Health insurance in Missouri
365,432 Missouri residents bought a marketplace plan for 2026. What they were offered depended on which of the state's 113 counties they live in.
Source: CMS Marketplace Open Enrollment Public Use Files and US Census Small Area Health Insurance Estimates, 2026 release. Figures cover the under-65 population.
Where you enroll
Missouri uses the federally facilitated marketplace, so you enroll at HealthCare.gov on the federal calendar — the dates are here.
Medicaid covers the bottom of the range in Missouri
Missouri expanded Medicaid, so there is no coverage gap here: adults under 138% of the poverty guideline — about $22,025 for one person — go to Medicaid rather than falling between it and the subsidy.
456,594 under-65 Missouri residents are uninsured all the same, 9.2% of them — 22nd of the 51 states and DC, and 0.9× the 26-state median of 9.9%.
How much choice Missouri counties get
Counties in Missouri carry between 2 and 6 insurers, so competition is fairly even across the state without being uniform.
No county in Missouri is down to a single insurer. Since the previous plan year, 113 counties in Missouri gained an insurer and none lost one.
How many Missouri residents buy on the marketplace
365,432 Missouri residents selected a marketplace plan for 2026. Against the state's under-65 population that is 74 per thousand, close to the 26-state median of 79, and 15th highest of the 26 states on this site.
Of those, 46,261 — 13% — were new rather than renewing, which is a fairly typical mix of new and renewing enrollees (23rd of 26).
The spread inside Missouri
St. Louis County is the largest county we publish here, with 777,655 under-65 residents; Franklin County is the smallest, with 85,622. St. Louis County has 6 insurers offering 68 plans, and Franklin County has 4 offering 48.
The widest choice in Missouri is in St. Louis County — 6 insurers, 68 plans. The narrowest is Greene County, with 4 insurers and 48 plans. Same state, same rules, 20 more plans to choose from.
Uninsured rates range from 5.3% in St. Charles County to 12.1% in Jasper County — 2.3 times as high, within one state.
The 12 largest counties in Missouri
By under-65 population, covering 63% of the state's under-65 residents. Missouri has 113 counties with complete federal data; we publish pages for the largest.
| County | Under 65 | Uninsured | Insurers | Plans | Per 1,000 |
|---|---|---|---|---|---|
| St. Louis County | 777,655 | 6.6% | 6 | 68 | 79 |
| Jackson County | 596,930 | 10.2% | 5 | 58 | 76 |
| St. Charles County | 348,262 | 5.3% | 6 | 68 | 51 |
| Greene County | 247,489 | 9.9% | 4 | 48 | 86 |
| Clay County | 221,547 | 8.0% | 5 | 55 | 59 |
| St. Louis city | 220,460 | 10.4% | 6 | 68 | 103 |
| Jefferson County | 191,304 | 7.7% | 4 | 48 | 57 |
| Boone County | 155,950 | 7.6% | 4 | 48 | 46 |
| Jasper County | 103,631 | 12.1% | 4 | 48 | 77 |
| Platte County | 94,270 | 6.4% | 5 | 55 | 55 |
| Cass County | 92,931 | 8.2% | 5 | 54 | 58 |
| Franklin County | 85,622 | 8.8% | 4 | 48 | 72 |
Source: CMS Marketplace Open Enrollment Public Use Files and US Census Small Area Health Insurance Estimates, 2026 release. "Per 1,000" is marketplace plan selections per thousand under-65 residents.
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