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Pulaski Health Insurance

Facts and Figures

  • Insurance
    Carriers
    9
  • Number of
    General Doctors
    88
  • Number of
    Hospitals
    1

State Government Insurance Programs Offered

Missouri Health Insurance Pool (MHIP) www.mhip.org


Hospital, physician care, maternity, prescription drugs, some limitations on alcohol and drug abuse care. For most services, plan will pay for 80% of covered charges after you satisfy your annual deductible if you receive care in-network. After paying maximum amount of coinsurance charges for covered in-network services, MHIP will pay 100% of your covered charges for the rest of the calendar year. MHIP: Must be a Missouri resident with a qualifying health condition and show proof of one of the following: 1) Rejection for health coverage by an insurers for pre-existing condition; 2) Offer of coverage similar to but at rates higher than MHIP’s coverage; 3) Involuntary loss of coverage for a reason other than non-payment of premium or fraud; 4) Being a dependent of a person eligible for MHIP; 4) Eligibilty for HIPAA or Trade Adjustment Assistance. PCIP: Must be a Missouri resident, be uninsured for at least six months, and show proof of the following: 1) Lawful presence in the United States; 2) Having a pre-existing health condition.

MO Healthnet (Medicaid)


www.dss.mo.gov/mhd Inpatient and outpatient hospital care, Laboratory and x-rays, Physician’s services, Emergency ambulance, Audiology, Podiatry, Ambulatory surgical services, Durable medical equipment, Prosthetics and orthotics, Vision care, Family planning, Rehabilitative services and therapies, Midwife services, Federally qualified health centers or rural health clinics, Psychiatry, Transplants, Home and community based services, Waivers to person 65 and older, Persons with AIDS, or developmentally disabled individuals, Early and periodic screening, diagnosis and treatment (EPSDT) for children under 21 years old. Pre-Existing Health Conditions Covered Must be U.S. citizen or an eligible qualified non-citizen living in Missouri. Income limits: Infants ages 0–1: 185% FPL. Children ages 1–5: 133% FPL. Children ages 6 –18: 100% FPL. Parents/caretakers living with children ages 0–18: 25% FPL. Pregnant women: 185% FPL. Aged, blind, and disabled: 85% FPL with asset limit of $1,000 for singles and $2,000 for couples. Limited assets such as cash, savings, stocks and bonds.

Children and Youth with Special Health Care Needs Program (CYSHCN)


Children and Youth with Special Health Care Needs Program (CYSHCN) health.mo.gov Search: (Children Special Health Care Needs) Limited coverage includes Tests and evaluations, Inpatient care, Surgery, Therapy (physical, occupational, speech, language), Prescription medicines, Equipment, and supplies. Covered conditions include but are not limited to arthritis, Burns, Cerebral palsy, Cleft lip and palate, Cystic fibrosis, Digestive disorders, Ear infections (chronic), Hearing disorders, Heart disorders, Hemophilia, Hydrocephalus, Neuromuscular disorders, Orthopedic disorders, Paraplegia, Quadriplegia, Seizures, Sickle cell disease, Spina bifida, Spinal cord deformities, Traumatic brain injury, Urinary disorders. CYSHCN is payer of last resort. The program‘s service coordinator will assist the participant/family with resource identification and referral. All third party liability must be exhausted prior to accessing CYSHCN funds. Must be age 0–21, and reside in Missouri, with income limit of 185% FPL and a eligible special health care need.

MO HealthNet for Kids (MHK)


www.dss.mo.gov (Search: MHK) Comprehensive care including but not limited to doctor visits, mental, dental, prescriptions, hospitalization and more. Must be a U.S. citizen or an eligible qualified non-citizen living in Missouri. Income limits: Infants age 0–1: 185% FPL. Children ages 1–5: 133% FPL. Children ages 6–18: 100% FPL. Children ages 0–18 with no prior health insurance in the last 6 months: 300 % FPL.

Women-Infant- Children (WIC)


www.dhss.mo.gov/wic Nutrition education and services, breastfeeding promotion and education, monthly food prescription of nutritious foods, and access to maternal, prenatal and pediatric health-care services. Pregnant women, non-breastfeeding postpartum women (up to 6 months after delivery or termination of the pregnancy), breastfeeding women (up to 1 year after delivery as long as they are breastfeeding the baby), children age 0 to 5, and individually determined to be at “nutritional risk” by a health professional. Income must be at or below 185% FPL and live in Missouri.

Show Me Healthy Women


Offers screenings for breast and cervical cancer. Pelvic exams, Pap tests, clinical breast examinations (CBE), diagnostic breast and cervical exams, and mammograms. Must be U.S. citizens or legal permanent residents and live in Missouri. Income limit of 200% FPL. Must be women ages 50–64, or older without Medicare Part B. Women ages 35–49 are eligible for pelvic exams, Pap tests, clinical breast examinations (CBE), diagnostic breast services if CBE results are suspicious for cancer, and diagnostic cervical services if their initial/follow-up Pap test was abnormal. Women ages 50 and older get all benefits above plus mammograms. Cervical cancer screenings are offered to women who have had a hysterectomies. Treatment is available for U.S. citizens diagnosed with cancer through the Show Me Healthy Women program. Women with MO HealthNet, Medicare Part B or HMO health coverage are not eligible. WISEWoman: Must participa

WISe Woman


www.dhss.mo.gov/WISEWOMAN Offers health screenings and lifestyle education that can reduce the risk of heart disease and stroke. Must participate in the Show Me Healthy Women breast and cervical cancer control project and be 35–64 years old

Medicare www.medicare.gov


Medicare offers Part A, inpatient care in hospitals and rehabilitative centers; Part B, doctor and some preventive services and outpatient care; Part C allows Medicare benefits through private insurance (Medicare Advantage); Part C includes Parts A, B, and C not covered by Medicare. Part D covers prescription drugs. Senior Rx is a prescription discount program. Medicare: Must be U.S. citizen or permanent U.S. resident, and: 1) If 65 years or older, you or your spouse worked for at least 10 years in Medicare-covered employment, or 2) You have a disability or end-stage renal disease (permanent kidney failure requiring dialysis or transplant) at any age. Senior Rx: To qualify for Senior RX you must have Medicare Part D. If you are single your income must be at or below $21,660 and if you are a married your income must be below $29,140

VA Medical Benefits Package


www.va.gov Comprehensive preventive and primary care, outpatient and inpatient services. ”Veteran status” = active duty in the U.S. military, naval, or air service and a discharge or release from active military service under other than dishonorable conditions. Certain veterans must have completed 24 continuous months of service.

Heath Care Reform

Small business tax credits.  94,300 small businesses in Missouri could be helped by a new small business tax credit that makes it easier for businesses to provide coverage to their workers and makes premiums more affordable.1  Small businesses pay, on average, 18 percent more than large businesses for the same coverage, and health insurance premiums have gone up three times faster than wages in the past 10 years.  This tax credit is just the first step towards bringing those costs down and making coverage affordable for small businesses.

Closing the Medicare Part D donut hole. Last year, roughly 82,100 Medicare beneficiaries in Missouri hit the donut hole, or gap in Medicare Part D drug coverage, and received no extra help to defray the cost of their prescription drugs.2 Medicare beneficiaries in Missouri who hit the gap this year will automatically be mailed a one-time $250 rebate check. These checks will begin to be mailed to beneficiaries in mid-June and will be mailed monthly throughout the year as new beneficiaries hit the donut hole. The new law continues to provide additional discounts for seniors on Medicare in the years ahead and completely closes the donut hole by 2020. 

Support for health coverage for early retirees. An estimated 82,600 people from Missouri retired before they were eligible for Medicare and have health coverage through their former employers. Unfortunately, the number of firms that provide health coverage to their retirees has decreased over time.3  Beginning June 1, 2010, a $5 billion temporary early retiree reinsurance program will help stabilize early retiree coverage and help ensure that firms continue to provide health coverage to their early retirees. Companies, unions, and state and local governments are eligible for these benefits.

New consumer protections in the insurance market beginning on or after September 23, 2010.

Insurance companies will no longer be able to place lifetime limits on the coverage they provide, ensuring that the 3.3 million Missouri residents with private insurance coverage never have to worry about their coverage running out and facing catastrophic out-of-pocket costs.

Insurance companies will be banned from dropping people from coverage when they get sick, protecting the 335,000 individuals who purchase insurance in the individual market from dishonest insurance practices.

Insurance companies will not be able to exclude children from coverage because of a pre-existing condition, giving parents across Missouri peace of mind.

Insurance plans’ use of annual limits will be tightly regulated to ensure access to needed care.  This will protect the 3 million residents of Missouri with health insurance from their employer, along with anyone who signs up with a new insurance plan in Missouri.

Health insurers offering new plans will have to develop an appeals process to make it easy for enrollees to dispute the denial of a medical claim.

Patients’ choice of doctors will be protected by allowing plan members in new plans to pick any participating primary care provider, prohibiting insurers from requiring prior authorization before a woman sees an ob-gyn, and ensuring access to emergency care.

Extending coverage to young adults. Beginning on or after September 23, 2010, plans and issuers that offer coverage to children on their parents’ policy must allow children to remain on their parents’ policy until they turn 26, unless the adult child has another offer of job-based coverage in some cases. This provision will bring relief to roughly 20,000 individuals in Missouri who could now have quality affordable coverage through their parents.4  Some employers and the vast majority of insurers have agreed to cover adult children immediately.

Affordable insurance for uninsured with pre-existing conditions. $81.3 million federal dollars are available to Missouri starting July 1 to provide coverage for uninsured residents with pre-existing medical conditions through a new transitional high-risk pool program, funded entirely by the Federal government. The program is a bridge to 2014 when Americans will have access to affordable coverage options in the new health insurance exchanges and insurance companies will be prohibited from denying coverage to Americans with pre-existing conditions. If states choose not to run the program, the Federal government will administer the program for those residents.

Strengthening community health centers. Beginning October 1, 2010, increased funding for Community Health Centers will help nearly double the number of patients seen by the centers over the next five years. The funding could not only help the 180 Community Health Centers in Missouri but also support the construction of new centers.

More doctors where people need them. Beginning October 1, 2010, the Act will provide funding for the National Health Service Corps ($1.5 billion over five years) for scholarships and loan repayments for doctors, nurses and other health care providers who work in areas with a shortage of health professionals. This will help the 19% of Missouri’s population who live in an underserved area.

New Medicaid options for states. For the first time, Missouri has the option of Federal Medicaid funding for coverage for all low-income populations, irrespective of age, disability, or family status. 

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