• Individuals earning less than $58,320 may qualify for a subsidy if purchased on exchange.
• Subsidies are on a sliding scale: the less an individual earns, the more subsidy they receive.
• Plans purchased off exchange are not subsidized and do not qualify for tax credits.
• All individual Missouri plans use an EPO network (Exclusive Provider Organiza- tion). EPO networks can be limited and do not include out of network benefits, unless in an emergency. Members must stay in network with EPO plans.
• Max out-of-pocket for marketplace plans is $9,450 for individual coverage and $18,900 for family coverage.
• Many plans do not have first-dollar ben- efits on specialty care visits and higher tiered prescriptions. These claims may go toward deductible first with some plans.
• Individual plans have specific enroll- ment periods. Open enrollment for the individual market opens November 1 and ends January 15. (The current administration sets the open enrollment window.)
• Short-term medical plans are available year-round; however, they are not con- sidered major medical due to limits and caps on benefits.
For the 2024 plan year, marketplace plans will increase an average of six percent, due to growth in health care prices. In addition to inflation, carriers are seeing an uptick with pandemic-related costs. Claim costs are expected to be lower in 2024.
Health insurance is one of the biggest con- cerns we face today. MDIS works with doz- ens of health insurance carriers to provide our clients with the best options and rates available. Let MDIS help with a plan that fits your needs. Contact Christy for more information on group and individual health insurance options.
Christy Diehl is the MDIS Health Insurance Manager. Contact her at
christy@mdis4dds.com or 573-469-7003.
800-944-7550 /
MDIS4DDS.COM ISSUE 3 | FALL 2023 | focus 13
There are alternatives to high-cost
ACA group health insurance plans? Underwritten self-funded or level-funded plans have become popular options to try to reduce plan premiums. Most plans follow ACA benefit mandates, so designs can look and feel like fully insured plans.
Call us today to learn about options!
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