Availability of short-term health insurance in Missouri

Yes. As of 2024, at least eight insurers offered short-term health insurance in Missouri.

The average monthly premium for a short-term health insurance plan sold in Missouri was $171.10 in 2023, according to data from IHC Specialty Benefits.

For short-term health plans issued or sold before September 2024, initial terms can be up to 364 days, and total duration (if the plan is renewable) can be up to 36 months. But starting with plans issued or sold in September 2024, new federal rules will sharply reduce those limits. Initial terms will be capped at no more than three months and total duration will be capped at no more than four months.

Here’s a summary of how the rules have changed over time in Missouri:

In October 2018, a federal rule change began to allow short-term health insurance to have initial terms of up to 364 days and total duration, including renewals, of up to 36 months. These rules were applicable unless a state had more restrictive rules in place.

At that point, Missouri regulations limited short-term healthcare plans to no more than six months in duration. The state did not limit the renewability of short-term plans, but short-term health insurance plans in Missouri were still limited to a maximum initial term of six months, since this was stricter than the federal rule.

However, the Missouri Department of Insurance confirmed that the state did not limit renewals, and defaulted to the federal rules for the total duration of a short-term plan. So an insurer could offer a plan that could be renewed for up to 36 months (the limit in the federal rules), as long as each term wasn’t more than six months.

But in 2021, Missouri enacted HB604, which changed the definition of a short-term plan to one with a term of 12 months or less (this was an amendment adopted during the legislative process). So short-term plans in Missouri were allowed to start following the federal rules that allowed for initial terms of up to 364 days, and total duration, including renewals, of up to 36 months.

Insurers could still choose to offer plans with shorter terms, or to offer plans without the option to renew the coverage. And plans issued or sold starting in September 2024 will have to conform to the much stricter federal rules that limit initial terms to three moths and total duration to four months.

Short-term health insurance in Missouri can be purchased by applicants who qualify for coverage based on the underwriting rules the insurers use.

Most short-term health plans can be purchased by people who are younger than 65 and who do not have any of the short list of medical conditions that will result in a declined application.¹ But the specific requirements vary from one insurance company to another.

Most short-term health insurance plans exclude coverage for pre-existing conditions. It’s also common for them to use post-claims underwriting, which means that if a claim is filed they can go back through the person’s medical records to make sure that the claim isn’t related to a pre-existing condition.²

It’s also common for short-term health plans to exclude coverage for some of the ACA’s essential health benefits (most commonly, maternity care, prescription drugs, and mental health care),¹ and impose dollar limits on the coverage they do provide. It’s important to double-check all of the plan information before purchasing a short-term policy, to make sure that you understand the limitations of the plan.

If you need health insurance coverage in Missouri, your first step should be to see whether you’re eligible to enroll in an ACA-compliant major medical plan (an Obamacare plan). Open enrollment for these plans runs from November 1 to January 15 each year, with coverage effective January 1 or February 1, depending on when you enroll (this enrollment window applies in Missouri’s Marketplace/exchange and also outside the exchange).

You may be able to enroll in an ACA-compliant plan outside the open enrollment period, if you’re eligible for a special enrollment period (in most cases, special enrollment periods are triggered by a specific qualifying life event).

ACA-compliant plans are purchased on a month-to-month basis, so you can enroll in one even if you’re only going to need it for a few months before another policy takes effect. And depending on your income, you may qualify for a premium subsidy (premium tax credit) that will make the monthly premiums much less costly than you may have been expecting.

But if you’re not able to enroll in an employer-sponsored plan or an ACA-compliant plan, or you just cannot afford the premiums, a short-term plan will likely be a better option than remaining uninsured, despite its limitations. And even though there are no premium subsidies for short-term health insurance plans, the monthly premiums tend to be relatively affordable, due to the plan limitations and the use of medical underwriting.

Despite the limitations of the coverage, these are times when you may want to consider a short-term health insurance plan:

• You missed open enrollment for ACA-compliant coverage and do not have a qualifying event that would trigger a special enrollment period (you can then switch to an ACA-compliant plan for the following year, by signing up during the annual open enrollment period that runs from November 1 to January 15 in Missouri).
• You’re newly employed and will soon be covered by your employer’s health plan, but they have a waiting period of up to three months before you’re eligible for coverage.
• You’ll soon be enrolled in Medicare, but do not have any other coverage options in the meantime. If your Medicare won’t take effect until after the start of the coming year, you can enroll in an ACA-compliant health plan during the autumn open enrollment period (November 1 – January 15) and then cancel it when your Medicare coverage takes effect.
• You’ve already enrolled in an ACA-compliant plan, but have to wait up to several weeks before it takes effect. You can use a short-term plan to bridge the gap until your new coverage is in force.
• You’re not eligible for Medicaid or a premium subsidy for marketplace coverage, making an ACA-compliant plan unaffordable. This includes people who aren’t lawfully present in the U.S. and thus are not able to enroll in a plan through the exchange/marketplace at all.