Curious about health insurance in Missouri? According to a study by U.S. News, Missouri has the 39th best health care in the country. That's based on access, quality, and good public health.
Health insurance options in Missouri
According to the MO Department of Insurance, state residents can get health insurance several different ways:
- From your employer
- Through your spouse's employer
Individual or family plans
- Through HealthCare.gov
- Directly from a health insurance company
Where do most Missouri residents get their health insurance coverage?
|Individual or family||6%|
|Source: Kaiser Family Foundation, Health Insurance Coverage of the Total Population|
Nine percent of Missouri residents are uninsured, about the same as the national average. That's good news for policyholders. More uninsured people leads to higher rates for insured residents.
Missouri health insurance companies
There are several options for residents to get health insurance in Missouri. Here are some of the top health insurance providers in the state:
- Blue Cross Blue Shield Kansas City
These companies offer both individual and family plans. Check insurer websites to find out how your zip code could affect policy options.
Missouri health insurance costs and rate factors
Missouri residents spend an average of $8,107 on health care per year. What influences health care costs? Insurance companies analyze several factors to price your policy. Health care costs vary person to person, but here are the main things that will determine your rate:
Marketplace plans come in metal tiers: bronze, silver, gold, and platinum. More coverage will cost you more in monthly premiums.
So, how much should you expect to pay in Missouri for health care? This is the average cost for each plan type for a middle-aged Missouri resident in 2020:
|Source: Kaiser Family Foundation, Change in Average Marketplace Premiums by Metal Tier|
Premiums for a gold plan cost about 56 percent more than a bronze plan. That's because gold plans cover 80 percent of medical costs, whereas bronze plans cover 60 percent of costs.
You may qualify for a catastrophic plan, the lowest level of health insurance coverage available. Catastrophic plans come with low monthly premiums but a yearly deductible of $8,150. Although bronze and silver plans have higher premiums, they may save you money if you need to use your health insurance.
Body mass index
According to the CDC, having a body mass in the obese range leads to serious health risks. That's why insurers consider your BMI. A higher BMI leads to higher health insurance rates.
In 2018, Missouri had a 35 percent obesity rate, the 9th highest rate in the country. Out of the many MO residents who used QuoteWizard to compare health insurance plans, 34 percent of users have a BMI in the obese range.
Due to the high risks that come with smoking, tobacco users pay more for health insurance. According to America's Health Rankings, 22.1 percent of MO residents are smokers, the eighth highest rate in the country.
Health insurance plans cost up to three times more for older people than younger people. Missouri residents who used QuoteWizard to shop for health insurance are, on average, 39 years old.
One of the biggest factors with cost comes down to where you live in the U.S. This is because every state has different rules, regulations, and providers surrounding the health care marketplace.
Also, your location-based prices could even be as specific as the neighborhood you live in. Many health insurance rates are community rated, meaning your prices depend on the combined claims everyone files. So if your neighbors file an abnormally high number of claims, your costs could jump.
Living in a health-conscious state could help keep your premiums low. According to America's Health Rankings, Missouri is the 40th healthiest state in the U.S.
Missouri health insurance laws
The Affordable Care Act mandates that insurance companies can't use certain factors to price your policy.
- Pre-existing conditions: Before the ACA, people with pre-existing conditions paid more for health insurance. Now, insurance companies cannot charge more to people with pre-existing conditions.
- Gender: According to a study by Health Services Research, women historically pay more for health care. The ACA doesn't allow insurance companies to charge men and women different premiums for the same plan.
- Insurance and medical history: People with previous medical problems or lapses in insurance used to face high premiums. Insurance companies can't analyze your medical history and your past insurance coverage.
There's a limit to how much you'll be paying out-of-pocket for a marketplace plan. In 2020, the out-of-pocket maximum is $8,150 for an individual plan and $16,300 for a family plan.
Missouri law requires health insurance companies to provide at least some coverage for the following services:
- Hospitalization after childbirth
- Mental illness, alcoholism, and drug addiction
- Outpatient diabetes management
- Autism spectrum disorders
- Well-child care
- Coverage for severe mental disorders
There are more services that insurers are required to cover. Read the full list from cms.gov.
Medicare and Medicaid in Missouri
Medicare and Medicaid are both government-funded programs that offer affordable health care to Americans. They offer coverage to two different groups of people. Medicare provides health coverage to seniors 65 and over, and Medicaid aids low-income families and children.
Medicare is meant for people 65 and older. There are plenty of options within the program including parts A, B, C, D, and supplemental coverage plans. As a Missouri resident, you may qualify for one of these Medicare Savings Programs with these income limits:
- Individual monthly income limit: $1,456
- Married couple monthly income limit: $1,960
In Missouri, Medicaid is referred to as MO HealthNet. These are the state's Medicaid financial requirements:
|Household Size||Maximum Yearly Income|
Missouri Office of the Insurance Commissioner
- Insurance Commissioner:
- Chlora Lindley-Myers
- Insurance Hotline:
- (800) 726 – 7390
- Office Hours:
- Monday - Friday
8:00 am to 5:00 pm
- File a Consumer Insurance Complaint
- Complaint Page
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