This guide, including the FAQs below, was created to help you understand the health insurance options available to you and your family in Missouri. An Affordable Care Act (ACA) Marketplace plan is cost-effective for many people.
These plans are also called Obamacare or exchange plans (exchange is another word for Marketplace). Missouri uses the federally-run health insurance Marketplace, HealthCare.gov. The Marketplace website will let you shop for health plans offered by nine private insurance companies (plan availability varies from one area of the state to another). 1 If you buy a plan on the Marketplace, the government may help pay for it through an income-based advance premium tax credit.
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Learn about Missouri's Medicaid expansion, the state’s Medicaid enrollment and Medicaid eligibility.
Use our guide to learn about Medicare, Medicare Advantage, and Medigap coverage available in Missouri as well as the state’s Medicare supplement (Medigap) regulations.
Short-term health plans provide temporary health insurance for consumers who may find themselves without comprehensive coverage. Learn more about short-term plan availability in Missouri.
You can buy individual and family health insurance from Missouri’s Marketplace if: 2
Eligibility for financial assistance with your Marketplace coverage will depend on your income. In addition, to be eligible for financial assistance in the Marketplace:
In Missouri, the open enrollment period to sign up for ACA-compliant individual and family health plans is from November 1 to January 15.
Outside of open enrollment, you can still make plan changes or enroll in the Marketplace if you qualify for a special enrollment period (SEP). Most SEPs require a qualifying life event, such as involuntary loss of coverage, marriage, or having a baby.
But there are instances where you don’t need a qualifying life event to apply. 6 For example:
In Missouri, you have a few options to enroll in a Marketplace health plan:
Many people – like early retirees not yet on Medicare, self-employed people, and those who work for small businesses without health benefits – use the ACA Marketplace.
In Missouri, you can find affordable health plans through the ACA Marketplace’s website: HeathCare.gov.
Under the ACA, you may qualify for income-based subsidies called Advance Premium Tax Credits (APTC). These credits lower your premiums.
As of early 2024, 95% of the people with effectuated coverage through Missouri’s exchange were receiving premium subsidies, saving an average of $595 per month. The average after-subsidy premium (including the 5% of people paying full price) was about $85/month. 10 (Note that these numbers are based on effectuated enrollment in early 2024, so they differ from the graphic below, which is based on total enrollment during the open enrollment period that began in the fall of 2023.)
If your income isn’t more than 250% of the federal poverty level, you may also receive cost-sharing reductions (CSR), as long as you enroll in a Silver-level plan. 11 CSRs reduce your out-of-pocket costs when you use your health insurance.
Missourians may also find affordable coverage through Medicaid if eligible. Missouri expanded Medicaid eligibility guidelines in 2021, under the terms of a voter-approved ballot measure that implemented the ACA’s Medicaid expansion. This allows adults younger than 65 to enroll in Medicaid with a household income up to 138% of the poverty level. Learn more in our Missouri Medicaid guide .
Short-term plans are also a low-cost option for people who are not eligible for employer plans, Medicaid, Medicare, or subsidies through the exchange. However, for short-term plans issued starting in September 2024, new federal rules limit initial terms to no more than three months, and total duration will be capped at four months, including renewals.
Nine insurers offer coverage in the Missouri Health Insurance Marketplace for 2024, including a few that expanded their coverage areas for 2024, resulting in more available plans in some areas of the state. 1
For 2025, all nine insurers will continue to offer coverage in Missouri’s Marketplace. Three of the insurers are expanding their coverage area. This includes a UnitedHealthcare expansion to offer coverage statewide (the only carrier to do so). The other six carriers will continue to offer coverage in the same number of counties they serviced in 2024. 13
There were ten insurers offering plans in 2023, 14 , but Cigna exited Missouri’s individual insurance market at the end of 2023. 15
Here are the average rates that Missouri’s Marketplace insurers have proposed for 2025 individual/family health insurance (before any subsidies are applied) 16
Source: Missouri Department of Insurance 17
The proposed rate changes are for full-price premiums. Sinc e most people on Missouri’s exchange receive premium tax credits, they don’t pay the full price. 10 If you qualify for subsidies, your net rate change depends on changes in your plan rates and your subsidy amounts.
A note about rate review in Missouri: Prior to 2017, Missouri did not have an effective rate review program, but that changed in 2017 (as of 2024, only three states — Oklahoma, Tennessee, and Wyoming — do not have an effective rate review program and thus rely on the federal government for this). 18
Since 2017, under the terms of SB865, the Missouri Department of Insurance has taken an active role in reviewing insurers’ proposed rate changes. 19 State regulators determine whether the proposed rates are justified, although they are not allowed to prevent an insurer from implementing a rate change, even if the state does not consider it to be justified (this is the same as the federal rate review process).
For perspective, here’s a summary of how unsubsidized premiums have changed over the years in Missouri’s individual/family health insurance market:
During the open enrollment period for 2024 coverage, 359,369 people signed up for private health plans through Missouri’s exchange/Marketplace. 30 This was a significant new record high (see graph below).
Usually, when a state expands Medicaid, Marketplace enrollment drops. That’s because people with income between 100 and 138% of the federal poverty level transfer from Marketplace plans to Medicaid.
But Missouri’s Marketplace enrollment grew in 2022 and 2023 despite the 2021 Medicaid expansion. This growth is likely because of larger subsidies from the American Rescue Plan and the Inflation Reduction Act. The larger and more accessible subsidies make coverage more affordable. 31
And the enrollment growth in 2024 was also driven by the “unwinding” of the pandemic-era Medicaid continuous coverage rule. CMS reported that by April 2024, more than 124,000 Missouri residents had transitioned from Medicaid (MO HealthNet) to a Marketplace plan. 32
Source: 2014, 33 2015, 34 2016, 35 2017, 36 2018, 37 2019, 38 2020, 39 2021, 40 2022, 41 2023, 42 2024 43
HealthCare.gov
The official federal website where you can sign up for health insurance plans through the ACA Marketplace.
Missouri Department of Insurance
Oversees and regulates health plans, brokers, and agents.
Medicare Rights Center
National resource with a website and call center to provide information and help for people on Medicare.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org.
