Financial Help for Individuals & Families

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If you use the Missouri Health Insurance Marketplace, you may be able to save money through s and s. This financial help uses a so families making less money pay a smaller portion of their income for health insurance and health care.

When you fill out your Marketplace application, you will find out if you can get financial help and how much you can save.

The Open Enrollment Period for 2019 health coverage is Nov. 1 through Dec. 15, 2018. However, if you experience a major life change before or after open enrollment, you may qualify for a Special Enrollment Period to enroll in Marketplace coverage. Click here to find out more.

Premium Tax Credits

Premium tax credits can lower the amount you pay for your health insurance plan. The value of the tax credit depends on how much money you make and how many people are in your family. In general, the less money you make, the larger your tax credit will be. This amount can go up or down based on changes in your job status, size of your family, or marital status. There are two ways to use the tax credit to lower your s:

  1. Take it now: This allows you to lower your premiums every month. You can choose to take your tax credit in advance. Your tax credit will be paid directly to your insurance plan on a monthly basis. When you file your taxes, you will report that you already used your tax credit.
  2. Take it later: If you choose this option, you will pay your full premium each month. When you file your taxes, you will subtract your premium tax credit from any taxes you owe. If you do not owe taxes, you will get a bigger refund.

Your family size is based on the number of people that will be on your 2018 federal income tax return. If you do not file taxes, count the number of people who live with you. This includes your spouse, kids, other s, and yourself.

Cost-Sharing Reductions

Cost-sharing reductions – sometimes called subsidies – is money the government pays to help cover health care costs for people who qualify. People who qualify, in general, are those who enroll in a Marketplace Silver plan and have a yearly income that is from 100 percent to 250 percent of the Federal Poverty Level (). These are different from premiums and include things like s, , and s. Some people can get BOTH tax credits and cost-sharing reductions.

Qualifying for Medicaid

Missouri’s Medicaid program, called MO HealthNet, covers very low-income people. Whether or not you qualify depends on how much money you make and how many people are in your family. Children, their parents, people with disabilities, and people age 65 or older are covered by Medicaid at different income levels. See the charts below.

Covered Populations Income Guidelines
Children (up to age 19) Up to 300% of the Federal Poverty Level () (meaning at or up to three times as much as the FPL).
Parents Up to about 18% of the FPL(meaning at or up to 0.18 times as much as the FPL).
Pregnant women Up to 185% of the FPL (meaning at or up to 1.85 times as much as the FPL).
Disabled individuals Up to 85% of the FPL (meaning at or up to 0.85 times as much as the FPL).
Missourians (age 65 and over) Up to 85% of the FPL (meaning at or up to 0.85 times as much as the FPL).
Blind individuals Up to 100% of the FPL (meaning up to as much as the FPL).
Qualified Medicare beneficiaries Up to 100% of the FPL (meaning up to as much as the FPL).
Family size 2017 federal poverty level

(100%-400%)                          (250%)

1 $12,140 – $48,560 $30,350 or less
2 $16,460 – $65,840 $41,150 or less
3 $20,780 – $83,120 $51,950 or less
4 $25,100 – $100,400 $62,750 or less

You may have heard talk about whether or not to expand Medicaid to cover more people. Each state can choose whether or not to expand their Medicaid program to cover people making up to 133% (meaning 1.33 times the FPL amount) of the federal poverty level. At this time, Missouri has not chosen to expand Medicaid, but our state elected officials are continuing to have this conversation.Note: Income guidelines for parents are based on the July 1996 Aid for Families with Dependent Children (AFDC) payment standard.

If you make less than 133% of the federal poverty level (1.33 times the FPL amount) and do not qualify for MO HealthNet now, you will not have to pay a penalty if you do not have health insurance in 2018.

If you need more help figuring out if you can get financial help or qualify for Medicaid, visit the Missouri Health Insurance Marketplace or call 1-800-318-2596 (TTY: 1-855-889-4325). If you want help in person, click here to find a location near you.

Family Glitch

You may have heard about something called the “family glitch” in the health law. The law requires employers to provide “affordable” insurance only for the workers themselves – not for their families. The family glitch is a regulation that keeps children and some adults from obtaining Marketplace coverage and tax credits if one parent has affordable employer coverage that is deemed “affordable”, even if family coverage is not affordable.

Legislation has been introduced to try and fix this glitch. To learn about coverage options for those who might be affected by the glitch, view this handout from Community Catalyst.

Premium tax credit

Money the government pays to help cover monthly premium payments for people who qualify. People who qualify, in general, are those who enroll in a Marketplace plan and have a yearly income that is between 100 percent and 400 percent of the Federal Poverty Level (FPL). Other rules for qualifying for tax credits are shown at www.healthcare.gov. To see how much you could save, use the calculator.

Cost-sharing reduction

Money the government pays to help cover out-of-pocket health care costs for people who qualify. People who qualify, in general, are those who enroll in a Marketplace Silver plan and have a yearly income that is from 100 percent to 250 percent of the Federal Poverty Level (FPL). Other rules for qualifying for cost-sharing reductions are shown at www.healthcare.gov.

Sliding scale

Sliding scales are used to set prices or costs based on your ability to pay. For example, premium tax credits in the Missouri Health Insurance Marketplace are based on a sliding scale. That means the tax credit is larger for people with lower incomes and smaller for people with higher incomes.

Premium

A premium is the cost of your health insurance. Premiums may be paid by you, your employer, or both. It is usually paid monthly or every three months. Or, it can be paid all at once for the whole year.

Dependent

A child or other person who you claim on your taxes for a personal exemption tax deduction.

Out-of-pocket

Money that you pay for health care services yourself, out of your own pocket. These costs include deductibles, copayments and coinsurance. They do not include monthly premiums.

Federal poverty level (FPL)

A measurement of how much a person or family needs to earn so they can pay for food, clothing, housing and other necessary things. The government decides what the FPL is for each year.

For example, in 2016 the FPL was set at $11,880 for one person and $24,300 for a family of 4 people.

Deductible

The amount you must pay for your covered health care services each year – for example, $1,000 – before your insurance plan will begin sharing the cost with you (see “coinsurance”).

Coinsurance

Your share of the cost for health care services, after you have paid your deductible amount each year. For example, if you go for a doctor visit that costs $100, your share may be $20 and your insurance plan’s share may be the remaining $80.

Co-payment/Co-pay

A fixed amount you may pay at the time you receive a health care service – for example, you may pay $15 when you go for a doctor visit.

Federal poverty level (FPL)

A measurement of how much a person or family needs to earn so they can pay for food, clothing, housing and other necessary things. The government decides what the FPL is for each year.

For example, in 2016 the FPL was set at $11,880 for one person and $24,300 for a family of 4 people.