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Plans and Networks
If you are in Missouri and you need to have healthcare coverage through Obamacare, you want to know the different plans, networks, and providers that are available. If you don’t have a plan currently, though, you will not be able to get one until the next open enrollment period unless you qualify for Special Enrollment. Only those who have a qualifying event, such as giving birth or getting married, will be able to qualify. However, Native Americans are able to enroll at any time of the year. When you start to look at your options during the next open enrollment, though, you will find that you have quite a few things to consider with Obamacare in Missouri.
Understanding the Plan Levels
When you start to look at the various options, you will notice that the plans are separated into different levels based on precious metals. There is bronze, silver, gold, and platinum tiers and a number of plans within those tiers from the different providers. The plans that are in the bronze tier will have the lowest monthly premiums and the highest out of pocket expenses. These types of plans are often a good idea for those who are in good health and who do not need to visit the doctor very often over the course of the year.
At the opposite end are the platinum plans. With these plans, the cost for the out of pocket expenses is much lower. They will cover around 90% of the costs. However, the monthly premiums that you have to pay for the coverage will be much higher. For those who have health issues and who are visiting the doctor often, the platinum plans are generally the best option.
For those Missouri residents who are under 30, there is also the catastrophic plan. This is a low cost option that will be useful for emergencies. They have lower monthly premiums, but the out of pocket costs are high. This plan, along with all of the plans in the various metal tiers will have the essential benefits included, although some of the higher level and more expensive plans may have additional benefits.
What Are the Essential Benefits?
The essential benefits included with all of the plans feature a number of services as mandated by Obamacare. Missouri residents can expect outpatient care, emergency services, treatment in the hospital, maternity and newborn care, addiction treatment and mental health services, prescription drugs, rehabilitative services and devices, pediatric care, preventative services and lab services for the essential benefits.
Which Providers Are Available?
Depending on where you live in Missouri, the providers available can vary. Across the state, there are six companies offering Obamacare coverage. These include All Savers (United Healthcare), Blue Cross Blue Shield of Kansas City, Cigna, Coventry, Healthy Alliance Life, and Humana.
When it comes time to choose your plan, or at the end of the year when you can choose another plan, it is important to check and see what everyone is offering. You need to find the plan that will work the best for you and your family.
Missouri uses the federal exchange system, so you can find the plans from which to choose through Healthcare.gov. When you first start looking at the different options and plans, and you are trying to figure out just what you need to do in order to comply with Obamacare, it can be confusing. Missouri residents who are trying to make their way through the Obamacare system should take some time to familiarize themselves with the basics first.
Open Enrollment and Special Enrollment
One of the first things you need to be aware of is the open enrollment period. This is the only time during the year that you can enroll in Obamacare unless you qualify for special enrollment. Open enrollment for 2016 was from November 1, 2015 to January 31, 2016. It is closed until November, 2017. If you aren’t already enrolled with Obamacare, you have to wait, unless you qualify for special enrollment.
Special enrollment is allowed for those who have qualifying events in their lives. If they moved to Missouri from another state, they could qualify. You can also qualify if you got married, divorced, had a child, or adopted a child. You will then have 60 days from the date of the qualifying event to find your coverage. Native Americans are allowed to enroll at any time of the year.
The Types of Plans and the Providers
When it comes time to enroll, you need to learn a bit about the different types of plans that are available. First, you will note that the plans are separated into different tiers named after precious metals. They include bronze, silver, gold, and platinum. The plans that fall into the bronze tier will have low monthly premiums, but they will have high out of pocket expenses for copays and deductibles. As you go through the other metals to the platinum tier, the cost of the monthly premiums increases, but the out of pocket costs decrease. Platinum plans will pay for 90% of the out of pocket costs.
For Obamacare in Missouri, there are six different providers from which you can choose. They include All Savers (United Healthcare), Blue Cross Blue Shield of Kansas City, Cigna, Coventry, Healthy Alliance Life, and Humana. All of the plans include the essential benefits, as mandated by Obamacare. The essential benefits are outpatient care, emergency services, hospital treatment, maternity and newborn care, addiction treatment and mental health services, prescription drugs, rehabilitative services and devices, pediatric care, preventative services and laboratory services.
Paying for Coverage and Renewing
After you find a plan that will provide you with the coverage you need, and that you can afford, you need to fill out the application and enroll. You will then pay the insurance company the required premium each month. You might qualify for tax subsidies that can help to reduce the amount you have to pay on your monthly premiums, or you can apply them to your taxes at the end of the year.
When it comes to renewing the Obamacare plan, you will not usually have to do anything. If there are any changes to the plan, or if the plan is being cancelled, the insurance company will let you know. Even though most renewals are automatic, you should still check other options during open enrollment just to see if you can find a better deal.
One of the biggest questions and concerns that Missouri residents were asking when they learned that Obamacare was to become the law of the land was how they were supposed to pay for coverage. The reason that so many people didn’t have coverage in the past was not because they thought it was a bad idea. The reason they didn’t have it was because they did not feel they could afford it. They already had all of their other bills to take care of. Now, with the addition of Obamacare in Missouri, it is going to cost them even more money just to make it through the year. Fortunately, there are several different types of financial assistance that could help.
Use the Tax Subsidies
One of the best ways to help make your Obamacare more affordable in Missouri is to make use of the tax subsidies. 87% of the people who have Obamacare plans are able to qualify for these subsidies. When you fill out your application, you will find out how much you are eligible to receive, and then you can choose how you want to use them. Many people choose to use the subsidies immediately, as this can help to lower the amount of money they have to pay for their monthly premiums. Others choose to save the subsidy until the end of the year, and then they apply it to their taxes. This can lower the amount they owe, or increase their return if they don’t owe taxes.
You May Qualify for Medicaid
It is true that Missouri is one of the states that decided not to expand Medicaid. This means that there is something of a gap between the people who can qualify for Medicaid and those who can afford Obamacare coverage. It’s unfortunate, but some may fall into this gap and not be able to get the coverage they need. However, when you go through the exchange to look for affordable plans, they will let you know if you can qualify for Medicaid. Those who have disabilities, who are blind, over the age of 65, are pregnant, or are the caretaker of a child in their home can qualify.
There are also income requirements. For an individual, you would have to make less than $11,700 a year to qualify. For a family of two, the amount is $15,930, a family of three is $20,090, and a family of four is $24,250.
The Mo HealthNet for Kids
The Department of Social Services in Missouri has developed MO HealthNet for Kids, a program that allows children to have full, comprehensive coverage. It will include primary care coverage, acute and preventative care, vision, dental, hospital care, and coverage for prescriptions. Many who are having financial trouble and who can’t afford healthcare for their children can apply for the program. This ensures that the smallest residents in Missouri still get the coverage they need.
As you can see, there are still several ways that you can get the coverage you need without completely breaking the bank.
Common Mistakes on the Application Process
You can’t simply opt out of Obamacare, and that means you will eventually need to fill out an application to get your coverage. If you are without coverage right now, you will have to wait until the next open enrollment period, which starts in November of 2017. Some people may be able to qualify for special enrollment. Those who have a life event that qualifies them, such as having a child, moving to the state, or getting married or divorced, will find that they can qualify for 60-day open enrollment period where they can choose and sign up for their plan.
No matter when you sign up for your plan, you need to make sure that you do so carefully and that you fill out all parts of the application. This will make the entire process easier. The application isn’t too difficult to fill out, but there are still a number of mistakes that people are routinely making. You do not want to make any of these mistakes when filling out your application for Obamacare in Missouri.
Forgetting Parts of the Application
You should fill out all of the parts on the application. One of the biggest complaints from officials is that the applications are being turned in when they are only partially completed. If you forget important information on the application, it is going to cause delays, and you certainly do not want to miss the deadline. The current fines are $695 for an adult and $347.50 for a child without coverage.
Another one of the issues is putting the wrong information on the application form. You need to make sure that the names, birthdates, and Social Security numbers are all correct. You also need to make sure that your dependents and your spouse are in the right locations on the application. There have been a number of incidents where the person filling out the application has put their spouse in the dependents section inadvertently.
You should also keep in mind that just because your children are 18 or 21, it doesn’t mean they can’t be on your insurance. Under Obamacare, you are able to keep your children on your plan up until they are 26 years old.
Make Sure the Income Is Correct
You need to make sure that you fill out your income accurately on the application. They need to know your income so they can determine how much you will be able to receive in subsidies. The more you make, the less you will receive, but that doesn’t mean you should try to put a lower income on your application so you can get more subsidies. The IRS will find out, and they could make it so you are unable to get any subsidies in the future.
Always go through and double-check the information on your application to make sure it is filled out properly. In addition, make sure you turn the application in before the deadline. If you don’t, you will have to wait until the following year to get Obamacare in Missouri.
One of the big questions that people had when Obamacare first became law was what type of effect it might have on their taxes. They wanted to know if their taxes would be skyrocketing, and they wanted to know if it would be difficult to do their taxes at the end of the year. They also wanted to know how the government would know, and fine them, if they did not have coverage. Residents in Missouri with Obamacare will be happy to know that even though there may be some changes to how you do your taxes, they are easy to incorporate.
Understanding the Forms
Before it comes time to do the taxes, you will receive a letter in the mail. This form will provide you with the information that you need to include on your taxes, and depending on what type of coverage you have, the form will be different. The 1095-A form is the Healthcare Marketplace Statement, and those who have Obamacare will receive this form. The 1095-B is the Health coverage form that private insurance companies will send if you have coverage through them. 1095-C is the form that is for those who receive their coverage from their employer. It is called the Employer Provided Health Insurance Offer and Coverage form.
If you are expecting a 1095-B or 1095-C, you do not have to wait to do your taxes. However, those who are getting the 1095-A for Obamacare in Missouri will need to wait until they get the form. Once it arrives, they can fill out Form 8962, which you will send in with your taxes. You will then keep your 1095-A for your records
When you have Obamacare, it doesn’t generally complicate taxes too much for most people. It’s a single form that should be relatively easy to add to your returns, and it shouldn’t take up too much more time. Of course, some people have taxes that are quite a bit more complicated, and adding another form on top of everything else could get to be too much. In those cases, it might be a good idea to have a professional help you with your tax returns instead. Just supply them with the paperwork they need.
What If You Don’t Get Coverage?
If you do not have other coverage, and you do not get Obamacare in Missouri, the government will find out when you do your taxes. If they see that you do not have coverage, you will have to pay the fines. Those fines are currently $695 for adults and $347.50 for children who are under 18 and who do not have coverage. The penalties will be applied to your taxes, so you do not want to go without coverage, or you could end up owing the government.
If you do not file, or if you file late, you have to worry about more than just the fines. You also have to worry that the IRS might no longer allow you to use tax subsidies to help pay for the insurance. It’s the best practice to take care of your taxes right away.
Enrollment for Small Businesses and the Small Business Tax Credit
Many of the business owners in Missouri were concerned when they heard about Obamacare. Naturally, they wondered what it would mean for their business. If everyone was required to have coverage, they wanted to know if that meant they had to offer a healthcare plan. This caused quite a bit of ire amongst small business owners, but they may have gotten their hackles up too soon. Small businesses, those that have fewer than 50 employees, are not required to provide coverage for their employees.
Do You Need to Enroll?
However, they are required to make sure that all of their new employees know about Obamacare and what they need to do to sign up on their own. If you have fewer than 50 employees who are full time equivalent, then you don’t have to provide coverage. The law says that someone is considered a full time equivalent employee if they work an average of 30 hours a week or 130 hours in a month. It is important to keep in mind that an FTE employee doesn’t have to be just a single person. If you have two people working an average of 15 hours per week, they would qualify as one FTE employee.
Benefits of Enrolling
Even though you might not be required to offer coverage for your employees, it may still be something you want to consider. There are a number of benefits that offering health insurance can provide. First, it helps to keep your employees healthy and happy, and it can reduce the number of absences. It can also help to make them more productive. Many people are going to find that insurance is a good incentive to stay at the job as well, which means you could reduce the amount of turnover your company has.
If you are going to look further into enrolling, you will be able to go through the Small Business Health Options Program, or SHOP. This is an online marketplace that is similar to the personal marketplace. You can look at all of the different plans available and get an idea of how much it would cost to provide coverage. Keep in mind that you can’t pick and choose whom you offer coverage to in your company. If you offer it to one employee, you have to offer it to all of them.
You can go through SHOP for your plans if you have fewer than 25 employees and if you are paying at least half of their premiums (35% for nonprofits). In addition, the average wages need to be less than $50,000. If you qualify, then you may be able to use the small business tax credits, which will help to reduce the amount that you are actually paying for your employees’ coverage.
If you are on the fence about offering coverage, think about all of the benefits it can provide to your employees, and consider the tax benefits. Start shopping for a plan to look at the options that are out there.
Unique Aspects of Obamacare in Missouri
Those who are residing in Missouri and who need to have Obamacare health coverage will find that there are quite a few similarities between coverage in this state and in many other states around the country. If you need to have coverage for 2016, you are not going to be able to get it, though. The open enrollment period has ended, and that means you will have to wait until the next open enrollment, which starts in November, to get coverage through Obamacare in Missouri. If you have a qualifying life event, such as getting married or having a child, there is the possibility of getting special enrollment.
No Medicaid Expansion
One of the things you will notice right away is that many states in the country decided to expand their Medicaid program to make sure there were no people who fell between the gap – not being able to afford healthcare and not qualifying for Medicaid. However, Missouri was not one of those states. They do not have expanded Medicaid, and it can be more difficult for some people in the state to get the coverage they need. Fortunately, there are some ways to help lower the amount that you have to pay, namely through the use of tax subsidies. Around 87% of the people enrolled are able to get subsidies, so you may qualify.
Missouri has fewer health insurance providers than a number of the other states as well. There are currently six companies providing insurance in the state. However, not all of the companies are available in all counties. When you sign up, you will discover which ones are available in your area. The available providers in the state include All Savers (United Healthcare), Blue Cross Blue Shield of Kansas City, Cigna, Coventry, Healthy Alliance Life, and Humana. All but one of these carriers has an increase in rates this year. The only one that has decreased in the cost of rates is Cigna, and they have dropped by an average of 2.02%.
Missouri is one of only five states in the country that has the review process conducted by the Center for Consumer Information and Insurance Oversight to ensure that plans are compliant with the Affordable Care Act. The state regulators do not review or approve/deny the rate changes.
All Plans Have at Least the Essential Benefits
One of the great things about Obamacare is the fact that all of the plans that are available now have the essential benefits are part of the package. These include outpatient care, emergency services, treatment in the hospital, maternity and newborn care, addiction treatment and mental health services, prescription drugs, rehabilitative services and devices, pediatric care, preventative services and lab services. Of course, some plans offer much more than this, and the actual amount you will have to pay for services depends on the plan level that you have.
There are a number of things to consider when you are looking for your insurance plan. Always make sure you have a plan that covers what you need and that is affordable for you.
What’s New for 2016
If you are new to Obamacare and only got your plan this year, or if you have to wait until the next open enrollment period, you probably want to know what’s new with the plans and the prices. While the system is much the same as it was last year, there have been some changes to note, particularly in the prices.
Thus far, the system has proven to be popular in Missouri. In 2016, 290,201 residents of the state enrolled in plans through the exchange. Around 40% of the enrollees were new to the system this year, and the rest were renewing coverage or changing their plans from the previous year. One of the reasons that so many people have signed up is because they do not want to have to pay the penalty for not having coverage. The current penalty for adults without coverage is $695 or 2.5% of their income, whichever is higher. The penalty for children without coverage is $347.50.
A Large Number of People in Missouri Are Still Using Subsidies
The tax subsidies were introduced with Obamacare, and many Missouri residents have been taking advantage of this so they can pay for their healthcare. Currently, 87% of the people who enrolled in Obamacare plans through the exchange are using such subsidies.
The Providers and the Rates
There are currently six different carriers offering Obamacare plans in Missouri. They include All Savers (United Healthcare), Blue Cross Blue Shield of Kansas City, Cigna, Coventry, Healthy Alliance Life, and Humana. This is the same as last year, but it is increased from 2014. Something to note is that all but one of the providers have increased their rates this year. All Savers have increased the rate of their premiums by an average of 9.9%, while the increase for Blue Cross Blue Shield of Kansas City has been between 8% and 12%. Coventry has some very substantial increases – between 20% and 30%. Healthy Alliance Life is increased by nearly 10%. Humana has an increase of 14.81%. Cigna is the only company that has decreased their rates this year. Their average decrease is 2.01%.
Regardless of the plan you choose, it will contain all of the essential benefits as mandated by Obamacare. These include ambulatory care, emergency services, hospital care, maternity and newborn care, addiction treatment and mental health services, prescription drugs, rehabilitative services and devices, pediatric care, preventative services and lab services.
In early 2016, there was legislation introduced that would “allow for more broad use of gatekeepers in managed care plans.” This would mean that the health plan could then require their members to first see a primary care physician in order to get a referral to a specialist. This potential law is still being debated, and many feel that the language is too broad and that it could limit the patient’s rights even when using out of network benefits. It is currently unclear what will happen with the legislation going forward.
It is a good idea for residents to keep an eye out for changes that may affect the 2017 year for Obamacare as well.
Obamacare Fact Sheet
People who live in Missouri know that Obamacare is now law and that they are required to get coverage unless they want to pay hefty fines. However, many people do not know the details of the system beyond this, and that is often how misinformation spreads. It is important to understand the system and to know how it can affect you. The following are some of the most important facts that you have to know regarding coverage.
If You Don’t Have Coverage You Have to Pay Penalties
There is no longer a choice of whether to get health coverage or not. This doesn’t mean you have to go through the Obamacare exchange though. It is possible to have insurance through your employer, Medicaid, or through a company that’s not part of the exchange, for example. There are also some individuals who are exempt from getting coverage including those who do so on religious grounds, as well as Native Americans. For everyone else, though, you need coverage, and there is a good chance you will be getting that coverage through the Obamacare exchange in Missouri.
Those who do not have coverage will have to pay a penalty to the IRS. The current fines are $693 for an adult that does not have coverage (or 2.5% of their income – whichever is highest), and $347.50 for children who do not have coverage.
The Open Enrollment Period
You can’t enroll in Obamacare whenever you want. You need to make sure you are enrolling during the open enrollment period. The 2016 period is over, but it will open again in November of 2017. If you didn’t make the open enrollment this year, you will have to wait until the next year unless you qualify for special enrollment. Not everyone is going to qualify. You need to have some type of qualifying event in your life, such as getting married or having a child, in order to get the 60-day special enrollment period.
Obamacare has brought with it quite a bit of change to the health insurance industry. One of the best is the fact that the insurance companies are no longer allowed to deny coverage if you have a preexisting condition. The companies are not allowed to increase the cost of insurance for those patients either. This means that many people who were having a difficult time finding affordable coverage in the past are now able to get the coverage they need.
Another one of the nice benefits is the fact that many people are able to qualify for tax subsidies. 87% of the people on Obamacare in Missouri are getting subsidies that help to make it much easier for them to afford the cost of coverage. All of the plans, regardless of the levels, include the essential benefits – outpatient care, emergency services, hospitalization, maternity and newborn care, mental health services and addiction treatment, rehabilitative devices and services, prescription drugs, lab services, preventative services, and pediatric services.
By understanding the facts about Obamacare in Missouri, you can understand just how it will affect your life.
Cons and Pros of MO Obamacare
No matter what you think about Obamacare, good or bad, it is now the law. Everyone needs to have health insurance coverage, and this has caused many people to bring up the cons of the system. Of course, it has caused people on the other side of the fence to point out all of the good things that Obamacare is able to provide. Missouri residents should take the time to look at both the pros and the cons so they can make up their own mind about the new healthcare system, and so they can have a better idea of what it will mean for them.
The Cons of Missouri Obamacare
First, let’s look at some of the elements that people think are the biggest cons of Obamacare. One that is most often brought up is simply the fact that people dislike being told by the government that they are required to do something. People do not like feeling as though they are forced into healthcare, even if they think having coverage is a good idea. They also do not like the fact that the fines for not having coverage are getting more expensive. The fines are now $695 per person, or 2.5% of their income, whichever is higher. For children, the penalty is $347.50.
Another one of the things that people do not like about Obamacare is the limited open enrollment window. You are only allowed to sign up for a couple of months out of the year. It generally starts in November and lasts through the end of January. If people do not sign up at that time, they have to wait until the following year. If they don’t get coverage from their employer or through another company in the meantime, they will have to pay the fines.
The Pros of Obamacare
Of course, there are also a number of great things about Obamacare, and many believe that the pros far outweigh the cons. For example, insurance companies can’t deny someone coverage just because they have a preexisting condition. They can’t charge people more for coverage either. If someone develops a condition while they have coverage, they can’t hike up the rates for that individual. This means many people who were not able to afford coverage before – the people who really need it – are now able to get it. Kids can stay on their parent’s insurance until they are 26 years old as well.
With the introduction of tax subsidies, it makes the insurance more affordable as well. You can use the subsidies to help lower the amount of your monthly premiums, or you could use them to reduce the amount of taxes that you owe at the end of the year.
As you can see, there are a number of good things that have come from the introduction of Obamacare. It’s now the law, and it’s a good idea to focus on the pros as much as possible and to find a good plan that’s right for you and your family during the open enrollment.
How much do you know about Obamacare beyond just what you hear on the news and from your peers? Although Obamacare has been the law for several years, many Missouri residents still have quite a few questions about how the system works and what it means for them. Here are some of the most frequently asked questions, along with answers, about Obamacare for residents in Missouri.
Do I Need Coverage Through Obamacare in Missouri?
You need to have health coverage, but that doesn’t mean you need to go through the exchange to get it. For example, you may qualify for Medicaid, which would satisfy the Obamacare requirement. You might have coverage from an employer as well, and this would mean you don’t need to go through Obamacare for your coverage. However, you do need to have some type of coverage. If you don’t, then you will have to pay a fine. The current fine is $695 for an adult without coverage (or 2.5% of their income, whichever is higher). For children without coverage, the cost of the fine is $347.50.
If I Have a Preexisting Condition, Can I Get Coverage?
This is a very common question, and fortunately, the answer is a good one. Today, the insurance companies are not allowed to deny providing coverage just because someone has a preexisting condition. They can’t stop giving you coverage or increase your rates if you develop a condition.
Who Provides Coverage?
In Missouri, Obamacare plans through the exchange are available through six different companies. Depending on where you live in the state, not all of these carriers will be available to you. Current carriers in the state include All Savers (United Healthcare), Blue Cross Blue Shield of Kansas City, Cigna, Coventry, Healthy Alliance Life, and Humana.
What Are the Tiers?
When you start to look for plans, you will notice that they are separated into four different tiers based on precious metals. In the bronze tier, you will find plans that have low premiums, but they have high out of pocket costs for deductibles and copays. The silver plans are a very popular option. They have relatively low cost premiums, and they have lower out of pocket expenses than the bronze plans. The gold plans have higher monthly premiums, but they cover more of the out of pocket expenses. The plans that are in the platinum tier have the highest monthly premiums, but they will pay for 90% of the out of pocket expenses.
What are the Essential Benefits?
All of the plans, no matter the provider and tier, will contain at least the essential benefits required by Obamacare. The essential benefits are ambulatory patient services, treatments in the hospital, emergency services, pediatric care, lab services, maternity and newborn care, mental health services and addiction treatment, prescription drugs, rehab services and devices, and preventative services.
These are some of the most commonly asked questions about Obamacare. Now that you have the answers, you can start looking for a plan to choose during the next open enrollment period.