Depending on the county, here are some of the insurance carriers Missouri employees can choose from:

• Aetna

• Ambetter from Home State Health

• Anthem Blue Cross Blue Shield

• Blue Cross Blue Shield of Kansas City

• Oscar Health

• UnitedHealthcare

Missouri's individual health insurance market includes nine carriers for 2026, giving employers meaningful choice for their employees depending on location. St. Louis metro residents typically see seven carriers competing for their business, which helps keep plans competitive, while UnitedHealthcare's statewide coverage ensures every Missouri employee has at least one reliable marketplace option, no matter their county.

• QSEHRA (Qualified Small Employer Health Reimbursement Arrangement): For businesses with fewer than 50 employees that don't offer a group plan. It has set annual contribution limits ($6,450 for individuals / $13,150 for families in 2026).

• ICHRA (Individual Coverage Health Reimbursement Arrangement): For businesses of any size. There are no contribution limits, and you can offer different reimbursement amounts to different employee classes (e.g., $400/mo for full-time and $200/mo for part-time).

No, Missouri doesn't operate its own state health exchange. Employees shop for ACA-compliant plans through the federal marketplace at HealthCare.gov, where they can compare and enroll in coverage from any of Missouri's participating carriers.

HRAs offer a double tax advantage in Missouri. Contributions made by the employer are 100% tax-deductible as a business expense, and the reimbursements received by employees are 100% tax-free.

Missouri small business health insurance typically comes in three forms: traditional group plans, QSEHRA, and ICHRA. Group plans require you to pick one plan for your whole team and often come with steep annual renewal increases. QSEHRA and ICHRA let you set a fixed monthly allowance instead, and your employees choose their own plan from Missouri's individual marketplace—where most counties offer four or more carriers to choose from. For small businesses with fewer than 50 employees, QSEHRA is often the simplest starting point, while ICHRA works for businesses of any size and offers more flexibility in how you structure contributions.