The few things we know about Missouri's health insurance marketplace

Mar 20, 2013

This is the second in a two-part discussion about health literacy and the healthcare reform.  

Not knowing what the online health insurance marketplace looks like might be problematic for Missourians. 

As part of the Affordable Care Act, Missouri’s uninsured can choose to buy insurance from the state’s health exchange come October. The exchange is an online marketplace where anyone who isn’t already insured will be able to compare and purchase private insurance plans. Some uninsured Missourians would be eligible for help with the cost, too.  

Missouri has missed the deadline to create its own marketplace or start a state-federal partnership. So, the federal government is setting it up. The problem is, even though the marketplace is supposed to be open for enrollment in about six months, no one knows what it looks like yet.

“We’re losing time that could be useful in helping people understand and prepare [for the exchange],” said Catina O’Leary, the director of Health Literacy Missouri, a nonprofit group that’s working to make health care topics more understandable for Missourians. “It would be really great if we could manage people’s expectations and start training on what they’re going to need to know.”

But here's what we know so far: 

Missouri’s health insurance marketplace will be run by the federal government. It’s unclear where the federal government is currently at in the process of creating the marketplace for Missouri, but regardless of what happens, that online marketplace will be open for enrollment by October.

In November, Missouri voters passed Proposition E, effectively enacting a law that limits the state government’s ability to help the federal government with creating the marketplace.

To see the entire history of Missouri’s health insurance marketplace’s complicated relationship with the federal government, read this roundup from our friends at KCUR.

Who’s eligible to buy insurance in the marketplace?

According to the Department of Health and Human Services, you can buy insurance through the health insurance marketplace if:

·         You live in the U.S.

·         You are a U.S. citizen or national (or lawfully present)

·         You aren’t currently incarcerated

Small businesses (fewer than 100 employees) can also purchase insurance through the exchange.

If you're already insured, you can keep your plan. The Congressional Budget Office expects the health exchange to provide insurance for 26 millions Americans by 2022. 

Can people get help with premium costs?

Yes! If you make between one or four times the federal poverty level, you’ll be eligible for tax credits on a sliding fee scale. The less you make, the less you’ll have to pay for a premium. If your family’s income is at the federal poverty level ($23,500 for a family of four), you’ll only have to pay 2 percent of your total income for an insurance premium. Check out our nifty graphic about how many Missourians could be eligible for this subsidy, and more details about different levels of the tax credit.

In Missouri, about 851,000 people are uninsured. About half of that group will be eligible for these tax credits through the marketplace.

Credit Libby Burns / KBIA

What does an application to the marketplace looks like?

There’s no final draft yet. The Center for Medicaid and Medicare Services recently made public an early draft of the general application for anyone looking to get financial support to with their premiums.

As The Associated Press reports, the draft of the paper application for a family of three is about 15 pages. An online version has 21 steps. The Department of Health and Human Services estimates it will receive more than 4.3 million applications for financial assistance in 2014, with online applications accounting for about 80 percent of them.

What does an online health insurance marketplace looks like?

We don’t know how Missouri’s marketplace would look yet, but some other states that chose to run their own exchange already have websites up and running. It might be helpful to visit these websites to have an idea of what Missouri’s marketplace might look like.

Generally, these websites look pretty consumer-friendly. Covered California, for example, has a cost estimate calculator. It also has tables of benefits summary for exemplary health plans.  

The federal government requires state health marketplaces to have four levels of coverage: bronze, silver, gold and premium. Each level will also have different plans for people to choose from, most likely from several different private insurers, as well.  

Who can help me with the marketplace?

The Affordable Care Act requires every state’s health insurance marketplace to have navigators – those who are trained to help and educate people as they make their way through the exchange and get to the correct insurance plan. Nonprofits, trade associations and unions are expected to be potential navigators, among others.

The federal government is running Missouri’s exchange, so they’re also responsible to establish a program that would give grant money to possible navigators. It's not clear when the feds are going to start giving grants yet in Missouri.  

To illustrate the importance of navigators: According to The Washington Post, California plans to hire 21,000 “in-person assistors” that would help more than 700,000 people get insurance coverage under the health insurance marketplace.

Our neighbor Arkansas plans to hire 535 assistors. The state’s director of planning for the exchange told The Washington Post:

“Our population has a lot of uninsured, not a lot of Internet use, and is very rural and very diverse,” Crone said. “We felt like we couldn’t wait.”

What can we do to get ready?

The Department of Health and Human Services has this to say:

1.       Learn about different types of health insurance. Through the Marketplace, you’ll be able to choose a health plan that gives you the right balance of costs and coverage.

2.      Make a list of questions you have before it’s time to choose your health plan. For example, “Can I stay with my current doctor?” or “Will this plan cover my health costs when I’m traveling?”

3.      Make sure you understand how insurance works, including deductibles, out-of-pocket maximums, copayments, etc. You’ll want to consider these details while you’re shopping around. Visit Insurance Basics to learn more about how insurance works.

4.      Start gathering basic information about your household income. Most people will qualify to get a break on costs, and you’ll need income information to find out how much you’re eligible for.

5.      Set your budget. There will be different types of health plans to meet a variety of needs and budgets, and breaking them down by cost can help narrow your choices.

6.      Find out from your employer whether they plan to offer health insurance, especially if you work for a small business.

7.      Explore current options. You may be able to get help with insurance now, through existing programs or changes that are in effect already from the new health care law. Use our resources to get information about health insurance for adults up to age 26, children in families with limited incomes (CHIP), and Medicare for people who are over 65 or have disabilities.

If you’re a small business owner, click here for the Department of Health and Human Services's checklist of what you can do to get ready for enrollment in October.