Small business health insurance in Missouri
In today’s competitive job market, providing health benefits isn’t just an optional perk. Adding them to a benefits package is a key strategy for attracting and retaining great employees. For small employers in Missouri, a healthy benefits package sends a clear message that your employees’ well-being matters. However, navigating health insurance options can be confusing, especially for smaller businesses with limited resources.
If traditional employer-sponsored health coverage feels financially out of reach, you’re not alone. There are budget-friendly alternatives like health reimbursement arrangements (HRAs) that give you more control and flexibility. With PeopleKeep by Remodel Health, Missouri employers can deliver tailored, affordable benefits that fit the needs of their workforce without the hassle of a one-size-fits-all plan.
- Introduction Missouri small business health insurance information
- Chapter 1 Overview of small business health insurance in Missouri
- Chapter 2 Importance of small business health insurance
- Chapter 3 Small business health insurance options in Missouri
- Chapter 4 Average health insurance costs in Missouri
- Chapter 5 What plans are available on the individual market in Missouri?
- Chapter 6 COBRA in Missouri
- Chapter 7 How PeopleKeep and Remodel Health can help Missouri employers
Missouri small business health insurance information
Missouri has more than 99,000 small businesses with fewer than 50 workers1. Yet, only 39% provide their employees with health coverage2. It’s easy to see why this would be the case. Group health insurance coverage is pricey, and self-funding options can have serious financial risk. But other health benefits can provide meaningful coverage without breaking the bank.
This guide will walk Missouri employers through the reasons why health benefits matter and how to evaluate their choices, including affordable, flexible alternatives to traditional group plans.
Overview of small business health insurance in Missouri
Offering health coverage is a powerful way to show your employees that you care about them. It also builds trust, boosts morale, and can improve your company culture.
Many businesses turn to fully insured group plans because they are familiar with them. But this type of coverage can be costly and may have hard-to-reach participation requirements for smaller teams. Self-insured plans may also seem attractive initially. But these policies can leave employers strapped for cash if employees’ medical claims spike unexpectedly.
Missouri's small employers have more options than just traditional group insurance. That’s where HRAs come in. These defined contribution health plans allow you to reimburse employees tax-free for individual insurance premiums and other qualified expenses. HRAs offer a more flexible, customizable approach, putting you in control of your health benefits budget while meeting your employees’ needs.
Understanding your options can help you build a benefits strategy that aligns with your company’s goals and your team’s medical needs.
Importance of small business health insurance
Providing employee health benefits isn’t just about meeting federal and state legal requirements. It’s also a smart business investment. Below are a few reasons why offering health coverage is a good choice for small to mid-sized Missouri employers.
Satisfying the Affordable Care Act’s employer mandate
If you have 50 or more full-time equivalent employees (FTEs), the Affordable Care Act (ACA) requires you to provide at least 95% of your full-time employees and their dependents with affordable health insurance that meets minimum value. The health plan must also provide minimum essential coverage (MEC). Failing to meet these requirements can lead to tax penalties if one or more of your employees receive subsidized coverage through the Marketplace.
If you have fewer than 50 FTEs, the law doesn’t require you to offer your workers health insurance. But by doing so, you can better attract qualified job seekers and retain more satisfied employees.
Benefits of providing health insurance to employees
Offering quality health benefits can strengthen your Missouri-based business in several important ways.
Providing health insurance coverage has many key advantages, including:
- Improved employee retention. Employees are likelier to stay with a company that prioritizes their health, reducing your turnover rate and hiring costs.
- Greater recruitment power. Health insurance ranks among the most valued benefits. Our data shows that 81% of job seekers consider benefits when choosing a job, and 92% say that health coverage is important.
- Better staff productivity. Healthy employees are more engaged, focused, and reliable, leading to better performance and fewer absences.
Choosing the right health benefits for your workforce will support your team’s overall well-being and set your business up for long-term success.
Small business health insurance options in Missouri
Missouri employers have several health coverage options with specific pros and cons. Whether you want a traditional benefit or a more flexible option, researching the coverage that will work best for your budget and support your employees' health is a good first step.
Some of the health benefit options available to small employers include:
- Traditional group health insurance
- Health reimbursement arrangements (HRAs)
- Self-funded medical plans
- Association health plans (AHPs)
- Supplemental and ancillary health insurance benefits
Fully-insured traditional group health insurance
For many businesses, traditional group health plans remain a go-to option. They’re familiar, offer premium cost-sharing between employers and employees, and allow companies to extend coverage to employees’ spouses and dependents, supporting the entire family unit.
Common types of group health insurance plans include:
- Preferred provider organization plans (PPOs) offer a wide range of in-network providers. Employees may be able to receive care from providers outside their network, but they’ll pay higher out-of-pocket costs.
- Health maintenance organization plans (HMOs) require members to stay in-network and get referrals to see specialists. However, this type of coverage generally has lower monthly premium amounts.
- Exclusive provider organization plans (EPOs) incorporate many aspects of PPOs and HMOs. For example, employees must receive in-network provider care, but don’t need referrals for specialists.
- Point of service plans (POSs) work like HMO policies by requiring referrals. They also allow limited out-of-network options with higher cost-sharing.
Larger employers typically have an easier time meeting the participation requirements of group plans and navigating annual rate hikes. But small businesses in Missouri may find this challenging.
In 2024, the average group plan premium for single coverage was $8,951 per year (around $746 per month), while family plans averaged $25,572 annually ($2,131 per month)3. Employers typically cover most of that cost, which can impact small companies with tight benefits budgets.
Small employers in Missouri with fewer than 50 FTEs can browse and buy plans through the federal Small Business Health Options Program (SHOP) Marketplace.
Businesses with fewer than 25 FTEs and average annual salaries under $56,000 can apply for the small business health care tax credit to help offset premium costs. To qualify, you must offer SHOP coverage and contribute at least 50% toward your employees’ premiums.
According to HealthCare.gov's rate review site, the following health insurance companies offer small group plans in Missouri in 20254.
|
Insurance company |
Network type |
SHOP status |
|
Blue Cross and Blue Shield of Kansas City |
PPO |
Off-exchange |
|
Cox Health Systems Insurance Company |
Off-exchange |
|
|
Healthy Alliance Life Co. (Anthem BCBS) |
PPO |
Off-exchange |
|
UnitedHealthcare Insurance Company |
Off-exchange |
Integrated HRAs
If you already offer a group plan but find that it leaves employees with steep out-of-pocket costs, consider adding a group coverage HRA (GCHRA). This type of HRA allows employers of any size to reimburse enrolled employees tax-free for out-of-pocket medical costs not fully covered by their group plan.
Eligible expenses under the GCHRA include cost-sharing amounts, such as:
- Deductibles: This is the amount an employee pays before their health insurance company begins covering their medical expenses.
- Coinsurance: This is the percentage of healthcare costs employees are responsible for paying after meeting their annual deductible.
- Copays: This is a fixed fee employees must pay after receiving specific healthcare services and items, like office visits or prescriptions.
Employers set a monthly allowance, and employees buy qualified out-of-pocket expenses. Once they prove they bought an eligible service or item, you reimburse them tax-free up to their allowance amount. While legally they can’t receive reimbursements for group plan premiums, you can offer a high deductible health plan (HDHP) to keep employee premium costs low.
Lastly, GCHRAs are highly customizable. There are no minimum or maximum contribution limits, and employers can tailor allowances and eligibility using seven employee classes, such as job type, and by family status.
Self-funded health plans
Some employers look to self-funded health plans to gain more control over their benefits. Instead of paying a fixed premium to an insurer, you pay employee medical claims directly. This can offer long-term savings and plan customization. But it comes with higher financial risk and greater administrative responsibility. Small businesses often don’t have the funds to cover high claims volume.
If this sounds too overwhelming, level-funded plans could strike the right balance. They combine self-funding with stop-loss insurance to protect against large claims. While this can reduce risk, level funding may still be too complex or financially demanding for smaller businesses. Plus, if any employees frequently have expensive claims, your stop-loss policy may exclude them from the coverage, leaving you on the hook.
Stand-alone HRAs
When comparing individual and group health plans in Missouri, you can see that individual health insurance coverage is more affordable than group health plans in several of the most populated counties.
Below are the average monthly premiums for a 50-year-old with a silver plan in some of the most populated Missouri counties in 2025:
|
County |
Small group coverage |
Individual coverage |
|
Pike County |
$938 |
$834 |
|
Stoddard County |
$861 |
$753 |
|
Boone County |
$779 |
$767 |
|
Greene County |
$758 |
$652 |
|
Jasper County |
$744 |
$684 |
|
Platte County |
$743 |
$612 |
|
Clay County |
$743 |
$612 |
|
St. Francois County |
$710 |
$614 |
|
Jefferson County |
$710 |
$546 |
|
St. Louis County |
$710 |
$546 |
All table data from Ideon’s 2025 premium comparison map5.
For Missouri small businesses seeking more cost-effective alternatives to group plans, stand-alone HRAs are a great solution. These benefits allow you to reimburse your staff tax-free for individual health insurance coverage and other qualified medical costs.
There are two types of stand-alone HRAs you can offer:
- The individual coverage HRA (ICHRA) is for employers of any size with no minimum or maximum contribution limits. You can vary allowances and eligibility by employee classes or family status. Employees must have an ACA-qualified individual health plan to participate in the benefit.
- Applicable large employers (ALEs) can also leverage an ICHRA to comply with the employer mandate without offering group health coverage.
- The qualified small employer HRA (QSEHRA) is only for businesses with fewer than 50 FTEs. It has annual maximum limits but no minimum limits. Employees must have a health plan with MEC to use the benefit.
In Missouri, individual health insurance premiums are lower than group rates in every county, making ICHRAs and QSEHRAs an affordable and sustainable option for small to mid-sized employers.
Learn more about the HRAs you can offer with PeopleKeep
Qualified small employer HRA (QSEHRA)
A powerful first-time benefit or alternative to group health insurance made specifically for small employers.
Individual coverage HRA (ICHRA)
A health benefit that enables employers to cover the individual insurance plans their employees choose.
Group coverage HRA (GCHRA)
A health benefit that employers can use to help employees with their out-of-pocket expenses. It pairs with a group plan.
Association health plans
Another route some small businesses explore is joining an association health plan (AHP). These plans allow businesses with similar industry backgrounds or geographic locations to pool resources to obtain group health insurance at a lower rate.
While AHPs operate like group health plans, they’re not subject to all ACA requirements. For example, they don’t satisfy the employer mandate for ALEs. Coverage can also be limited for employees, so it’s important to weigh how well these plans align with their medical needs.
If you want more flexibility and control over your health benefits, HRAs offer customization options at a more predictable price than AHPs.
Supplemental and ancillary health insurance benefits
Major medical plans often leave gaps in coverage. But supplemental and ancillary benefits can fill them easily. These benefits add extra value to your compensation package and give your team peace of mind.
Most supplemental and ancillary policies don’t provide MEC individually. But they can make your major medical insurance or HRAs more compelling and help you offer a more robust health benefit.
Here are some popular types of supplemental and ancillary benefits:
- Critical illness insurance pays a lump sum if an employee faces a serious health condition like cancer or a heart attack.
- Accident insurance covers out-of-pocket medical expenses related to accidental injuries.
- Vision and dental insurance cover routine eye and oral care, such as cleanings and eye exams. These services are also eligible for reimbursement with an HRA.
- Hospital indemnity insurance provides enrollees with a daily cash payout for hospital stays.
- Health savings accounts (HSAs) are tax-advantaged benefits that work only with qualified high-deductible plans. Both employers and employees can contribute to the HSA, but the account and its funds stay with the employee if they leave their company.
- Flexible spending accounts (FSAs) let employees set aside pre-tax dollars for out-of-pocket healthcare costs. However, employees can’t use FSA funds to pay health insurance premiums.
These benefits help boost your healthcare offering and reinforce your role as an employer that supports its employees’ well-being.
Average health insurance costs in Missouri
Your group plan's premium costs depend on several factors, such as:
- Age
- Number of enrolled employees
- Plan type
- Family size
- ZIP code
- Medical history (only for large group coverage)
Under the ACA, insurance carriers that sell individual health plans must use different determining factors than group health policies.
The cost of an ACA individual health plan will vary by the following criteria:
- Age
- Geographic location
- Tobacco use
- Family status
- Metal level
Below are the average health insurance costs for each metal tier for a 40-year-old in Missouri, according to 2025 KFF data6.
|
Average lowest-cost bronze premium |
Average lowest-cost silver premium |
Average benchmark premium (second-lowest-cost silver plan) |
Average lowest-cost gold premium |
|
$377 |
$484 |
$489 |
$471 |
All health insurance plans sold on public exchanges must meet ACA requirements. This includes offering MEC and covering ten essential benefits, such as emergency care, prescription drugs, and maternity services. Once a person meets their annual out-of-pocket limit, the insurer pays 100% of covered medical services for the rest of the plan year.
Private health insurance exchanges also offer ACA-compliant plans alongside supplemental and ancillary benefits.
What plans are available on the individual market in Missouri?
Missouri residents looking for individual health insurance can shop on the federal Health Insurance Marketplace at HealthCare.gov7. During the 2024 Open Enrollment Period, more than 359,000 Missourians secured coverage through the platform.
Here are the enrollment period timelines:
- Open Enrollment Period runs annually from November 1 to January 15 in Missouri. This is the main opportunity to buy or switch plans.
- Special enrollment periods (SEPs) triggered by certain life events — such as losing job-based coverage, getting married, or having a child — allow individuals to enroll or change plans outside the regular window. Offering an ICHRA or QSEHRA midyear also creates an SEP for your employees to enroll in individual coverage.
The following is a list of health insurance carriers offering individual plans in 2025.
|
Insurance company |
On- or off-exchange |
|
Aetna CVS Health |
On- and off-exchange |
|
Blue Cross and Blue Shield of Kansas City |
On- and off-exchange |
|
Celtic Insurance Company (Ambetter) |
On-and off-exchange |
|
Cox Health Systems Insurance Company |
On-and off-exchange |
|
Healthy Alliance Life Co. (Alliance BCBS) |
On-exchange |
|
Medica Central Insurance Company |
On-exchange |
|
Medica Insurance Company |
On-and off-exchange |
|
Oscar Insurance Company |
On-exchange and off-exchange |
|
SSM Health Insurance Company |
On-exchange |
|
UnitedHealthcare Insurance Company |
On-exchange and off-exchange |
All table data from HealthCare.gov’s rate review site8.
Individuals may qualify for federal premium tax credits to help them reduce their monthly health insurance costs. In 2024, more than 92% of Missouri residents enrolled in a plan through the HealthCare.gov website qualified for subsidies, including premium tax credits.
COBRA in Missouri
Employees who separate from your organization often lose access to their group health benefits. Fortunately, the federal Consolidated Omnibus Budget Reconciliation Act of 1985 offers temporary continuation coverage for eligible individuals. If they qualify, individuals can maintain access to their employer-sponsored health insurance for a limited time.
Here’s how federal COBRA works:
- Eligibility. Employees who quit, retire, or lose their jobs for reasons other than gross misconduct may qualify for coverage.
- Spouses and other qualified dependents may also continue coverage in certain situations, like divorce, the employee’s death, or a dependent aging out of their parents’ health plan at 26.
- Duration. COBRA typically allows coverage for up to 18 months, with possible extensions in some circumstances.
- Affected organizations. Federal COBRA applies to all companies with 20 or more employees that offer fully-insured group health plans. Self-funded plans are exempt.
- Cost. Former employees are responsible for the full monthly premium, including the employer and employee portions, plus a small administrative fee.
Additionally, Missouri has a mini-COBRA law that ensures that former employees at small businesses have access to temporary health coverage.
Here’s a snapshot of how mini-COBRA in Missouri works:
- Eligibility. Employees who voluntarily or involuntarily leave a job are eligible if they participated in their employer’s group plan at the time of termination.
- Qualifying events include termination of employment other than for gross misconduct, reduction in work hours, divorce or legal separation, death of the covered employee, or a dependent child reaching age 26.
- Eligible individuals must elect continuation coverage within 31 days of the qualifying event.
- Duration. Continuation coverage under mini-COBRA lasts for up to 18 months in the case of a loss of coverage due to the end of employment or a reduction in hours of employment.
- Affected organizations. The law applies to all small employers with fewer than 20 employees who offer fully-insured plans.
- Cost. The covered employee must pay the full plan premium and an administrative fee directly to the insurance company.
How PeopleKeep and Remodel Health can help Missouri employers
Small and midsize businesses in Missouri looking for a simpler, more cost-effective way to provide employee health benefits can turn to PeopleKeep by Remodel Health. Our platform enables you to design custom HRAs that put control back in the hands of your employees, while easing the burden of plan administration for you.
With PeopleKeep by Remodel Health, small and mid-sized organizations can:
- Offer QSEHRA, ICHRA, or GCHRA options to give your employees the freedom to choose qualifying health plans that suit their needs.
- Build a benefits strategy that aligns with your company’s size, budget, and goals without locking you into one-size-fits-all group plans.
- Automate your benefits administration with tools that handle reimbursements, document management, and compliance tracking.
- Stay updated with federal and state regulations to avoid costly tax issues or penalties.
- Enable employees to browse and select individual insurance plans from their PeopleKeep dashboard.
Already working with a broker? No problem! PeopleKeep works with your existing advisor, who can continue helping you choose the best coverage and collaborate with us to design the right HRA solution.
Suppose your business is growing or requires advanced benefits support. In that case, Remodel Health’s ICHRA+ offering delivers hands-on service, enhanced compliance tools, and more robust administrative support for larger or more complex teams.
Ready to offer better health benefits?
Get in touch with a PeopleKeep by Remodel Health HRA specialist who can answer your questions and provide expert guidance.
Contributors:
Elizabeth Walker
Content Marketing Specialist