Missouri residents
who cannot obtain affordable health insurance due to pre-existing conditions may have two state-sponsored health insurance options. The Missouri Health Insurance Pool and the MHIP-PCIP Federal High Risk Pool Program, supervised by the Missouri Department of Insurance, offer full coverage plans. The Affordable Care Act, enacted in 2010, provides that each state must make health insurance available to anyone with pre-existing conditions that prevent her from obtaining private health insurance.
MHIP State High Risk Pool Program
The Missouri Health Insurance Pool (MHIP) is the original health plan offered to high-risk Missouri residents since 1991. Several MHIP plans are available with differing deductibles, copays and co-insurance amounts. Deductibles run from $1,000 to $5,000 per calendar year, as of 2011. The insured individual is responsible for paying the premium and out-of-pocket costs. Premiums are based on plan type, age and gender. Plan administration is through Anthem Blue Cross and Blue Shield and Blue Cross and Blue Shield of Kansas City.
MHIP-PCIP Federal High Risk Pool Program
A second pool, the Missouri Health Insurance-Pre-Existing Condition Insurance Plan (MHIP-PCIP) receives federal funding under the Affordable Care Act. The plan available offers comprehensive preferred provider organization coverage with a $1,000 annual medical deductible and a $100 pharmacy deductible, as of 2011. Co-insurance is 80 percent for in-network services and 50 percent for out-of-network care. Premium rates are based on age, higher for older residents. Per federal law, the MHIP-PCIP cannot limit, restrict or exclude coverage for any pre-existing conditions.
Eligibility Requirements
Eligibility is different for each pool. MHIP applicants must be Missouri residents who could not obtain insurance from at least two carriers or who could obtain insurance but at an extremely high premium. Additionally, if the individual has not had a break in coverage or lost coverage and is offered a plan with insurance premiums over 300 percent of standard rates, she may be eligible for MHIP. MHIP-PCIP eligibility is simpler. An applicant must be a U.S. citizen, resident of Missouri, uninsured for at least six months and unable to obtain insurance elsewhere due to a pre-existing condition.
Apply
Missouri residents apply for the MHIP or MHIP-PCIP pools using the same MHIP application. Downloadable applications are available on the MHIP website. Fill in the application including the requested date for the insurance to take effect. Mail the application and supporting documentation to the appropriate address listed at the end of the form. The plan administrators review the application and send written notification to the applicant specifying which pool, MHIP or MHIP-PCIP, under which the individual is accepted.
Tags: Missouri residents, Health Insurance, health insurance, High Risk, High Risk Pool
