Family MO HealthNet (MAGI)

1855.020.60 Private Insurance

IM-#92, July 11, 2017IM-#10, January 30, 2017IM-#110, December 31, 2015

If affordable employer sponsored insurance is not available, evaluate access to affordable private insurance coverage. FSD must refer to the Affordability Calculator to determine if affordable insurance is available.

If the Affordability Calculator determines that affordable insurance is available and the family disagrees with this decision, they may provide quotes verbally or in writing on the cost of health insurance for the mother and unborn child which include maternity services from two private insurance companies.

Applicants may submit this information in one of the following ways:

  • contacting the FSD Information Center (855-373-4636); or
  • Reporting verbally or in writing at a FSD office.

NOTE: Written verification from the insurance companies is not required, but the applicant must supply names of the insurance companies.

NOTE: Undocumented immigrants do not have access to affordable insurance, as they cannot purchase an insurance plan through the Federally-facilitated Market Place at www.Healthcare.gov.

A private insurance policy causes ineligibility if it:

  • Has a premium that meets the affordable definition in Section 1840.010.15.05 Affordable Insurance Definition; or
  • Covers the same pregnancy-related services as SMHB.

If the private insurance quotes are above the affordable amount, the family does NOT have access to affordable insurance and the pregnant woman and unborn child are eligible on that factor. If one or both of the private insurance quotes are less than the affordable amount the family has access to affordable insurance and the pregnant woman and unborn child are not eligible for SMHB coverage.