While the average premium for one carrier will decline, most consumers in the health care marketplace will pay more due to the loss of tax credits passed during the pandemic
By:Rudi Keller and Steph Quinn
Missouri Independent
Most individual health insurance plans sold in Missouri will increase in price next year even as customers prepare to dig deeper into their own funds to replace costs previously covered by federal tax credits.
The state Department of Commerce and Insurance on Friday released the approved rates for individual plans, most of which are sold on the health insurance marketplace. One carrier, Blue Cross Blue Shield of Kansas City, is lowering premiums an average of 4.1% for its plans available in 30 western Missouri counties. Some plans offered by the company will see an increase of as much as 9%.
Premiums will increase for the other eight carriers offering plans in all or part of the state. Ambetter Health plans, available off the marketplace in 109 counties, will increase an average of 1.9%, while Cox Health Plans, available in five southwest Missouri counties, will go up an average of 30.4%.
The costs for some Missourians will increase 70% or more if Congress does not extend tax credits enacted during the COVID-19 pandemic.
The federal government has been shut down since Oct. 1 because congressional Democrats refuse to vote to fund the government until Republicans add an extension of the credits to the spending bill. Republicans argue the government should be reopened before negotiations over subsidies resume.
Premiums will increase for the other eight carriers offering plans in all or part of the state. Ambetter Health plans, available off the marketplace in 109 counties, will increase an average of 1.9%, while Cox Health Plans, available in five southwest Missouri counties, will go up an average of 30.4%.
There are at least two companies offering health plans in every county, with a handful in the St. Louis area seeing seven vying for their business.
“First and foremost, Missourians need to know our state continues to have a competitive market, which means they will continue to have meaningful choices when it comes to their health coverage,” Angela Nelson, department director, said in a news release.
In addition to reporting the average change, the department also provided the largest change in cost for any single plan offered by the nine carriers. Those increases ranged from 6.4% for an Ambetter Health plan, to 110% for a Medica plan offered in 54 counties.
Open enrollment for the individual health plans begins Saturday. Consumers who purchase coverage by Dec. 15 will have it start Jan. 1. Plans may be purchased until Jan. 15, but coverage will not begin until Feb. 1, the release stated.
Missourians will start considering their choices without knowing whether enhanced subsidies enacted during the COVID-19 pandemic emergency will be extended.
The original Affordable Care Act subsidies that took effect in 2014 tied the actual cost to consumers to a percentage of their income for people earning less than four times the federal poverty level. Consumers with poverty level income — $15,650 for 2025 for individuals, $32,150 for a family of four — paid 2.1% of their income as premiums, sliding up to 10% for households with income between three and four times the poverty level.
The enhanced tax credits put a cap on out-of-pocket premium costs for all consumers, with the highest earners paying 8.5% of their income and those with incomes below 150% of poverty level paying no premiums for their insurance.
“There is still a tremendous amount of uncertainty about whether Congress will extend the premium tax subsidies into 2026, and we are keeping a close eye on any developments at the federal level,” Nelson said.
Only two of the eight companies offering individual plans in Missouri through the federal marketplace will have plans available in every county or almost every county in the state. United Healthcare plans are available in every county and Ambetter from Home State Health plans can be purchased in every county except Clark, Lewis, Marion, St. Francois, Schuyler and Scotland.
The average monthly premium is about $755 for both the United Healthcare and Ambetter offerings, an increase of about 15% and 25%, respectively.
An individual with an income of $62,600 a year or more would have to pay the full premium if the enhanced credits are not extended. That means paying $9,060 over a year for the average Ambetter or United Healthcare plan instead of $5,321, an increase of 70%.
Cost increase impacts
A panel of community members and experts hosted by the Community Health Commission of Missouri in St. Louis on Thursday underlined potential impacts of the expiring subsidies.
Sheldon Weisgrau, vice president for health and policy advocacy at the Missouri Foundation for Health, said higher premiums could lead younger, healthier people to forgo insurance, driving up prices for those who continue to purchase plans.
“When folks can’t afford to buy insurance, it doesn’t mean they won’t get sick,” Weisgrau said. When they do enter the health system, providers pick up the cost, “and again, that eventually gets passed on to everybody else.”
As Missourians confront higher insurance premiums, 650,000 low-income residents of the state could also be forced to cope with a loss of federal food benefits, with the Supplemental Nutrition Assistance Program, or SNAP, set to run out of funding on Nov. 1. Federal judges in Massachusetts and Rhode Island on Friday ordered the Trump administration to use contingency funds to pay at least partial benefits, but SNAP recipients could still face delays.
Panelists on Thursday said instability across federal safety net programs means communities will have to fill in the gaps through mutual aid.
“I think the neighborhood, the village, needs to be recreated,” said Shanelle Woods, one of the community members.
“There’s someone probably on your block that has extra,” Woods said. “Maybe Miss Jones has a pot of soup and she’s willing to share with your children. But, you have to build a relationship with your neighbor first.”
Panelists said policy conversations don’t address the difficulty of accessing safety net programs even when they are not being cut or suspended.
Shellie Robinson, who went on medical leave after being diagnosed with an autoimmune disease, said she struggled so long to prove she was eligible to receive disability benefits that she eventually had to go back to work.
Her doctors vouched for her, but, Robinson said, “it still wasn’t enough.”
“Who has the time to wait online or wait on a call for nearly three hours to talk to someone, to get it?” Robinson asked.
Timothy McBride, a health economist at Washington University in St. Louis, said that despite a “myth” that people who buy marketplace insurance plans are “undeserving, or they’re lazy,” many working people don’t have access to affordable insurance. Older adults who don’t qualify for Medicare – for instance, due to a chronic condition – may also need marketplace plans.
“There are flaws in our insurance markets that put people in this situation,” McBride said. “That’s the truth of the matter, and you don’t hear that from Washington. It’s a blame game.”