Missouri Health Insurance Exchange Guide

This guide provides an overview of the Missouri Health Insurance Exchange including the history of the Exchange, how the Exchange will operate, and Exchange information for Missouri residents and small businesses.

Missouri Health Insurance Exchange Introduction

Beginning in 2014, as part of the Affordable Care Act (ACA), health insurance coverage for individuals and small businesses will become available through new state health insurance exchanges (also called health insurance marketplaces).

Most importantly, the key tax credits (e.g. the small business healthcare tax credits) and tax subsidies (e.g. individual health insurance tax subsidies) will only be available for coverage purchased through a state health insurance exchange.

All states have three options for setting up a state health insurance exchange for 2014:

1. Build a state-based exchange
2. Enter into a state-federal partnership exchange
3. Default to a federally-facilitated exchange

Missouri will default to a federally-facilitated health insurance exchange.

Missouri Health Insurance Exchange - History 

Missouri Governor Jay Nixon originally supported the idea of a state-based Exchange, however he did not receive backing from state government, nor from Missouri voters.

The Governor established Missouri’s Health Insurance Exchange Coordinating Council to coordinate the state’s response to the ACA. In June 2011, the Senate created the Senate Interim Committee on Health Insurance Exchanges to explore Missouri’s options to establish a state-based Exchange. Legislation to create a state-based Exchange was introduced in the 2011 and 2012 sessions, but failed. In November 2012, Missouri voters approved a ballot measure blocking the Governor from establishing an Exchange by Executive Order.

Therefore, efforts to run a state-based Exchange stalled and Missouri will default to the federally-run Exchange.

Missouri Health Insurance Exchange - What is It?

The Missouri Health Insurance Exchange will be operated through a federally-run health insurance exchange, also referred to as the Health Insurance Marketplace. Starting October 1, 2013, Missouri residents will be able to access information about all the plans available through the Exchange, shop for plans, and access individual premium tax credits. The SHOP Exchange will be available to small businesses with 100 or fewer employees. Coverage from the Exchange starts in January 2014.

According to an estimate by healthcare.gov, 799,250 or 16% of Missouri’s non-elderly residents are uninsured, of whom 744,700 (93%) may qualify for either tax credits to purchase coverage in the Marketplace or for Medicaid if Missouri participates in the Medicaid expansion.

Missouri Health Insurance Exchange - What Plans will be Available?

All plans offered through the Missouri Health Insurance Exchange will meet the ACA definition of a Qualified Health Plan (QHP). The plans will be offered by level of coverage for essential health benefits (EHB), to allow consumers to compare plans on an "apples to apples" basis. The four metal levels are: Bronze (plan pays 60%), Silver (plan pays 70%), Gold (plan pays 80%) and Platinum (plan pays 90%).  

Details on plan carriers and rates will be available by October 1, 2013.

Missouri Health Insurance Exchange - Role of Brokers and Navigators

The Missouri Health Insurance Exchange will follow federal guidelines for insurance professionals selling policies through the Exchange and for navigators assisting consumers and small businesses.

Insurance professionals will be able to register with the Missouri Health Insurance Exchange and receive any commissions directly from the carriers (using their Exchange ID number and NPN). 

The Missouri Health Insurance Exchange navigator program will assist consumers in making choices about their health care options and accessing their new health care coverage, including access to premium tax credits for some consumers. The federal government will run the navigator program in Missouri.