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.
Open enrollment for 2021 health plans ended on December 15, 2020 in Missouri, but the federal government is currently offering a one-time COVID-related enrollment window, which continues through August 15, 2021.
This window allows people to newly enroll, switch from off-exchange coverage to on-exchange coverage (necessary in order to take advantage of any financial assistance), or switch from one exchange plan to another. Plan changes may be necessary in some cases in order to allow people to best take advantage of the American Rescue Plan’s larger and more widely available subsidies.
For 2021, Blue KC (BCBSKC) is returning to the northwestern part of the state, offering on-exchange and off-exchange plans in 30 counties. So there are eight insurers offering individual market plans in Missouri, on- and off-exchange, for 2021 (expected coverage area map here).
The existing seven insurers implemented an overall average rate increase of 4.7% for 2021. In addition to Blue KC’s return to the exchange, Medica and Anthem also expand their coverage service areas for 2021.
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 each year from 2017 through 2020, when just 202,750 people enrolled in plans through the health insurance marketplace in Missouri.
But enrollment grew during the open enrollment period for 2021 coverage, with 215,311 people signing up for plans. And enrollment is continuing to grow during the COVID/American Rescue Plan enrollment window. During the first several weeks of this window (through the end of March 2021), 12,692 people enrolled in plans through Missouri’s exchange. This was more than triple the normal enrollment volume in Missouri during that timeframe (a qualifying event would normally be necessary to enroll during that time, but that’s not the case in 2021).
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).
Missouri resisted the implementation of the Affordable Care Act, opting for a federally facilitated exchange and declining Medicaid expansion. 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 percent 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. 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, 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 2021, 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.
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 have rejected funding proposals for the state’s portion of the cost, which means Medicaid expansion might end up culminating in a protracted legislative battle and/or lawsuits instead of a smooth eligibility change in the summer of 2021.
If and 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.
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 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.