If you do not have access to quality health insurance at an affordable cost, you may be eligible for an exemption from the penalty for not having health insurance. Other circumstances may qualify you or your family members for an exemption. Click here for more information.

 

How does insurance work?

 

Some plans may also include more benefits than what they are required by law. Insurance companies cannot put lifetime limits on essential health benefits, but they can still place limits on nonessential benefits. For example, your health plan can limit how much it will cover for dental care each year or over your lifetime because dental care for adults is not an essential benefit.

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• Premiums - A premium is a set amount you pay for your health insurance plan, usually paid every month. You pay your premiums even if you don't receive medical care for that month. 

• Deductibles - A deductible is the amount of money you pay for health care service before your insurance plan will begin to pay for the covered health services. For example, if your health insurance plan has a $1,000 deductible you must pay $1,000 for medical care before your insurance starts paying. A deductible may not apply to all health services, such as preventive care. 

 

What to bring to an enrollment appointment?

 

To see if you qualify for help paying for your health insurance, you will need accurate personal-identifying income information for you, and for all members of your tax household, regardless of whether they are applying for insurance.

 

To get the most out of your appointment, please bring all of the following that applies to you, and to any and all members of your tax household:

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• Social Security numbers – just the numbers, not the cards

• Copies of Legal Resident documents

• W-2 forms, work pay stubs (the two most recent, from all jobs), and/or a tax return from the previous year

• Also bring any of these if they apply to you, or to any member of your tax household:

  • A Social Security income statement

  • An unemployment letter

  • The amount of interest being paid on student loans

  • The amount of alimony being paid

 

Your Certified Marketplace Navigator will also need to know about any of the following:

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• Profits from stocks or real estate sales

• Early withdrawals from retirement or 401K funds

• Winnings from the lottery, and/or from any casino, either domestic or abroad

• The cash value of bartered items

 

During your appointment, an online Health Insurance Marketplace account may be created for you. As part of that process, you’ll be asked to login to your email account, so you’ll need to know both your username and password. If you don’t have an email account, don’t worry; one can be created for you.

 

If you already have an online Health Insurance Marketplace account, be prepared to supply your username and password at your enrollment appointment. If you don’t remember your login information, contact the Marketplace at 1 (800) 318-2596 for assistance prior to your appointment.

 

What are some good resources?

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• CoverMissouri.org: a project of the Missouri Foundation for Health (MFH) to promote quality, affordable health coverage for every Missourian.

• Our Frequently Asked Questions flyer.

• HealthCare.gov: information available in multiple languages on the Health Insurance Marketplace, Small Business Health Insurance Options Program (SHOP), Medicaid, Medicare, the Children’s Health Insurance Program (CHIP), fees, and exemptions.

• mydss.mo.gov:  If you are interested in information regarding Medicaid and what benefits you may qualify for.