Health Insurance Information
The new Health Insurance Marketplace helps uninsured people find health coverage.
The Health Insurance Marketplace is a better way for you to find health insurance. We realize that choosing a health insurance plan can be complicated, confusing, and difficult. We want to change that and not simply by providing you with clear, easy access to hundreds of plans online like we already do. We want to lead you through the process and help you find the right health insurance plan at the right price for your specific needs, whether it's individual health insurance or family health insurance.
We accomplish this by speaking simply and with respect, and by having an appreciation for the fact that you can buy insurance elsewhere. More importantly, it means listening.
We take the time to learn about you. Your needs, your budget, and your medical history come first. Once we've gotten to know you, we research and present only those personalized health insurance quotes that best fit your specific needs.
When you fill out the Marketplace application we’ll tell you if you qualify for:
Private insurance plans. We’ll tell you whether you qualify for lower costs based on your household size and income. Plans cover essential health benefits, pre-existing conditions, and preventive care. If you don’t qualify for lower costs, you can still use the Marketplace to buy insurance at the standard price.
Medicaid and the Children’s Health Insurance Program (CHIP). These programs provide coverage to millions of families with limited income. If it looks like you qualify, we’ll share information with your state agency and they’ll contact you. Missouri is not expanding Medicaid in 2014 to cover more people.
What does Marketplace health insurance cover?
All private health insurance plans offered in the Marketplace will offer the same set of essential health benefits. These are services all plans must cover.
The essential health benefits include at least the following items and services:
- Ambulatory patient services (outpatient care you get without being admitted to a hospital)
- Emergency services
- Hospitalization (such as surgery)
- Maternity and newborn care (care before and after your baby is born)
- Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
- Prescription drugs
- Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services
Essential health benefits are minimum requirements for all plans in the Marketplace. Plans may offer additional coverage. You will be able to make side-by-side comparisons when we present your choices to you.
All Marketplace insurance plan categories offer the same set of essential health benefits. The categories do not reflect the quality or amount of care the plans provide.
The category you choose affects how much your premium costs each month and what portion of the bill you pay for things like hospital visits or prescription medications. It also affects your total out-of-pocket costs —the total amount you’ll spend for the year if you need lots of care.
Note: The Marketplace also offers "catastrophic" plans to people under 30 years old and to some people with very low incomes.
Balancing monthly premiums with out-of-pocket costs
As with all health plans, you'll have to pay a monthly premium. But it's also important to know how much you have to pay out-of-pocket for services when you get care.
Premiums are usually higher for plans that pay more of your out-of-pocket medical costs when you get care. For example, if you have a Gold plan, you'll likely pay a higher premium, but may have lower costs when you go to the doctor or use another medical service.
With a Bronze plan, you'll likely pay a lower premium, but you'll pay a higher share of costs when you get care.
Platinum plans will likely have the highest monthly premiums and lowest out-of-pocket costs. The plan will pay more of the costs if you need a lot of medical care.
In general, when choosing your health plan, keep this in mind: the lower the premium, the higher the out-of-pocket costs when you need care; the higher the premium, the lower the out-of-pocket costs when you need care.
What to consider when choosing your plan
Think about the health care needs of your household when considering which Marketplace insurance plan to buy.
Do you expect a lot of doctor visits or need regular prescriptions?
If you do, you may want a Gold or Platinum plan.
If you don't, you may prefer a Bronze or Silver plan. But keep in mind that if you get in a serious accident or have an unexpected health problem, Bronze and Silver plans will require you to pay more of the costs.