About the Health Insurance Law

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The federal health law was created to:

  • Make it easier and more affordable for Americans to get quality health insurance.
  • Improve the quality of health insurance and health care.
  • Increase the focus on preventive care.

For Individuals & Families

If you are uninsured or do not have access to insurance through your job, you can enroll in the Missouri Health Insurance Marketplace. It is an online marketplace where you can buy a Qualified Health Plan (, and in Missouri) or coverage from private insurance companies.

for 2019 health coverage is Nov. 1 through Dec. 15, 2018. If you experience a major life event before or after open enrollment, you may qualify for a .

Find the plans that will cost you least, offer top-quality care and service, and will let you use the doctors and hospitals you want: Use our tool to quickly compare all plans and prices for individuals and families.

Do I have to have health insurance?

Starting in 2019, it is not required to have health insurance. If you did not have insurance in 2018, you may have to pay a penalty. The penalty is either a flat rate or a percentage of income – whichever is the larger amount. The exact amount depends on your family size.
But, there are some exemptions. Learn more about the penalty here.

What if I do not have insurance?

For people without health insurance, the Missouri Health Insurance Marketplace is a website where you can compare and buy a Qualified Health Plan from private insurance companies. You can get information here, by phone, or in person. Individuals can call 1-800-318-2596 (TTY: 1-855-889-4325). Find in-person help here.

What if I cannot afford health insurance?

You may be able to get financial help if you cannot afford to buy health insurance. Small businesses may also be able to get help buying health insurance for employees.

Depending on how much money you make, you may be eligible for:

  • s that help lower the cost of your monthly health insurance premiums.
  • s that help you pay for costs when you see the doctor or get other health care services.

If you cannot afford health insurance, you may qualify for Medicaid. Medicaid is a public health insurance program for people with very low income.

If you have a hard time paying for health insurance and have kids, they may qualify for the Children’s Health Insurance Program (). CHIP is a public health insurance program for kids with family income above limits.

Some people may not be able to afford health insurance but find they do not qualify for Medicaid or financial help through the Missouri Marketplace. If this applies to you or your family, you may not be required to buy health insurance.

Learn more about financial help here.

For Small Businesses

As a owner, you have access to Small Business Health Options Program (SHOP) health insurance plans. Small businesses should call 1-800-706-7893 (TTY: 711) or visit www.healthcare.gov/small-businesses/ for more information.

Affordable and minimum value coverage

Employers who offer insurance may be subject to penalties if the coverage they offer is not considered affordable or does not provide a minimum level of coverage. To be considered affordable coverage, a worker’s share of premiums should be less than 9.5% of their pay. For example, if a worker is paid $35,000 a year, his or her share of premiums for individual coverage should be less than $3,325 for the year.

For coverage to meet the minimum value requirement, it should have an actuarial value of 60%. For example, if a covered health service costs $100, the health plan would pay $60 and the worker would be responsible for paying $40.

Bronze health plan

A bronze health plan is one of four types of health plans you can buy in the Health Insurance Marketplace. Bronze plans usually have lower monthly costs, but higher out-of-pockets. They usually cover about 60 percent of your health plan costs. You would have to pay the other 40 percent.

Silver health plan

A silver health plan is one of the four types of health plans you can buy in the Health Insurance Marketplace. Silver plans usually have lower monthly costs, but higher out-of-pockets. They general cover 70 percent of your health plan costs. You would have to pay the other 30 percent.

Gold health plan

A gold health plan is one of four types of health plans you can buy in the Health Insurance Marketplace. Gold plans usually have higher monthly costs, but lower out-of-pockets. They usually cover about 80 percent of your health plan costs. You would have to pay the other 20 percent.

Catastrophic coverage or plan

An insurance plan in the Health Insurance Marketplace that offers limited coverage for health care services. This plan is only available to adults under age 30 or adults who get a hardship waiver. Rules for qualifying for Catastrophic coverage are shown at www.healthcare.gov.

Open enrollment period

Open enrollment is a time period, usually a few months, when you can choose or change your health insurance plan. Open enrollment often happens in the fall with changes to the coverage starting in January. If you have a major life change, like getting married, having a baby, or losing your job, you may be able to change your health insurance outside of the open enrollment period.

The Open Enrollment Period for 2019 Marketplace health coverage is November 1 – December 15, 2018.

Job-based health insurance plans and Medicare have their own open enrollment periods where you can add family members who may have been covered by a different insurance plan the year before.

Special enrollment period

A period of time outside of Open Enrollment when some people can enroll in an insurance plan, or change their insurance plan, in the Marketplace. In general, you may get a Special Enrollment Period when you have a qualifying life event.

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.

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.

Children’s Health Insurance Program

The Children’s Health Insurance Program (CHIP) is public health insurance for children. CHIP covers children in families who may not have access to other health insurance coverage and have family income above the Medicaid eligibility level. In Missouri, this program is called MO HealthNet.

Medicaid

A government health insurance program for Americans who have low incomes or disabilities. In Missouri, this program is called “MO HealthNet” for adults, and “MO HealthNet for Kids” for children up to age 19.

Small business

Under the Affordable Care Act, a small business is a for-profit or nonprofit business with 50 or fewer full-time equivalent employees.