CoverMissouri.org: Tools to Help You: Path to Coverage

Your Path to Affordable Coverage

This tool will walk you through different paths to getting health care coverage in 2014, when most parts of the health care law will be in effect. You'll be able to see what choices you have. You'll also get a sense of whether you can get help to lower your health insurance costs. Answer the questions below to find your path to coverage.

Are you age 65 or older?

Yes

YOUR RESULT:
You should be eligible for Medicare. Medicare is the federal health program for older adults (age 65 and over) and individuals with permanent disabilities.

No

Do you choose not to buy health insurance coverage?

Yes

Are you exempt from the requirement to have coverage for one of the following reasons:
  • You are not required to file income tax or your income is below the federal poverty level ($11,480 for an individual, $23,550 for a family of four in 2013);
  • The premium for the health plan available to you costs more than 8% of your income;
  • You are temporarily without coverage (less than 3 months);
  • You are a member of a religious group exempt from paying Social Security, Medicare, and payroll taxes (e.g., Amish) or a health care sharing ministry;
  • You are a member of an Indian tribe;
  • You are incarcerated; or
  • You are an undocumented immigrant.

Yes

YOUR RESULT:
You will not be subject to a penalty for not having health insurance.

No

YOUR RESULT:
You may be subject to a penalty for not having health insurance. The penalty will be phased-in as follows:
  • $95 or 1% of taxable income in 2014,
  • $325 or 2% of taxable income in 2015, and
  • $695 or 2.5% of taxable income in 2016.

No

Are you under age 19?

Yes

Do you have the option to be added to a parent's health plan? Dependent or family coverage is often available through an employer-sponsored insurance plan for an additional fee.

Yes

YOUR RESULT:
You should be able to be covered under a parent's health plan and will not be subject to a penalty for not having health insurance. Parents can contact their Human Resource department (if they obtain insurance through work) or their insurer for more information.

No

Is your family income below the federal poverty level? ($11,480 for an individual, $23,550 for a family of four in 2013)

Yes

YOUR RESULT:
You may be eligible for Medicaid (called MO HealthNet in Missouri)if you qualify. Medicaid is the federal-state program providing coverage for people with very low-incomes. If you don't qualify for Medicaid and have income below the poverty level, you may be exempt from the requirement to have health insurance.

No

Is your family income less than 300% of the federal poverty level? ($34,470 for an individual, $70,650 for a family of four in 2013)

Yes

YOUR RESULT:
You may be eligible for the Children's Health Insurance Plan (CHIP). In Missouri the CHIP program is called MO HealthNet for Kids and a monthly premium may be required based on family income.

No

Is your family income less than 400% of the federal poverty level? ($45,960 for an individual, $94,200 for a family of four in 2013)

Yes

YOUR RESULT:
You can buy coverage through the Missouri Health Insurance Marketplace and should be eligible to receive a premium tax credit to offset the cost of the plan.

No

YOUR RESULT:
You do not appear to qualify for assistance in purchasing health coverage. You can purchase coverage through the Missouri Health Insurance Marketplace or directly from an insurer (the individual market).

You could also choose not to purchase coverage, and may be subject to a penalty. The penalty will be phased-in as follows:
  • $95 or 1% of taxable income in 2014,
  • $325 or 2% of taxable income in 2015, and
  • $695 or 2.5% of taxable income in 2016.

No

Are you under age 26?

Yes

Do you have the option be added to a parent's health plan? The health reform law allows young adults (under age 26) to remain on or be added to a parent's health insurance plan offering family or dependent coverage. Young adults are not required to be students, dependents, or residing with a parent to qualify for this coverage. However, if your employer offers a health plan you are not eligible to be added to a parent's health plan.

Yes

YOUR RESULT:
You should be able to be covered under a parent's health plan and will not be subject to a penalty for not having health insurance. Parents can contact their Human Resource department (if they obtain insurance through work) or their insurer for more information.

No

Are you interested in purchasing catastrophic-only coverage? This type of plan usually has a high-deductible which must be paid by the individual before the insurance pays for covered benefits. Three primary care visits and select preventive services would be covered with no cost-sharing requirements.

Yes

YOUR RESULT:
You should be able to purchase catastrophic-only coverage through the Missouri Health Insurance Marketplace and will not be subject to a penalty.

No

Is health coverage available through your employer?

Yes

Is your family income below the federal poverty level? ($11,480 for an individual, $23,550 for a family of four in 2013)

Yes

YOUR RESULT:
You should have the option to accept coverage through your employer or enroll in Medicaid (called MO HealthNet in Missouri) if you qualify. Medicaid is the federal-state program providing coverage for people with very low-incomes. If you don't qualify for Medicaid and have income below the poverty level, you may be exempt from the requirement to have health insurance.

No

Is the premium for insurance through your employer (select one of the following):

Less than 8% of your income?

Is your family income less than 400% of the federal poverty level? ($45,960 for an individual, $94,200 for a family of four in 2013)

Yes

Does the health plan offered by your employer cover 60% or more of covered health expenses?

Yes

YOUR RESULT:
You should have the option to enroll in the health plan offered by your employer - OR - to buy a plan on your own. You can purchase coverage through the Missouri Health Insurance Marketplace or directly from an insurer (the individual market).

No

YOUR RESULT:
You should have the option to enroll in the health plan offered by your employer - OR - you can buy coverage through the Missouri Health Insurance Marketplace and should be eligible to receive a premium tax credit to offset the cost of the plan.

No

YOUR RESULT:
You should have the option to enroll in the health plan offered by your employer - OR - to buy a plan on your own. You can purchase coverage through the Missouri Health Insurance Marketplace or directly from an insurer (the individual market).

You could also choose not to purchase coverage, and may be subject to a penalty. The penalty will be phased-in as follows:
  • $95 or 1% of taxable income in 2014,
  • $325 or 2% of taxable income in 2015, and
  • $695 or 2.5% of taxable income in 2016.

Between 8% and 9.5% of your income?

Is your family income less than 400% of the federal poverty level? ($45,960 for an individual, $94,200 for a family of four in 2013)

Yes

Does the health plan offered by your employer cover 60% or more of covered health expenses?

Yes

YOUR RESULT:
You should have the option to enroll in the health plan offered by your employer - OR - you can buy insurance on your own. You can purchase coverage through the Missouri Health Insurance Marketplace> or directly from an insurer (the individual market). You also have the option to go without coverage and will not be subject to a penalty.

No

YOUR RESULT:
You should have the option to enroll in the health plan offered by your employer - OR - you can buy coverage through the Missouri Health Insurance Marketplace and should be eligible to receive a premium tax credit to offset the cost of the plan. You also have the option to go without coverage and will not be subject to a penalty.

No

YOUR RESULT:
You should have the option to enroll in the health plan offered by your employer - OR - you can buy insurance on your own. You can purchase coverage through the Missouri Health Insurance Marketplace or directly from an insurer (the individual market). You also have the option to go without coverage and will not be subject to a penalty.

More than 9.5% of your income?

Is your family income less than 400% of the federal poverty level? ($45,960 for an individual, $94,200 for a family of four in 2013)

Yes

YOUR RESULT:
You should have the option to enroll in the health plan offered by your employer - OR - you can buy coverage through the Missouri Health Insurance Marketplace and should be eligible to receive a premium tax credit to offset the cost of the plan. You also have the option to go without coverage and will not be subject to a penalty.

No

YOUR RESULT:
You should have the option to enroll in the health plan offered by your employer - OR - you can buy insurance on your own. You can purchase coverage through the Missouri Health Insurance Marketplace or directly from an insurer (the individual market). You also have the option to go without coverage and will not be subject to a penalty.

No

Is your family income below the federal poverty level? ($11,480 for an individual, $23,550 for a family of four in 2013)

Yes

YOUR RESULT:
You may be eligible for Medicaid. Medicaid, called MO HealthNet in Missouri, is the federal-state program providing coverage for low-income people.

No

Is your income less than 400% of the federal poverty level?

Yes

YOUR RESULT:
You can buy coverage through the Missouri Health Insurance Marketplace and should be eligible to receive a premium tax credit to offset the cost of the plan.

No

YOUR RESULT:
You do not appear to qualify for assistance in purchasing health coverage. You can purchase coverage through the Missouri Health Insurance Marketplace or directly from an insurer (the individual market). You could also choose not to purchase coverage, and may be subject to a penalty. The penalty will be phased-in as follows:
  • $95 or 1% of taxable income in 2014,
  • $325 or 2% of taxable income in 2015, and
  • $695 or 2.5% of taxable income in 2016.

No

Are you under the age of 30?

Yes

Are you interested in purchasing catastrophic-only coverage? This type of plan usually has a high-deductible which must be paid by the individual before the insurance pays for covered benefits. Three primary care visits and select preventive services would be covered with no cost-sharing requirements.

Yes

YOUR RESULT:
You should be able to purchase catastrophic-only coverage through through the Missouri Health Insurance Marketplace and will not be subject to a penalty.

No

Is health coverage available through your employer?

Yes

Is your family income below the federal poverty level? ($11,480 for an individual, $23,550 for a family of four in 2013)

Yes

YOUR RESULT:
You should have the option to accept coverage through your employer - OR - enroll in Medicaid (called MO HealthNet in Missouri) if you qualify. Medicaid is the federal-state program providing coverage for people with very low-incomes. If you don't qualify for Medicaid and have income below the poverty level, you may be exempt from the requirement to have health insurance.

No

Is the premium for insurance through your employer (select one of the following):

Less than 8% of your income?

Is your family income less than 400% of the federal poverty level? ($45,960 for an individual, $94,200 for a family of four in 2013)

Yes

Does the health plan offered by your employer cover 60% or more of your share of health expenses?

Yes

YOUR RESULT:
You should have the option to enroll in the health plan offered by your employer - OR - to buy a plan on your own. You can purchase coverage through the Missouri Health Insurance Marketplace or directly from an insurer (the individual market).

No

YOUR RESULT:
You should have the option to enroll in the health plan offered by your employer - OR - you can buy coverage through the Missouri Health Insurance Marketplace and should be eligible to receive a premium tax credit to offset the cost of the plan.

No

YOUR RESULT:
You should have the option to enroll in the health plan offered by your employer - OR - to buy a plan on your own. You can purchase coverage through the Missouri Health Insurance Marketplace or directly from an insurer (the individual market).

You could also choose not to purchase coverage, and may be subject to a penalty. The penalty will be phased-in as follows:
  • $95 or 1% of taxable income in 2014,
  • $325 or 2% of taxable income in 2015, and
  • $695 or 2.5% of taxable income in 2016.

Between 8% and 9.5% of your income?

Is your family income less than 400% of the federal poverty level? ($45,960 for an individual, $94,200 for a family of four in 2013)

Yes

Does the health plan offered by your employer cover 60% or more of covered health expenses?

Yes

YOUR RESULT:
You should have the option to enroll in the health plan offered by your employer - OR - you can buy insurance on your own. You can purchase coverage through the Missouri Health Insurance Marketplace or directly from an insurer (the individual market). You also have the option to go without coverage and will not be subject to a penalty.

No

YOUR RESULT:
You should have the option to enroll in the health plan offered by your employer - OR - you can buy coverage through the Missouri Health Insurance Marketplace and should be eligible to receive a premium tax credit to offset the cost of the plan. You also have the option to go without coverage and will not be subject to a penalty.

No

YOUR RESULT:
should have the option to enroll in the health plan offered by your employer - OR - you can buy insurance on your own. You can purchase coverage through the Missouri Health Insurance Marketplace or directly from an insurer (the individual market). You also have the option to go without coverage and will not be subject to a penalty.

More than 9.5% of your income?

Is your family income less than 400% of the federal poverty level? ($45,960 for an individual, $94,200 for a family of four in 2013)

Yes

YOUR RESULT:
You should have the option to enroll in the health plan offered by your employer - OR - you can buy coverage through the Missouri Health Insurance Marketplace and should be eligible to receive a premium tax credit to offset the cost of the plan. You also have the option to go without coverage and will not be subject to a penalty.

No

YOUR RESULT:
You should have the option to enroll in the health plan offered by your employer - OR - you can buy insurance on your own. You can purchase coverage through the Missouri Health Insurance Marketplace or directly from an insurer (the individual market). You also have the option to go without coverage and will not be subject to a penalty.

No

Is your family income below the federal poverty level? ($11,480 for an individual, $23,550 for a family of four in 2013)

Yes

YOUR RESULT:
You may be eligible for Medicaid. Medicaid, called MO HealthNet in Missouri, is the federal-state program providing coverage for low-income people.

No

Is your family income less than 400% of the federal poverty level? ($45,960 for an individual, $94,200 for a family of four in 2013)

Yes

YOUR RESULT:
You can buy coverage through the Missouri Health Insurance Marketplace and should be eligible to receive a premium tax credit to offset the cost of the plan.

No

YOUR RESULT:
You do not appear to qualify for assistance in purchasing health coverage. You can purchase coverage through the Missouri Health Insurance Marketplace or directly from an insurer (the individual market). You could also choose not to purchase coverage, and may be subject to a penalty. The penalty will be phased-in as follows:
  • $95 or 1% of taxable income in 2014,
  • $325 or 2% of taxable income in 2015, and
  • $695 or 2.5% of taxable income in 2016.

No

Is health coverage available through your employer?

Yes

Is your family income below the federal poverty level? ($11,480 for an individual, $23,550 for a family of four in 2013)

Yes

YOUR RESULT:
You should have the option to accept coverage through your employer - OR - enroll in Medicaid (called MO HealthNet in Missouri) if you qualify. Medicaid is the federal-state program providing coverage for people with very low-incomes. If you don't qualify for Medicaid and have income below the poverty level, you may be exempt from the requirement to have health insurance.

No

Is the premium for insurance through your employer (select one of the following):

Less than 8% of your income?

Is your family income less than 400% of the federal poverty level? ($45,960 for an individual, $94,200 for a family of four in 2013)

Yes

Does the health plan offered by your employer cover 60% or more of covered health expenses?

Yes

YOUR RESULT:
You should have the option to enroll in the health plan offered by your employer - OR - to buy a plan on your own. You can purchase coverage through the Missouri Health Insurance Marketplace or directly from an insurer (the individual market).

No

YOUR RESULT:
You should have the option to enroll in the health plan offered by your employer - OR - you can buy coverage through the Missouri Health Insurance Marketplace and should be eligible to receive a premium tax credit to offset the cost of the plan.

No

YOUR RESULT:
You should have the option to enroll in the health plan offered by your employer - OR - to buy a plan on your own. You can purchase coverage through the Missouri Health Insurance Marketplace or directly from an insurer (the individual market).

You could also choose not to purchase coverage, and may be subject to a penalty. The penalty will be phased-in as follows:
  • $95 or 1% of taxable income in 2014,
  • $325 or 2% of taxable income in 2015, and
  • $695 or 2.5% of taxable income in 2016.

Between 8% and 9.5% of your income?

Is your family income less than 400% of the federal poverty level? ($45,960 for an individual, $94,200 for a family of four in 2013)

Yes

Does the health plan offered by your employer cover 60% or more of covered health expenses?

Yes

YOUR RESULT:
You should have the option to enroll in the health plan offered by your employer - OR - you can buy insurance on your own. You can purchase coverage through the Missouri Health Insurance Marketplace or directly from an insurer (the individual market). You also have the option to go without coverage and will not be subject to a penalty.

No

YOUR RESULT:
You should have the option to enroll in the health plan offered by your employer - OR - you can buy coverage through the Missouri Health Insurance Marketplace and should be eligible to receive a premium tax credit to offset the cost of the plan. You also have the option to go without coverage and will not be subject to a penalty.

No

YOUR RESULT:
You should have the option to enroll in the health plan offered by your employer - OR - you can buy insurance on your own. You can purchase coverage through the Missouri Health Insurance Marketplace or directly from an insurer (the individual market). You also have the option to go without coverage and will not be subject to a penalty.

More than 9.5% of your income?

Is your family income less than 400% of the federal poverty level? ($45,960 for an individual, $94,200 for a family of four in 2013)

Yes

YOUR RESULT:
You should have the option to enroll in the health plan offered by your employer - OR - You can buy coverage through the Missouri Health Insurance Marketplace and should be eligible to receive a premium tax credit to offset the cost of the plan. You also have the option to go without coverage and will not be subject to a penalty.

No

YOUR RESULT:
You should have the option to enroll in the health plan offered by your employer - OR - you can buy insurance on your own. You can purchase coverage through the Missouri Health Insurance Marketplace or directly from an insurer (the individual market). You also have the option to go without coverage and will not be subject to a penalty.

No

Is your family income below the federal poverty level? ($11,480 for an individual, $23,550 for a family of four in 2013)

Yes

YOUR RESULT:
You may be eligible for Medicaid. Medicaid, called MO HealthNet in Missouri, is the federal-state program providing coverage for low-income people.

No

Is your family income less than 400% of the federal poverty level? ($45,960 for an individual, $94,200 for a family of four in 2013)

Yes

YOUR RESULT:
You can buy coverage through the Missouri Health Insurance Marketplace and should be eligible to receive a premium tax credit to offset the cost of the plan.

No

YOUR RESULT:
You do not appear to qualify for assistance in purchasing health coverage. You can purchase coverage through the Missouri Health Insurance Marketplace or directly from an insurer (the individual market). You could also choose not to purchase coverage, and may be subject to a penalty. The penalty will be phased-in as follows:
  • $95 or 1% of taxable income in 2014,
  • $325 or 2% of taxable income in 2015, and
  • $695 or 2.5% of taxable income in 2016.
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Adapted from a chart by the Center for Healthcare Research & Transformation:
http://www.chrt.org/public-policy/policy-papers/aca-coverage-flowchart/