Health Insurance in Missouri

Health Insurance in Missouri
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 (5MHIP)
Website
https://www.mhip.org/
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:
• Are unable to obtain health care coverage
• Have been involuntarily terminated from their health care coverage
• Are being charged more than 150 percent of standard premiums for health care coverage.
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
https://www.dss.mo.gov/mhk/index.htm
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.
Some children must be uninsured for 6 months to qualify.
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
https://www.dss.mo.gov/mhd/index.htm
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
Non-working parents with household income up to 77% FPL
Infants through age 19 under 100% FPL
Pregnant women up to 185% 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.