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Missouri Health Insurance
Health insurance is one type of insurance which you cannot afford to overlook. Indeed, purchasing suitable health insurance coverage for your family is costly, but it also requires a good appraisal of all future risks and its impact on your financial health. In the U.S., more than 47 million people are uninsured and working families constitute a major part of this uninsured population. With the rising health care costs, many of these families get stuck with huge medical bills due to the lack of health insurance. For those families who are not covered under their employers’ group plan, many states provide low-cost health insurance programs to them.
In 2008, Missouri stood at the 38th spot, falling three places from its 2007 and 2006 ranking, according to the United Health Foundation's Health Rankings. Several factors have contributed to the weak health care system in Mississippi including prevalence of smoking, high percentage of children in poverty, and low public health funding. The state of Missouri, having the population of more than five million citizens, has both private-market and public health insurance alternatives. The private-market health insurance comprises of numerous types of health plans including family, Medicare supplemental, short-term, student, group and dental. Additionally, the state and federal government sponsored programs provide inexpensive health coverage to the uninsurable residents of Missouri who meet specific eligibility requirements.
The Missouri Department of Insurance, Financial Institutions & Professional Regulation is responsible for regulating all types of insurance sold in the state of Missouri including health insurance policies offered by private-market health insurers or public health coverage programs. Approximately 13% of the population remains uninsured. According to the Censor Bureau’s 2007 and 2008 Current Population Survey, approximately 33.0% of Missouri citizens continue to survive without any kind of health insurance and under the above 200% FPL category.
Choosing a health plan for your family can be intimidating and confusing. Therefore, it is important to consult with a licensed health insurance agent/broker to maximize on the benefits of the appropriate health insurance alternatives.
Individual/Family Health Insurance
Below is the guidelines for applying for and obtaining individual health insurance in the state of Missouri. These regulations apply to all insurance companies offering individual or family health insurance in Missouri:
| Medical Underwriting | Yes |
Pre-Existing Condition Exclusion Period | No Limit |
Look Back Period | No Limit |
Look Back Standard | No Definition |
Mandatory Benefits | Cancer screening for women including screening of breast cancer, cervical cancer, reconstructive surgery after mastectomy, osteoporosis, direct access to OB/GYNs, OB/GYNs as Primary Care Providers, eating disorder parity |
Market Rate Restrictions | None |
Guaranteed Issue Options | None |
Small Group Health Insurance
Below is the guidelines for small group health insurance in the state of Missouri. These regulations apply to all insurance companies offering small group health insurance in Missouri:
| Small Group Size | 2-50 |
Employee Qualifications | Owner can count as an employee |
Guaranteed Issue | Yes |
Premium Rating Factors | Rate Bands |
Rate Adjustment Factors | 25% |
Look-Back Period | 6 months |
Pre-existing condition exclusionary period | 12 months |
Mandatory Benefits | Same as individual |
State Cobra Variations for Small Groups
Below are the COBRA guidelines for small groups in the state of Missouri. For employer groups of more than 20 employees, refer to the federal COBRA guidelines:
| Mini-Cobra Option | Yes |
Eligible Group Sizes | 2-19 |
Extension of Benefits Period - Standard | 9 months |
Extension of Benefits Period - Disabled | 9 months |
Maximum Premium Increase | 100% |
State Legislation Reference | Chapter 376, Section 376.428 Missouri Revised Statutes |
Additional Notes | Eligible employees qualify for this continuation coverage provided they were insured under the group plan for at least 3 months. Coverage can be cancelled for failure to make timely payment of premium. |
State Sponsored Health Insurance Programs
There are several state sponsored health insurance programs in the State of Missouri to assist those without insurance in obtaining adequate coverage.
High-Risk Pools
Some states offer special state sponsored health insurance plans for qualified persons that are not eligible for individual health insurance due to pre-existing medical conditions. The guidelines for enrollment in these programs vary by state. The high-risk pool in the State of Missouri is summarized in the chart below:
| Plan Name | Missouri Health Insurance Pool (MHIP) |
Website | |
Phone Number | 800-821-2231 |
HIPPA Eligibility Required? | Yes |
Available Carriers | ANTHEM Blue Cross Blue Shield, Blue Cross and Blue Shield of Kansas City |
Pre-Existing Condition Waiting Period | 12 months |
Enrollment Periods | Currently open to new enrollment |
Premium Limits | Between 125% to 200% of standard rate |
Lifetime Maximum Benefit | $1 million |
Special Notes | The MHIP program is designed for residents who, because of high-risk status: |
Children’s Health Insurance Program
Through shared funding from the federal government, the State of Missouri provides health insurance for uninsured children that meet certain eligibility guidelines. A summary of this program is outlined in the chart below:
| Program Name | MO HealthNet for Kids |
Website | |
Phone Number | 573-751-3425 |
Apply Online | Yes |
Age Limits | Under 19 |
Insurance Carrier | HealthCare USA, Missouri Care, Molina, Harmony, Blue Advantage, Children’s Mercy |
Length of Coverage | 12 months |
Residency Requirements | Missouri resident, U.S. citizen or legal immigrant |
Other Eligibility Requirements | Children whose family income is under 300% of the federal poverty level are eligible. |
Pre-Existing Condition Exclusions | None |
Cost | The family must pay a monthly premium. Premium amounts change July of each year. The premium is based on family size and income to insure that no family pays more than 5% of their income for coverage. |
Medicaid
Medicaid is a state program partially funded through the federal government. Qualification guidelines, as well as the types of people that are eligible, will vary by state. The chart below provides a summary of the Medicaid programs in the State of Missouri:
| Governing Agency | Missouri Department of Social Services |
Website | |
Phone Number | 573-751-3425 |
Residency Requirements | Missouri resident and U.S. citizen |
Federal Poverty Line Income Limits | Working parents with household income up to 84% FPL |
Additional Resources
Missouri Health Care Options Matrix™ Guide
Provided by the Foundation for Health Coverage Education, the guide is a quick reference guide prepared by the non-profit Foundation for Health Coverage Education that outlines Missouri’s public and private health care choices for individuals and groups with various demographic profiles.
Family Health Insurance Guide by HealthInsuranceFinders.com
The guide created by HealthInsuranceFinders.com provides useful information regarding health insurance coverage such as individual/family health insurance, group health insurance, separate child health insurance and state-sponsored programs that are available for low to middle income families.
Missouri: At-A-Glance
Provides exclusive health data of the Missouri state. Statehealthfacts.org, a project of the Henry J. Kaiser Family Foundation, is designed to provide free, up-to-date, and easy-to-use health data on all 50 states.
