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Missouri sees spike in marketplace plan enrollment as state purges Medicaid rolls

An illustration shows two figures on an orange boat. The boat floating on a blue insurance plan folded in the shape of waves. One figure has a fishing pole that has caught a fish labeled "copayment." The other figure has caught a fish labeled "deductible."
Subin Yang
Special to NPR
Health insurance customers can buy plans on the federal marketplace during open enrollment. In Missouri, that period ended Tuesday, and preliminary data from the federal government shows the number of people enrolled in marketplace plans has jumped more than 35%.

More than 340,000 Missourians signed up for plans on the federal health insurance marketplace before open enrollment drew to a close, a more than 35% increase compared with the year before, according to preliminary data from the federal Centers for Medicare and Medicaid Services.

Open enrollment is the yearly sign-up window in which Americans who do not receive health insurance through their job can sign up for plans on Healthcare.gov or on state-run health insurance marketplaces.

As of late December, 340,534 people had signed up for plans on the open enrollment marketplace, about 80,000 more than last year, according to the latest available data. Open enrollment ended Jan. 16, and Missouri’s already high number of enrollees is expected to increase as new data comes in.

“We knew we were busy, but these numbers are surprising even to us,” said Julie Peetz, executive director of the Missouri Association of Area Agencies on Aging, an organization that helps people sign up for insurance plans. “It’s been pretty intense, our navigators have been booked around the clock and have not had time to let up.”

Missouri’s increase reflects a national trend of more people signing up for 2024 insurance coverage through the marketplace. More than 20 million people have signed up for plans, according to CMS officials, a record for national enrollment, they said.

Health experts say the increase could be in part because Missouri and other states are disenrolling people from Medicaid after national pandemic-related continuous coverage requirements expired. People who suddenly find they don’t qualify for the government-funded health plans are moving to find coverage on the marketplace.

"It takes a while for these numbers to shake out,” said Tim McBride, a health policy professor at Washington University’s Brown School. “But it's certainly going to be up from last year.”

Medicaid enrollment in Missouri has dropped by more than 100,000 since the Medicaid purge began in June, he said.

“Everybody's been suspecting that some of those people who lose coverage, they might have a job at this point,” said McBride, also co-director of the Center for Advancing Health Services, Policy and Economics Research. “They might go on other coverage, but some of them might go to the marketplaces, some of them may become uninsured.”

Congress in 2021 also approved government subsidies to offset the cost of health plans on the marketplace, said Krutika Amin, an ACA policy researcher at KFF, a health research organization. How much the federal government gives customers toward paying their plan depends on their income. Some people can get coverage for as little as $1 a month.

“Enhanced subsidies have made marketplace plans more affordable for a lot of people over the last couple of years,” Amin said. “Many of those Medicaid enrollees are being disenrolled, and some of those people are finding their way to marketplace plans and finding them affordable enough to sign up.”

Many health departments and nonprofits have also dedicated marketing and awareness campaigns to signing up for health insurance as Medicaid disenrollments continue, she said. That could make people more aware of the open enrollment window.

Peetz, of the Missouri Area Agencies on Aging, said she has also seen staff at the organization help many new US residents sign up for insurance.

“We do a lot of enrollments in St. Louis, and in the city we’ve seen a lot of immigrants,” she said. “A lot of those people are getting on Medicaid, but a lot of people are on the marketplace as well, because so many of them can get a plan for under $10.”

Sarah Fentem is the health reporter at St. Louis Public Radio.