting in 2021 due to the American Rescue Plan, and are available to some people who didn’t previously qualify for them.
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’s political leaders have mostly balked at the Affordable Care Act. The state legislature 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 (a court ruling blocked enforcement of that 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, and was later replaced by Sen. Eric Schmitt, also a Republican. And Sen. Josh Hawley replaced McCaskill.
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 2023, 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% of the cost, while the federal government pays 90%).
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 was reelected in 2020. One of Parson’s first acts as governor was to eliminate Medicaid funding for preventive care obtained at Planned Parenthood. Parson also opposed Medicaid expansion, but voters took that issue into their own hands and approved a ballot measure in 2020 that ultimately resulted in Medicaid expansion taking effect in 2021.
Yes, Missouri has expanded Medicaid. But it was a complicated process that was decided by voters after the state legislature resisted Medicaid expansion for years.
In 2020, Missouri voters went to the polls to support expansion of Medicaid eligibility in Missouri. In the August 2020 primary, about 53% of voters said Yes to a Medicaid expansion amendment.
Under that ballot measure, Medicaid expansion was set to take effect in July 2021. But Republican lawmakers in Missouri rejected funding proposals for the state’s portion of the cost, and the issue eventually resulted in a lawsuit that made its way to the Missouri Supreme Court.
The state Supreme Court ruled that the Medicaid expansion ballot initiative was constitutional and that the state Department of Social Services must implement Medicaid expansion as quickly as possible. Applications for Medicaid expansion finally began to be processed as of October 2021.
Medicaid expansion enrollment was initially much slower in Missouri than it had been in other states, and GOP lawmakers in the state were still trying to unravel Medicaid expansion as of the 2022 legislative session. But by early 2023, Medicaid expansion enrollment had grown significantly in Missouri, covering nearly 312,000 low-income adults.
Read more about Medicaid expansion in Missouri.
Missouri allows short-term health plans to follow federal regulations. The plans can have initial terms of up to 364 days, and total durations of up to 36 months, although insurers are free to set shorter limits.
Read more about short-term health insurance in Missouri.
Missouri Medicare enrollment reached nearly 1.3 million by late 2022. You can read more in our guide to Medicare in Missouri – which includes details about Medicare Advantage, Medigap, and Medicare Part D.
- Missouri Department of Insurance (oversees and regulates health insurance plans as well as the brokers and agents who sell the plans)
- Missouri HealthNet (Medicaid)
- Missouri State Health Insurance Assistance Program (CLAIM) for Missouri residents with Medicare benefits.
- Medicare Rights Center (a nationwide resource that includes a website and call center and can provide information and assistance about a wide range of Medicare-related issues).
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.
