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Missouri's Health Insurance Marketplace Toolkit 
Toolkit General Rules

- If you have coverage through Medicare or Medicaid, CHIP, certain Veterans programs, a federal program like TRICARE, or through your employer, none of this applies to you. (However, people with job-based health insurance might find better coverage and lower personal costs through Marketplace coverage.)

- All plans offered in the Marketplace must limit out-of-pocket expenses (copayments, deductibles, and co-insurance) to $6,350 a year for individuals, and $12,700 for families.

- Young adults under the age of 30 with a hardship exemption from the individual mandate can purchase a lower cost bare-bones “catastrophic” plan.

- Young adults can be covered by their parents’ plans until the age of 26.

- Plans sold in the Marketplace cannot charge more or deny coverage for individuals with pre-existing health conditions.
- Plans sold in the Marketplace cannot impose annual or lifetime dollar limits on coverage for essential health care services.

- Preventive care for children, immunizations, and certain preventive care and screenings for women must be covered with no extra out-of-pocket expense.

- Small businesses (those with fewer than 50 employees) can shop for insurance coverage through a separate marketplace, called the Small Business Health Options Program (SHOP) Marketplace. Find more information about that here: www.HealthCare.gov/Small‑Businesses
- The federal penalty for not having the minimum essential coverage under the federal individual mandate starts at $95 a year, or up to one percent of your income, whichever is greater. It begins in 2014, and goes up every year until it reaches 2.5 percent of income or $695 per person. It does not apply if your premiums are more than eight percent of your income, if you are uninsured for fewer than three months a year, or if you would have qualified for the ACA’s expanded Medicaid coverage had Missouri accepted that expansion. There are other exemptions as well, such as members of Indian tribes, religious conscience, illegal aliens, members of a health care sharing ministry, and individuals who are incarcerated. For more information about this issue, visit:

For More Information:


Contact MSMA or call 800-869-6762 for more information.







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