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Missouri insurance law and regulation
News that affects your health insurance and planning
June 2, 2019 – Status of alternative non-ACA health plans: Missouri does not require individuals to maintain adequate health coverage. The state provides no premium or cost-sharing subsidies for individual market coverage, permits insurers to sell non-compliant transitional policies in the individual market and does not limit the sale of short-term coverage more strictly than the federal government.
March 22, 2019 – While most of the state’s residents want to see medical care expanded to uninsured low income residents, cost is a huge impediment. Medicaid spending in Missouri accounted for 17 percent of the state’s revenue in 2009. In 2018, the state’s Medicaid spending grew to 24 percent, and it’s on track to equal 26 percent of revenue by 2023 if left untouched.
November 24, 2018 – A proposal to expand Medicaid under the Affordable Care Act, commonly known as Obamacare, could be on the ballot if a petition drive now underway is successful. Missouri Secretary of State announced the filing of paperwork seeking to place the question on the ballot in the 2020 election cycle. The last two ballot initiatives opposed by lawmakers were approved by the voters voters earlier this month. Under the proposal, coverage would be extended to anyone age 5 through 64 with an income level at or below 133 percent of the federal poverty rate. The move would extend health care to 300,000 Missouri residents, mostly the working poor who could not afford private insurance but made too much to qualify for federal subsidies under the federal program. In the meanwhile, Missouri residents should look for affordable partial coverage on the Smart Insurance Exchange as a temporary measure.
The history of health care planning in Missouri (Information is outdated and links may be expired)
2/20/2015 – More than 1,000 Missouri hospitals, ministries, local chambers of commerce and health groups sent a petition pleading with lawmakers to expand the state’s Medicaid eligibility rules. They point out that the state’s resistance to Obamacare is illogical and is hurting the state economy.
12/8/2014 – The monthly premium rate for the least-cost bronze plan offered though the insurance marketplace in 2015 that has the highest deductible and requires the highest level of customer out-of-pocket cost-sharing — rose by nearly 12%, from $146 to $163 for a 27-year-old nonsmoker in St. Louis County. Other plan choices had smaller rate increases. It appears that insurers may have underprices insurance for the youngest applicants in the first year of open enrollment through the insurance exchange.
2/11/2014 Professional support for any health care reform issue is available free of charge through an arrangement with OnlineNavigator. All online inquiries are handled personally by Tony Novak, CPA. Online support is available through a number of popular social media channels including Facebook and Google+ as well as e-mail. Telephone support for insurance enrollment is available through Members Insurance Exchange at (800) 609-0683.
8/10/2013 Assurant Health agreed to pay $1 million for violations of the state’s health insurance laws. This is not a company endorsed by Freedom Benefits and we have sometimes warned consumers of various indications of claims payment problems with this issuer of individual health insurance.
7/26/2013 Affordable Smart Term Life Insurance is now available to most Missouri residents from age 20 through 60 directly online with no physical exam, agent appointment or telephone verification. Most policies are issued on the same day with coverage amounts of $25,000 up to $350,000. The level premium life insurance is available for terms of 10, 15, 20 and 30 years. Sample rates for $150,000 coverage for a preferred risk male age 30, non-tobacco $30.85 per month; tobacco user $49.55 per month. A preferred risk female age 30 non-tobacco user would be $26.49 per month and a tobacco user would be $40.96 per month. Rates are higher for older applicants and lower health risks as described online. Pricing is based on input you provide about your medical history but, unlike most other life insurers, does not consider family medical history. Coverage is issued by innovative National Life Group, rated “A” by A.M. Best Company for 2013.
7/25/2013 The Missouri Department of Insurance reminds consumers that they can file a complaint or ask general insurance questions by calling the department’s Insurance Consumer Hotline at 800-726-7390 or by visiting http://www.insurance.mo.gov
3/11/2013 This page was updated to include a link to the insurance plan that will be used to determine specific “essential health benefits” for insurance that qualified for 2014 federal tax purposes. Also, a link to additional covered benefits required by state law. Non-qualified insurance is likely to continue to be available at a lower cost that does not include these benefits nor qualify for federal tax purposes.
11/8/2012 Governor Jay Nixon announced today that Missouri’s health insurance exchange will be run by the federal government. The state forfeits federal money to set up the exchange this year but will likely save money in the long run when federal assistance is reduced in future years.
2/1/2012 The Center for Consumer Information and Insurance Oversight, a division of the Center for Medicare and Medicaid Services (CMS)reported that as of June 30, 2011 Anthem BCBS, UnitedHealthcare and Mercy Health Plans are the state’s largest health insurance providers and as such, earn the right to set the benchmark for the development of the state’s essential benefit plans to debut in 2014 under health reform law.
10/17/2011 State law H 45 enacted 7/8/2011 creates a $20,000 employer tax deduction for each new full-time jobs created with an annual salary of at least the average annual county wage if the small business also offers new employee health insurance and pays at least 50% of the health insurance premiums of all full-time employees who opt into the offered plan.
7/12/2011 UnitedHealthOne critical illness insurance is now available. This insurance pays $10,000 to $50,000 in addition to any other insurance at the time that a diagnosis of stroke, heart attack or life-threatening cancer. Personal rates quotes are available by email fromOnlineAdviser. A brochure and application can be downloaded from www.uhcenrollment.com
7/10/2011 The U.S. Center for Consumer Information and Insurance Oversight announced that Missouri lacks proper resources or authority in the individual or small-group health insurance market to effectively review large rate increases as required by federal law. The federal government will temporarily take over the task of reviewing both individual and small business health insurance rate increases that are greater than 10%.
3/7/2011 Health insurance mandates, optional coverage and required insurance provisions in Missouri are listed in a newUniversal Health Insurance blog posting with links to the related legal citation
2/12/2011 With dozens of health plans choices available online offering a wide range of pricing and benefits, how do you find the best combination of price and benefits? Celtic Insurance realizes that the choices can be overwhelming; the company offers more than 40 possible health plan designs in many parts of the United States. A new feature called “Help Me Choose” lets users easily and quickly select the benefits they value most and narrows the list down to a few of the best choices. No personal information is required other than zip code and date of birth.
1/19/2011 Child-only health insurance for children with significant medical problems will be available through an open enrollment period mandated by federal state law during the month of March. All children, regardless of medical condition, continue to be eligible for insurance when applying as a dependent on a parent’s policy and healthy children are eligible for child-only insurance at any time. When applying for child-only insurance for more than one child, make a separate application for each child.
12/16/2010 Missouri Department of Insurance officials met representatives of 44 other states and numerous employees of the federal Health and Human Services Department in Washington DC this week for a two-day working meeting to discuss the next steps in establish a government-run health insurance exchange under the American Health Benefit Exchange Model Act. Their attendance at this meeting was paid for by a $1 million federal grant awarded by HHS in September to the state for research how to set up an insurance exchange. Two states (Alaska and Minnesota) declined to participate, saying that it was a waste of taxpayer money. Four other states (not identified in press reports) that received federal grants did not send representatives to the meeting. Attendees included representatives of 16 states that are suing the federal government in an attempt to overturn the federal health reform law; specifically the requirement that forces individuals to buy health insurance on the insurance exchange or pay a hefty tax fine.
In its initial federal grant request for the insurance exchange project, Missouri said that it would: 1) Provide a planning and development infrastructure to support launching an insurance Exchange, 2) Determine the organizational structure of any such Exchange, 3) Explore the establishment of a regional Exchange with neighboring States, and 4) Compile cost estimates for providing coverage to potential populations and gather health status for such populations.
The meeting reportedly did not address the role of the commercial health insurance exchanges on the implementation of new competing government systems. The model act does not address inter-state insurance exchange proposals nor insurance sales across state lines. Federal officials admitted that they may not be able to provide further guidance until 2012. Meanwhile, most states are motivated to continue to meet requirements to obtain additional funding promised by the federal government for the establishment of insurance exchange by 2014. Freedom Benefits has previously voiced the opinion that the huge amount of money being spent to set up alternate insurance sales system technologies could be better used providing health benefits to the public. We proposed on the Universal Health Insurance blog that adequate commercial insurance sales systems are already in place that could be modified in a public/private partnership to make health insurance more affordable.
7/18/2010 A new high risk health insurance plan run by RightChoice, a subsidiary of Anthem Blue Cross and Blue Shield is now available. Premiums are paid in part by a federal grant of $81 million that reduces the premium cost. Premiums are the same as other similar commercial insurance at $423 to $972 per month, depending on age. The annual deductible set at $1,000 and out-of-pocket expenditures limited to $5,950. The state’s previous high-risk pool called Missouri Health Insurance Pool (MHIP) has operated since 1991 and has more than 4,000 enrollees, charges higher rates.
5/14/2010 Diabetes Coverage: A new resource to help find health insurance for diabetics in Missouri is now available at Freedom Benefits.
5/11/2010 Missouri voters will decide the fate of the health insurance mandate in the upcoming August 2 general election. Legal experts predict that the federal law requiring insurance will eventually prevail, regardless of strong public opposition, but we could face years of legal wrangling and consumer confusion ahead.
Diabetes – There were 328,200 diabetics reported in Missouri as of the end of 2007, according to the most recent data available from the Centers for Disease Control and Prevention. The number of diabetics is expected to increase significantly each year through at least 2025. Missouri is one of three states that require health insurers to offer at least one type of policy that includes coverage of diabetes treatment, but does not require such coverage as a mandated benefit. Diabetics still face difficult challenges finding and keeping individual health insurance. For those not eligible for Medicare, Medicaid or employer-provided group coverage, the health plan choices are severely limited. Freedom Benefits offers a range of reference materials to help explain the laws that govern this area of health insurance as well as a list of specific insurance plans and other coverage options.