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.
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 2022 coverage ran from November 1, 2021 to January 15, 2022. Outside of that window, plan changes and new enrollments for 2022 coverage 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.
For 2022, Aetna joined the marketplace, with plans available in 34 counties. There are a total of nine insurers offering plans, and three of them expanded their coverage areas for 2022:
- Aetna (new for 2022, after previously exiting at the end of 2016)
- Ambetter/Celtic (Centene)
- Blue KC (Blue Cross Blue Shield of Kansas City)
For 2022, Missouri’s exchange insurers implemented rate changes that ranged from a 7% decrease to a 15% increase.
The year before, for 2021 coverage, the seven insurers that had already offered coverage in 2020 implemented an overall average rate increase of less than 5%.
During the open enrollment period for 2022 coverage, 250,341 people enrolled in plans through Missouri’s marketplace. That was an increase of 35,000 over the prior year’s open enrollment period, and the highest enrollment in Missouri’s exchange since 2016.
The enrollment growth in 2022 came 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.
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). 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 2021, before the American Rescue Plan made premium subsidies larger and more widely available, almost 182,000 Missouri residents were receiving premium subsidies to offset the cost of their individual market health insurance coverage. The subsidies averaged $553/month, which covered the vast majority of the average pre-subsidy premium costs ($639/month). Subsidies are larger now that the American Rescue Plan has been implemented, 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 has 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; 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, and Sen. Josh Hawley has 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 2022, 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 was reelected in 2020. One of Parson’s first acts as governor was to eliminate Medicaid funding for preventive care obtained at Planned Parenthood.
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.
But the enrollment process is much slower in Missouri than it is in most other states, and GOP lawmakers in the state are still trying to unravel Medicaid expansion as of the 2022 legislative session.
Read more about Medicaid expansion in Missouri.
- 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.