Individual/Family Health Plans
MDIS offers individuals and their families a variety of individual health plan options, including standard PPO plans and Health Savings Accounts (HSA) plans, both on and off the exchange. MDIS works with several health insurance carriers to offer affordable solutions for your insurance needs. Plans offer a variety of options, such as deductibles, co-insurance and prescription drug coverage. Due to the passage of the Affordable Care Act (ACA), major medical plans no longer put limitations on benefits due to medical underwriting.
The ACA enacted limitations to when an individual can purchase major medical coverage. Open enrollment begins November 1 every year, for coverage effective January 1. Unless you have a qualified event (Special enrollment periods), you will not be eligible to purchase coverage outside of open enrollment. *Short-term plans are available for purchase throughout the year.
Special enrollment periods allow individuals the option to purchase health insurance coverage outside open enrollment. Most qualified events trigger a 60-day window of opportunity to purchase a policy. Most events will have an effective date of first day of the month following receipt of application by the carrier. It is crucial to apply as soon as an individual receives notification of the impending event. (Exception is birth or adoption of a child, which would be date of event.)
Exchange Plans and Subsidies
In 2021, Missouri residents earning $17,609 - $51,040 annually may qualify for a premium tax credit or subsidy. The subsidies are on a sliding scale; the lower the income, the higher the subsidy. Missouri did not expand Medicaid and as a result, individuals earning $12,760-$17,608 annually are not eligible for subsidies nor Medicaid. Silver plans have additional cost-sharing benefits with a reduction in out-of-pocket expenses. If an individual does not qualify for a subsidy through the exchange, there is no incentive to purchase a policy through the exchange and be limited on plans, carriers and networks. MDIS can help you with eligibility determination and enrolling through the exchange. If you have access to employer sponsored coverage that is deemed affordable and provides minimum value, you may not qualify for a subsidy through the exchange.
Missouri passed Medicaid Expansion August, 2020, which will increase the number of subsidy eligible individuals in Missouri. Those earning 100%-138% of Federal Poverty Level ($12,760-$17,608) will qualify for a subsidy through the marketplace. Expansion will go into effect July 1, 2021.
Off Exchange Plans
Off exchange plans for higher income wage earners have greater access to carriers and plans with broader networks. Plan designs in the exchange are sometimes much different than plans outside of the exchange. Many times, exchange plans have a more limited network, with the exclusion of expensive hospital systems.
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For more information regarding this coverage, email
or call 800-944-7550.