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Missouri Health Insurance

Missouri Medical Insurance Overview

The state of health in Missouri has not been that great when compared to the other 49 states in the country.  Unfortunately, Missouri’s health status has only gotten gradually worse as time passed.  Despite that, the state of health insurance coverage has grown to a wider reaching area in the state and coupled with the strong points, the state can be on its way toward drastic improvements.

In the years ahead, it is hoped that the state of Missouri will see increased health care benefits overall.  By 2020, predictions show that over 30 million more Americans will have insurance benefits because of the health care reform that was put into motion by the Affordable Care Act.
Missouri’s Health Care Issues
According to statistics revealed by the United Health Foundation, the state of Missouri is ranked in 36th place when compared to the other states.  In 2012, the state was ranked in 42nd place, but this ranking has increased in the state overall.  Considering the drop in ranking, this state still has a low quality of health care and insurance as compared to the nation in its entirety.

In the state of Missouri, there are a few strengths and weaknesses.  Its strengths include its lower percentage of kids living in a state of poverty, its low prevalence of those who drink in excess and high rate of children who have graduated high school.  The state’s weaknesses include its low per capita health funding, its low rate of immunizations among teenage kids and its limited availability of dentists statewide.

Understanding Missouri’s Uninsured Population
Statistics shown by the Henry Kaiser Family dictate that 10.3 percent of residents were without insurance coverage as of 2014.  The recession can be blamed for some of the lingering numbers of people without insurance, but when the Affordable Care Act came into play, those numbers should’ve dropped.  Instead, the number was up a percentage point from the prior year.  In addition, the high costs associated with premiums were to blame for the percentage of people living in Missouri without health insurance coverage.

In the state of Missouri, 10.3 percent don’t have insurance coverage through any means.  In addition, ten percent of children residing in this state are not covered under a benefits package.  Additionally, 48 percent of private employers do not offer insurance plans to employees.

Group Health Plans
In the state of Missouri, if you are able to access medical benefits through your workplace, this would be the best option to get coverage that is affordable.  Group policies offer many benefits, but most of all, they have the best prices for the amount of coverage available.  Half of the insured residents of Missouri have insurance coverage through this means.

Private insurance companies offering group benefits packages do not have the liberty to deny coverage to people who have pre-existing medical conditions.  If group coverage is unavailable or expensive for you, you may attempt to get coverage through a trade union that offers similar benefits packages.

The Missouri Department of Insurance, Financial Institutions & Professional Registration governs the private health insurance companies operating in the state of Missouri.
Signing Up
If you are able to get group coverage through your employer, you need to enroll for insurance benefits through the company’s open enrollment period.  These times take place throughout different times of the year depending on the employer.  For more information, you need to discuss the period in which you can sign up for coverage with a representative of the company’s Human Resources department.

In addition to providing information on the enrollment period, you can glean a wealth of information on the benefits package offered by your place of employment.  Also covered during this meeting with HR should be the enrollment period, the options for coverage and how much premiums are going to cost you on a monthly basis.  Before you go ahead and register for coverage, consider the following questions:

  • Do you need to cover your wife/husband or dependents?
  • Do you have pre-existing medical conditions that will be more expensive to handle because of the comprehensive medical care needed?
  • Are there more than two or three plans available that differ in levels of insurance offered?

Pre-Existing Condition Exclusion Periods
For those people who suffer from a pre-existing medical condition, you can’t get turned down for coverage under a group plan in the state of Missouri.  However, you can be made to wait out a period of time called an exclusion period before accessing your insurance benefits.  In the state of Missouri, the pre-existing condition exclusion period is 12 months long.

Any dependents that are covered under your group benefits package cannot be subject to waiting out an exclusion period if they are 19 and under.  In addition, insurance companies are able to look back into your medical records for a period of six months in total in order to see if you have a pre-existing condition.  Lastly, the insurance company cannot use a predisposition for a medical condition as a means of excluding you for pre-existing conditions.

Affiliation or Waiting Periods
Waiting periods can last no longer than two or three months, depending on whether or not you have enrolled on time or late.  Affiliation periods will run concurrently with exclusion periods in the case that they both apply.

Individual Health Plans
Individual health policies are available to residents of Missouri who cannot obtain insurance coverage through a state program or through an employer.  If your company doesn’t offer benefits or you are self-employed, coverage is offered through this particular plan type.

In the state of Missouri, 6 percent of residents are covered under the terms of an individual insurance contract.  Estimates show that a healthy young person residing in Missouri can receive individual coverage for as low as $50 every month.

Unlike group health insurance policies, if you have a pre-existing condition, you can be denied coverage under the provisions laid forth for individual health plans.  If you are offered coverage under this plan type for a pre-existing condition, you will be subject to waiting out a two year exclusionary period before your benefits can be used.  In addition, medical benefits are subject to a great deal of underwriting in Missouri, leaving this as the most expensive option for health benefits in Missouri.

Continuation Coverage
Because of the enactment of HIPAA, continuation coverage is available under the Consolidated Omnibus Budget Reconciliation Act (COBRA).  If you are newly uninsured because of a job or marital status change, you can get up to 18 months of coverage under COBRA.  Eligibility under this program is strictly dependent on the size of the company with which the original policy was issued.

Conversion plans are available for those people who wish to keep the same policy benefits and insurance company.  This makes it possible for the group plan to be converted into an individual policy.

Missouri Health Benefit Exchange
There was a lot of effort placed into determining whether or not Missouri’s health benefits marketplace would be managed on a state or federal level.  The state wanted to meet the guidelines as set forth under the Affordable Care Act, but was unsure how to proceed to meet this mandate.  The ACA required every state in the country to run a state or federally managed marketplace where uninsured people could consider their options, get questions answered and select a policy for insurance coverage.

In 2012, it was determined that the best course of action for the state of Missouri was to allow it to default to having a federally managed marketplace.

Missouri State Insurance Programs
There are a lot of state-funded programs that exist to offer guaranteed and paid insurance benefits to those individuals and families in the state of Missouri who are in need of assistance and have low incomes.  Eligibility for these programs relies on the applicant’s age, sex, income level and medical history.

Below is a list of the programs offered by the state and information on each:

Missouri Health Insurance Pool (MHIP)
This is a program that offers varying levels of insurance coverage to people who can’t get benefits because of a pre-existing medical condition.  Covered under this plan are medications, abuse care, alcohol abuse treatment and physician care services.  To qualify for this program, you must be able to show proof that you have received a denial for an insurance application due to a pre-existing condition.

Pre-Existing Condition Insurance Plan (PCIP)
Like MHIP, the PCIP offers coverage to those who have been denied insurance coverage due to a pre-existing health condition.  In order to qualify for this program, you must have gone without insurance benefits for a period of six months in total.  Once you have been granted coverage, you can get a wide variety of medical services.

MO Healthnet
MO Healthnet is a program that helps low-income individuals and families obtain insurance coverage in the state of Missouri.  Eligibility for this program is largely based on your income level and it offers in and outpatient services, labs, x-rays, ambulatory services and much more.

Children and Youth with Special Health Care Needs (CYSHCN)
For children with special needs, the CYSHCN offers coverage that includes therapy, surgery, tests, prescription drugs and more.  Conditions covered include cerebral palsy, ear infections, cleft lip, digestive disorders, arthritis and more.

MO HealthNet for Kids (MHK)
This program serves pregnant women and children that fall under certain income guidelines.  Income level is used to determine your monthly premiums and it could be free to those who qualify.

Women, Infants, and Children (WIC)
The WIC program is managed by the USDA Food and Nutrition Service and helps pregnant women and mothers get nutritional guidance and breastfeed information.  It also allows for the mother to obtain certain food items free of charge and offers prenatal and postnatal counseling services.

Show Me Healthy Women (SMHW)
Women suffering from chronic illnesses can get coverage under the Show Me Healthy Women program.  This plan offers breast cancer screenings, breast and pelvic exams and many more services.  There is no charge for monthly premiums for those who qualify.

This program works to diminish the risk of heart disease and stroke in participants by offering various screenings and educational resources to women between 35 and 64 years of age.

Medicare, the Medicare Prescription Drug Program, and Missouri CLAIM
The Medicare program is strictly for a set group of individuals that includes seniors, the disabled and those who suffer from renal disease and are in the end stages.  If you are 65 or older and have worked in a job that was Medicare-covered for at least 10 years, you can be guaranteed coverage under Medicare.  Missouri CLAIM offers counseling services to those who qualify for Medicare.

MO Senior Rx
This program is only available to those participants who have Medicare Part D and meet the income guidelines for participation.  It offers discounts on the high costs associated with prescription medications.

VA Medical Benefits Package
The VA Medical Benefits Package is a plan that covers only veterans of any branch of the military who have completed their active duty requirement or have served for 24 consecutive months.  It provides guaranteed comprehensive benefits as long as the veteran has not been dishonorably discharged from the military.

Partnership for Prescription Assistance
This plan connects consumers with a wide variety of prescription assistance programs that work to lighten the costs of medications.  It is a free service that can connect you with some of the 475 programs available.

National Association of Mental Illness (NAMI) Helpline
For those experiencing problems with mental illness, the NAMI Helpline can offer guidance in coping with their condition.  Participants who call into the helpline are connected with knowledgeable volunteers who offer treatment options and resources to those who are mentally ill nationwide.

The Health Insurance Portability and Accountability Act (HIPAA)
The Health Insurance Portability and Accountability Act (HIPAA) offers protections for consumers against the practices of private health insurance companies.  It works to limit the terms in which enrollees can be denied coverage based on plan type, but does not make it mandatory for employers to offer benefits to their roster of employees.