Home to big cities like Kansas City and St. Louis, Missouri has many attractions and interesting sights to see. Both major cities are full of culture, museums, and food, and much of the rest of the state is recognized for its farming. Kansas City contains more fountains throughout its downtown area than any other city in the world except Rome. There is also a great deal of outdoor recreation available in the state, between lakes and parks. Wallace State Park, one hour outside of Kansas City, has several trails for walking, running and hiking, and a lake within for various activities. This is only one of many parks and natural recreation areas throughout Missouri.
Missouri residents have access to a variety of health care companies, including Aetna, Anthem Blue Cross Blue Shield, Celtic, Coventry, Humana and United Health One. The availability of these companies depends on the area in which you live, so it is helpful to get a quote to know your options. Enter your zip code below to compare plans and rates offered near you.
In Missouri, the overall health of the population is somewhat lacking. Due to several factors, including a large population of smokers, an increase in diabetes and obesity, the state could use better health care and a higher level of concern with wellness. Though smoking has decreased in the past decade, there are still 963,000 adults who smoke in the state. Obesity is a growing problem all over the country, now affecting more than 31% of Missouri adults, which is higher than many states. Diabetes is also becoming a more prevalent problem, having increased from 7.8% to 9.4% of the adult population in just one year.
There are is one positive aspect of the Missouri population regarding health, which is the high use of early prenatal care. Another area of importance is the lack of public health funding for uninsured individuals, which is very low compared to the rest of the country. Health insurance coverage is also not as widespread as perhaps it should be, with an uninsured population of 14.3% in 2011. These problems can be alleviated by getting a health insurance plan, if you can afford one, or using one of the few public health programs available. Also, making positive lifestyle alterations such as healthy eating and regular exercise are the best way to improve health in the immediate future.
Health Insurance Plans
- Preventive and Hospital Care plans are ideal for those who want a minimal plan, with basics as well as major medical coverage in case of emergency. These plans cover preventive care as soon as your plan starts for no cost with an in-network provider. When you reach the deductible amount, your plan will cover 80% of in-network hospital services. These are PPO plans, which gives you the freedom of using in-network providers for a lower rate or out-of-network doctors and hospitals for a lesser amount of coverage.
- Open Access Managed Choice PPO plans are available in traditional and value types. Some of these plans have additional benefits, including unlimited primary care visits and dental coverage. When you choose either a Value or a standard PPO plan, you will not be charged for preventive care with an in-network provider. These benefits start immediately, in addition to doctor’s office visits for a copay. Once you reach the deductible, you can receive in-network emergency care, specialist visits, outpatient surgery, and hospitalization services among other types of care for 20% coinsurance.
- Open Access Managed Choice High Deductible plans from Aetna are designed for use with an optional health savings accounts (HSA), offering more control over your health care expenses and how you pay. With these plans, there is a low monthly premium and a high level of coverage and benefits in-network after deductible. After you meet your deductible, which you can help reach by using money in your HSA, you can receive in-network care from inpatient work to doctor’s office visits in-network for no cost or 10% coinsurance. Deductible options are $3,500 and $5,500 for individuals, and preventive care is available immediately covered at 100% with network doctors.
- CelticCare Preferred Select PPO plans are available in Missouri with a variety of deductibles and either 80% or 100% in-network coverage. These plans connect you with Celtic’s preferred network of providers, and have either 80 or 100% coinsurance coverage options. After deductible, your plan covers hospital care including emergency and ambulance services, surgery, lab work and more. Primary care physician office visits will cost $15 for the first two visits, and prescription drugs are also available immediately for a copay of $10 for generics and $40 for brand names.
- CelticSaver HSA plans are qualified high deductible health plans with the choice of a plan covers 80% of in-network medical bills after deductible, or one where you pay nothing. No matter which HSA plan you choose, there is no lifetime maximum, and preventive care is covered in full as soon as your plan starts. Covered services after deductible include doctor’s office visits, prescription drugs, hospitalization, physical therapy, skilled nursing and more. You can choose to use your HSA funds for cost sharing and other medical payments, or save for the future with tax advantages.
- PPO plans from CoventryOne in Missouri have deductible options ranging from $1,000 to $5,000 for individuals. Each of these plans provide significant benefits after deductible, requiring you to pay 20% coinsurance on hospital services. As soon as your plan starts, you have access to primary care or specialist physicians through office visits or telemedicine for a copay, as well as wellness coaching and radiology. Also covered immediately is preventive care, which is no cost when using in-network providers, including child immunizations, routine health exams, OB-GYN exams and more.
- PPOSJ plans are value plans that cover 100% of your in-network health care costs after deductible. These plans come in $1,500, $2,500 or $5,000 deductibles for individuals. SJ plans also come with immediate benefits that include doctor’s office visits for a copay starting at $15 for primary care, telemedicine, wellness coaching and prescription drugs. Preventive care is available with in-network providers for no cost as soon as your plan starts. After deductible, major medical care is covered at 100%, though some services have an additional copayment, such as emergency room visits and inpatient hospitalization.
- QHDHP plans are qualified high deductible health plans with the option of opening a health savings account. Missouri QHDHP plans give you the option of a $2,500 or $5,000 deductible for individuals. Both levels offer 100% coverage after deductible on doctor’s office visits with a specialist or primary care physician, telemedicine PCP, wellness coaching and hospital services. These plans also cover out-of-network care at 50% after deductible, which makes the in-network option much more appealing. Prescriptions are also covered at 100% with no separate deductible.
- Copay plans are available in the following types in Missouri: Portrait Share 80 and Autograph Share 80 Plus Rx. Both of these copay plans offer the convenience of instant benefits when your plan starts, including doctor’s office visits and prescription drugs. Once you meet the deductible, these plans cover 80% of your hospital care with network providers, including surgery, inpatient stays, outpatient diagnostic, emergency room visits and more. Portrait Share 80 has an individual deductible of either $1,000 or $2,500, and Autograph Share 80 plans have deductibles of either $5,000 or $6,000 for individuals in Missouri.
- Monogram plans offer 100% coverage on all types of medical services after you meet the deductible. These plans have a deductible of $7,500 for individuals and $15,000 for families. Once the deductible is met, you can use in-network services such as doctor’s office visits (specialist or PCP), inpatient and outpatient care, emergency care, and mental health care for no cost. There is a separate deductible for prescription drugs, though it does not apply to generics. Preventive care is available from the day your plan begins, covered in full when using network doctors.
- Health Savings Account plans have the largest selection of deductibles and come in two types: Autograph Total HSA or Autograph Total HSA Plus Rx. This clearly indicates one plan has prescription coverage and one does not. Both plans do have the same 100% coverage after deductible. Individual deductibles range from $1,500 to $5,000 for Autograph Total HSA plus Rx, and $2,000 to $5,200 for Autograph Total HSA plans. These plans cover preventive care at 100% without any deductible requirement with in-network providers. You also have the option of using a health savings account for optimum control over your medical spending.
United Health One
- Copay plans are a favorite for their convenience and immediate benefits. With fixed rates for office visits to primary care doctors and specialists, as well as prescription medications, you can receive care as soon as your plan begins. These plans are offered in Copay Select and Copay Select Value options in Missouri, which offer different levels of coverage. Copay Select plans give you the option of 70, 80 or 100% coverage, and Value plans all cover 70% after deductible. This type of plans has higher premiums than other types, but once you meet the deductible, your plans covers most medical services in full. Such services include emergency care, inpatient hospital stays, outpatient services like surgery, lab work, X-rays and tests, mental health care and physical therapy. As soon as your plan becomes active, preventive services are no cost to you and your dependents.
- High Deductible plans are available with a variety of deductibles and several different plan types, including Plan 100, Plan 80 and Saver 80. If you choose Plan 100, the plan will cover 100% of your medical expenses after deductible, including emergency room care, diagnostic work, inpatient hospital care and outpatient services. Plan 80 and Saver 80 require you pay 20% coinsurance on such services once your deductible has been met. These plans cover preventive care at 100% with an in-network provider, and is available at any time before meeting the deductible.
- Health Savings Account plans have multiple high deductibles to choose from, and can be paired with a health savings account for greater health care cost management. These plans are available with either 100% or 70/30 coverage after meeting the deductible on a broad range of medical services. Such services include doctor’s office visits, prescription drugs, inpatient hospital care, outpatient services, surgery, lab work, X-rays and care for several serious physical injuries and disorders. Preventive care is available from the day your plan starts at no cost to you. Deductibles start at $1,250 for individuals and $2,500 for families with HSA 70 plans, and $2,500 for individuals and $5,000 for families with HSA 100 plans.
Public Health Options
In the state of Missouri, there are a variety of public health programs that are funded by the state for residents who have a low income, do not have insurance and have certain medical needs. Primarily, health insurance coverage is offered through Medicaid in Missouri to uninsured families and children and other qualifying individuals. There are multiple Medicaid programs and plans for different groups of people depending on their financial and medical condition. Other health related programs are offered through the state for nutritional assistance, treating illnesses, helping individuals with disabilities and more. For a full list of what your state offers for uninsured individuals, visit the Missouri Department of Social Services.
- MO HealthNet/Medicaid: medical insurance for uninsured individuals in Missouri who meet certain criteria. To find out more about who is eligible, read our Medicaid Eligibility by State page.
- Missouri Rx Plan (MoRx): prescription drug assistance for Missourians who cannot afford to pay for prescriptions due to lack of insurance and/or low income.
- MO HealthNet for Kids: health insurance for children of all ages and income levels who are uninsured in Missouri.
- Women, Infants & Children (WIC) Program: nutritional assistance program for new mothers, pregnant and breastfeeding women.
Health Insurance Laws
Missouri health insurance regulations exist to keep health insurers selling health insurance plans and keep those who buy them insured. One law that helps you as a Missouri resident and health insurance consumer is the guaranteed renewability provision of HIPAA. This law makes sure that any person who buys a health plan can keep their coverage, and renew it the following year. Insurers in Missouri must offer the same plan a client has had the previous year for another term in order to have continuous coverage. This law also states that no insurer can terminate benefits on the ground of illness acquired after the plan has started. Insurance companies can only cancel a plan if someone is in violation of their policy, then they do not have to follow guaranteed renewal.
Pre-existing condition laws are not very consumer-friendly in Missouri, as there is an open definition for what such a condition entails. Usually it is specified as a condition for which you have received some kind of medical attention before applying for health insurance. Also, if an insurance company decides you have a pre-exsiting condition, they can reject you for a health plan they can decide to accept you with elevated monthly charges. The insurance company is also permitted to give you an exclusion period of any length of time they choose, which allows them to not have to pay for care related to the given condition. Elimination riders are also a possibility in Missouri, which would permanently give the insurance company permission to not cover care related to your condition.
Thanks to the Affordable Care Act, there is another option for health insurance coverage for adults with pre-existing conditions. The Pre-Existing Condition Insurance Plan offers medical coverage to qualified individuals in Missouri in need of an affordable solution and essential benefits. These plans are operated by the state of Missouri, and allot a certain amount of funding to make them work. PCIPs are a somewhat short term offer, as they will expire at the end of 2013. The ACA has mandated that all insurance companies in the nation accept all adults regardless of their health conditions starting January 1, 2014. This means that anyone who had a PCIP will have to sign up with a private insurer or state health exchange when that date arrives.