Saint Louis DSA

About health coverage

  • Cover Missouri – FREE in person help enrolling in marketplace (ACA)  insurance and choosing the best plan for you. Appointments can often be scheduled online. Plug in zipcode to find a location close to you. https://findlocalhelp.covermissouri.org/
    • If your income, insurance status (lost insurance through work or other plan ended), address (such as moved from out of state or different region), or family size has changed (having children, children aged out, marriage or separation, etc.). Otherwise, you must enroll towards the end of the year. Check healthcare.gov for up to date information.
  • Gateway to Better health – Apply on site at one of the St. Louis City or County Health Centers or Health Departments. Once you are enrolled, you select which health center you want to establish care at. You do not have monthly premiums and, depending on your income, your copays are very low or none at all. Specialty referrals are available if needed. Individuals making under 100% Federal Poverty Line (Less than $12,060/year before taxes) who do not qualify for Medicaid should apply for the Gateway to Better Health.
    • For full list of qualifications and eligible health centers, visit http://stlgbh.com/programoverview
    • Funding for Gateway to Better Health is not guaranteed. Applications are not guaranteed and enrollees are not indefinitely enrolled. Program subject to renewal and funding.
    • See below for the Federally Qualified Health Centers
  • Legal Services can assist with appealing and processing additional requests if you need assistance with the paperwork
  • http://lsem.org/medical-legal-partnership/
  • Medicaid: Individuals can apply online at mydss.mo.gov or by phone at 1-855-373-9994. More information may be requested by mail, be sure to follow-up as required.
    • https://mydss.mo.gov/qualify
    • Medicaid is a state insurance program for low income OR individuals with disabilities. Individuals MUST apply for the program and income guidelines vary by state and family size. Assets such as property including vehicles, life insurance policies, etc. are calculated to determine if someone qualifies.
    • When you apply, either in person, online or using a paper application, you will be mailed additional paperwork to fill out
      • For example, if you apply due to having a disability, you will be sent a disability questionnaire.
      • You may be sent a document that requests you list your history of employment
      • You may also be asked for your medical records
      • You may also be asked for additional proofs of income such as bank statements or check stubs
      • Whatever additional requests, you must complete them as soon as possible or your Medicaid application will be terminated and you will have to start over
    • Medicaid is not always free. Some people qualify and have to pay a spenddown, which is basically a monthly premium. or provide your medical bills for a month to demonstrate that your medical bills exceed your spenddown.
      • You may appeal Medicaid’s decision to reject your application or charge you a spenddown, but this will require some legal assistance unfortunately
    • If you have Medicaid, you must recertify every year or lose your Medicaid coverage. Make sure to update your contact information such as address and phone number.
    • Once you get Medicaid, coverage can also apply retroactively to some medical bills.

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