You can still get a nationwide PPO in Missouri, even though the marketplace sells only EPOs. Here is what that means for contractors in Kansas City and St. Louis who work on both sides of the state line.
Hi, I'm Sam. I'm a broker in Tampa licensed in 36 states, and Missourians paid on a 1099 can work with me by phone, whether you're a plumber in Independence, a sound tech in Florissant or a remodeler in Lee's Summit.
This page is about a situation that's unusually common in Missouri: living on one side of a state line and working on both. Kansas City spills into Kansas, and the St. Louis area reaches into Illinois. A contractor based in Missouri may spend half the week on job sites across the river, and that's where the network on a Missouri plan starts to matter.
Missouri's marketplace sells 117 individual medical plans this year. Every one is an EPO, and none is a PPO.
You can still get a nationwide PPO in Missouri, through me. It's a private plan priced on your health, and its network includes providers in Kansas, Illinois and every other state, so the urgent care near a job site in Overland Park or Belleville is in network too.
An EPO generally pays outside its network only for emergencies. Your Missouri plan's network may or may not include the clinics and doctors across the river, and the only way to know is to check before you pick. If it doesn't, a routine visit on the Kansas or Illinois side could be yours to pay.
Here's what to look up for each plan you're considering:
If nearly all your work is on the Kansas or Illinois side, network reach is the deciding factor. If you cross the line only now and then, an EPO with the right home doctors may be all you need, as long as you know which clinics to use when you do cross. Choice also varies by county. St. Louis County, St. Louis City and St. Charles County each have 6 marketplace insurers, and Jackson County has 5, so contractors in those areas can usually find more than one network to compare.
A HealthCare.gov EPO with the credit is generally the most affordable route for a contractor whose income lands in that range. HealthCare.gov wants net self-employment income for the year and expects you to update it when work picks up. Use the checklist above to choose the EPO whose network covers both sides of your working week.
Next step: Tell me where your doctors and job sites are, and I'll find the Missouri EPOs whose networks reach them.
Full price for an EPO that may not cover the other side of the river is a hard sell. An underwritten nationwide PPO is usually worth pricing: the insurer reviews your health and either issues the policy, declines it, or issues it without one condition. For a healthy contractor, that often costs less than the full marketplace rate, and your network crosses the state line with you.
Next step: Call me and I'll price a nationwide PPO for your household beside the Missouri EPOs in your county.
Missouri expanded Medicaid, and KFF lists the adult limit at 138% of the federal poverty level, so a lean year has a real safety net. If you qualify for Medicaid, you generally won't get the marketplace credit at the same time. When work comes back, report it and move to a marketplace plan.
Next step: If this year is thin, call me and we'll figure out whether Medicaid or a marketplace plan fits right now.
Straight answers, no sales pitch.
Missouri marketplace plans are EPOs, which generally cover out-of-network care only in emergencies. Check whether each plan's network includes providers across the line before you choose.
No medical PPO. All 117 individual medical plans are EPOs. Healthy contractors can get a nationwide PPO through me.
Possibly. Missouri expanded Medicaid to adults with income up to 138% of the poverty level.
Net self-employment income for the year, after business expenses, updated as soon as it changes.
Tell me your Missouri county, which side of the state line most of your work is on, who needs coverage and roughly what you netted. I'll show you which plan fits that map and what it costs.
The guide for every state, and other work I help with