Shopping for affordable health insurance in Missouri can feel overwhelming, especially when plans, networks, and subsidies seem to change each year. Fortunately, the Affordable Care Act (ACA) Marketplace — also known as Obamacare — is designed to give individuals and families in the U.S. access to cost-effective, comprehensive coverage.
At MBhealth Insurance Agency, we know ACA plans can be confusing, so we created this 10-step guide to help you make an informed decision for open enrollment 2026.
MBhealth’s 9-Step Guide to ACA Open Enrollment
Open enrollment for ACA Marketplace plans in Missouri is quickly approaching — your opportunity to secure health coverage for 2026. By exploring your options early, you can compare plans, keep your preferred doctors, and pick coverage that fits your needs and budget.
Step 1: Mark Your Calendar and Plan Ahead
Open Enrollment for 2026 ACA plans in Missouri runs November 1, 2025 through December 15th and could extend through January 15, 2026.
Before then, set aside time to review your options, compare costs, and gather key documents, such as your proof of income (pay stubs, tax returns, or unemployment statements), Social Security number(s), and current health insurance details.
Keep in mind: If you enroll between November 1, 2025 and December 15, 2025, your coverage starts January 1, 2026. If you select a plan between December 16, 2025 and January 15, 2026, your coverage begins February 1, 2026.
Step 2: Check Your Eligibility for Coverage and Savings
In Missouri, the ACA Marketplace is open to individuals and families who qualify based on specific requirements, such as:
- Living in Missouri
- Being a U.S. citizen or lawfully present
- Not having Medicare
- Not being incarcerated
You might also be eligible for income-based subsidies called Advanced Premium Tax Credits (APTCs) — federal tax credits that lower the monthly cost of your health insurance, known as premiums. However, APTCs are generally not available if you already have affordable employer coverage, Medicaid (MO HealthNet), or Medicare Part A.
To use subsidies, certain tax rules apply: married couples must file jointly, and you cannot be claimed as a dependent on someone else’s return.
You may also qualify for cost-sharing reductions (CSRs) — discounts that lower out-of-pocket costs — if you choose a Silver-level plan and you have an income that is at or below 250% of the federal poverty level.
Step 3: Understand Your Health Needs
To help you pick the best plan for your needs, create a health-priorities list to refer to while reviewing options, such as:
- Preferred doctors and specialists
- Current prescriptions and medications
- Medical history (conditions or past procedures)*
- Family health history (information to consider for preventative care)
- Upcoming treatments, procedures, or pregnancy
*Pre-existing conditions cannot raise your premiums or prevent you from enrolling.
Step 4: Learn About ACA Plan Types and Metal Levels
Missouri ACA plans come in various plan types and metal levels, giving you flexibility based on your preferences and finances.
Plan types:
- Health Maintenance Organization (HMO) — requires a primary doctor and referrals for specialists, with little or no out-of-network coverage
- Exclusive Provider Organization (EPO) — does not require referrals and out-of-network care is only covered in emergencies
- Preferred Provider Organization (PPO) — does not require referrals to see in- or out-of-network doctors
Metal levels:
- Bronze — lower monthly premiums and higher out-of-pocket costs
- Silver — moderate monthly premiums, moderate out-of-pocket costs, and opportunities to qualify for cost-sharing reductions
- Gold — higher monthly premiums and lower out-of-pocket costs
Understanding these tiers can help you balance monthly costs and care access to make the best decision for your needs in 2026.
Step 5: Check the Network
Since each ACA plan’s network can differ, make sure to confirm that your preferred doctors, hospitals, and pharmacies are in-network — this can lower your medical expenses significantly. And if you notice some are out-of-network, reach out to the healthcare providers to find out whether discounts are available or if you will face higher rates.
Step 6: Look Over Benefits
All ACA plans must cover essential health benefits, including:
- Preventive services
- Emergency care
- Hospitalizations
- Prescription medications
- Maternity and newborn care
- Mental health and substance use treatment
Some ACA options also include dental or vision coverage. Review each plan’s benefits to ensure they meet your needs.
Step 7: Estimate Your Costs
Your monthly premium is only part of your health-related expenses. Compare:
- Deductibles — what you have to spend in a calendar year before your plan starts paying its share of covered care
- Copays — what you pay as a set fee for certain services or prescriptions
- Coinsurances — what you pay as a percentage of costs after meeting your deductible
- Out-of-pocket maximums — what you have to spend in a calendar year on covered care before your plan pays 100% of covered services
- In-network rates — what you pay for in-network care (providers contracted with your plan) is usually lower
- Out-of-network rates — what you pay for out-of-network care (providers outside your plan) is typically higher
Combine these with your potential subsidies to estimate your total annual cost for both premiums and care.
Step 8: Prepare for Special Enrollment Periods (SEPs)
Outside of open enrollment, you may qualify to enroll during a special enrollment period due to life events like:
- Marriage or divorce
- Childbirth or adoption
- Loss of health coverage (job-based insurance or COBRA)
You typically have 60 days from a qualifying event to enroll or make changes. Be sure to act quickly to avoid gaps in coverage.
Step 9: Enroll in Your Plan
When you are ready to enroll, work with a licensed agent, navigator, or certified application counselor such as MBhealth Insurance Agency.
If you want to keep your current ACA plan, make sure it is being offered in 2026 and check your auto re-enrollment status — and update your expected income for 2026 to avoid subsidy miscalculations. All of this can be handled seamlessly with the help of our agents at MBhealth.
Reach Out to MBheath for an ACA Consultation
At MBhealth, we know health insurance is more than just paperwork — it is peace of mind. If the ACA open enrollment period feels confusing or time-consuming, we can make the process easier for you.
Our expert team is here to help you compare plans, find the best fit, and enroll with confidence. Call us at (314) 350-4879 with any questions, or book a consultation at your convenience.
