Missouri Health Insurance Plan

The Missouri Department of Social Services (DSS) administers the Missouri HealthNet program, which provides health care coverage for low-income Missouri residents. The program includes different coverage plans, for different age groups and income levels, and costs and services can vary depending on the plan for which a resident qualifies. While certain Missouri HealthNet plans offer services for adults, children can receive coverage through the Missouri HealthNet for Kids plan.

Enrollment

• To enroll in the Missouri HealthNet program, families and individuals can apply for coverage at their local Family Support Division (FSD) office. Residents can also apply by sending a completed application by mail to the Missouri HealthNet Managed Care Service Center in Jefferson City or by phone at 888-275-5908. FSD offices determine eligibility of applicants and notify residents of which Missouri HealthNet plan they qualify for. Missouri HealthNet plans include HealthNet for Families, HealthNet for Kids, HealthNet Managed Care, HealthNet Fee-for-Service or HealthNet for Pregnant Women. The HealthNet Managed Care program has multiple plans and requires eligible participants to enroll in a particular plan.

Covered Services

• Services covered by Missouri HealthNet plans include doctor visits, emergency services, home health care, hospitalization, substance abuse treatment, laboratory services, pharmacy services and hospice care. Depending on the age or eligibility category of a participant, he may also receive additional services, including dental care, adult day care, vision services and diabetic supplies. Missouri HealthNet plans do not cover acupuncture, weight control services, chiropractic services, infertility treatments or cosmetic surgery.

Premiums and Copayments

• Missouri HealthNet may require individuals and families in certain eligibility categories to pay premiums to receive coverage. Participants may also face requirements to make co-payments for certain services or dispensing fees for prescription drugs. Premium amounts and co-payments can depend on the age of the participant or the service received. As of March 2011, co-payments typically do not exceed $10. Examples of services requiring co-payments can include inpatient hospital services, psychological services, emergency room care, laboratory services, clinic services and doctor services. Participants that do not have to pay co-payments can include foster children, participants in hospice care, pregnant women or blind participants.

Missouri HealthNet for Kids

• Children up to 18 can receive coverage through Missouri HealthNet for Kids (MHK). Family income guidelines apply to MHK coverage. The program offers insurance for kids from households with incomes up to 185 percent of the federal poverty level (FPL). Children from families with household incomes between 150 percent and 300 percent of the FPL may qualify for Missouri HealthNet for Kids SCHIP, which works in conjunction with the federal government's State Children's Health Insurance Program. The Missouri HealthNet for Kids SCHIP plan requires premium payments, based on household income and family size. All plans available in the Missouri HealthNet for Kids program offer comprehensive health care coverage, that includes prescription drug coverage, primary care, hospital services, preventive care, vision care and dental services.