Medicaid expansion: the ballot initiative
Missouri's path to Medicaid expansion was unusual. In August 2020, voters approved Amendment 2 by a 53-47 margin, amending the state constitution to require Medicaid expansion. The state legislature initially refused to fund it, and the governor tried to block implementation. But the Missouri Supreme Court ruled in July 2021 that the constitutional amendment was binding. The Family Support Division began processing expansion applications on October 1, 2021.
By mid-2024, nearly 300,000 Missourians were enrolled in expansion Medicaid. The program covers adults under 65 with household income up to 138% FPL (about $22,025 for a single person, or $45,540 for a family of four, for 2027 coverage). This closed the coverage gap that had left low-income childless adults without any affordable option.
Expansion adults face new federal work requirements. States must start them by January 1, 2027 (a state making a good-faith effort can get extra time). Most expansion enrollees ages 19 to 64 will need to show 80 hours a month of work, school, job training, or community service. Parents of children under 14, pregnant people, people who are disabled or medically frail, and some others are exempt. Keep your address current with the Family Support Division so you get notices.
What plans cost in 2027
Premiums are up again for 2027, after a 23.1% weighted average increase for 2026. In filings posted by the Department of Commerce and Insurance in July 2026, insurers requested average 2027 increases ranging from about 10% (Blue Cross Blue Shield of Kansas City and Ambetter) to about 26% (Medica). Here is the benchmark (second-lowest cost Silver) premium for a 40-year-old before subsidies, from HealthCare.gov plan data:
- St. Louis City: about $590 per month, up from $523 in 2026
- Jackson County (Kansas City): about $649, up from $572
- Greene County (Springfield): about $686, up from $627
- Boone County (Columbia): about $801, up from $715
- Scotland County (rural northeast Missouri): about $948, up from $789
The subsidy cliff returned in 2026 after the enhanced credits expired, and it stays for 2027: people above 400% FPL ($63,840 for a single person, $132,000 for a family of four) get no premium tax credit. Between 2025 and 2026, Missouri marketplace enrollment fell by about 51,000 people. Many switched to cheaper Bronze plans or dropped coverage entirely.
Major carriers in Missouri (2027)
Six insurers offer plans on the Missouri marketplace for 2027. SSM Health no longer sells marketplace plans, and Cox Health Plans is listed by the state as off-exchange only for 2027. Every county has at least two marketplace insurers:
- UnitedHealthcare is the only carrier available in all 115 counties for 2027. It provides a broad network and is the default option in many rural areas where no other carrier operates.
- Ambetter from Home State Health (Centene) is available in 109 of 115 counties for 2027, missing a handful of northeast Missouri counties. Often has the lowest premiums but uses narrower networks.
- Anthem Blue Cross Blue Shield sells plans in 85 counties for 2027, covering most of the state outside the Kansas City area, including St. Louis, Springfield, and Columbia.
- Blue Cross Blue Shield of Kansas City operates in 30 western Missouri counties around the Kansas City metro. It cut rates by about 4% for 2026, one of the few carriers nationally to lower premiums.
- Oscar Health offers plans in 25 Missouri counties for 2027, including St. Louis, Kansas City, and Springfield, focusing on a technology-driven experience with virtual care and an app-based model.
- Medica sells plans in 41 counties for 2027, including St. Louis, Springfield, and Columbia. It requested the largest average increase for 2027.
Key regions
St. Louis metro
The St. Louis area (St. Louis City, St. Louis County, St. Charles, Jefferson, Franklin counties) has the most carrier competition in the state. St. Louis City has five marketplace insurers for 2027: Anthem, UnitedHealthcare, Ambetter, Medica, and Oscar. The region is anchored by major health systems including BJC HealthCare, SSM Health, and Mercy. Multiple carriers competing generally keeps premiums more competitive than outstate Missouri.
Kansas City metro
The Missouri side of Kansas City (Jackson, Clay, Platte counties) is served by Blue Cross Blue Shield of Kansas City, UnitedHealthcare, Ambetter, and Oscar for 2027. The HCA Midwest and Saint Luke's hospital systems form the backbone of local carrier networks.
Springfield
Greene County has five marketplace insurers for 2027: Anthem, UnitedHealthcare, Ambetter, Medica, and Oscar. CoxHealth is the dominant hospital system in the region, so check whether CoxHealth and Mercy Springfield are in a plan's network. Cox Health Plans is off-exchange only for 2027, which means no premium tax credit if you buy it.
Rural Missouri
Many rural counties have two or three insurers for 2027, usually UnitedHealthcare, Anthem, and Ambetter. In a few northeast counties such as Scotland and Clark, the only choices are UnitedHealthcare and Anthem. Premiums in rural areas tend to be higher because of limited provider competition and higher per-patient costs. If you live in a rural county, check your network carefully, as narrow networks may not include nearby providers.
Estimate your subsidy
Subsidy Estimator
Enter your info below to get a rough estimate of your monthly premium tax credit for a 2027 marketplace plan.
Resources for Missourians
- HealthCare.gov for plan shopping and enrollment (Missouri uses the federal marketplace)
- Missouri DSS for Medicaid (MO HealthNet) applications and information about expansion eligibility
- Missouri Department of Commerce and Insurance for rate filing information and consumer assistance
- Call 2-1-1 for help finding local enrollment assisters and navigators