Missouri health plans would cover recommended preventive care without cost-sharing

Health carriers and health plans would cover certain recommended preventive care without requiring patients to share the cost. This applies to health plans delivered, issued for delivery, continued, or renewed in Missouri on or after January 1, 2026. Covered care includes services with an A or B rating from the U.S. Preventive Services Task Force, recommended immunizations, and preventive care or screening in federal health guidelines. Plans may charge cost-sharing for these services when an out-of-network provider delivers them, to the extent allowed by law. For people in high-deductible health plans, plans may apply the deductible unless the insurance director determines the services qualify for a federal preventive-care safe harbor. The proposal does not prevent plans from covering additional services or denying coverage for services not recommended by the Task Force. The coverage requirement would apply to plans delivered, issued for delivery, continued, or renewed on or after January 1, 2026.

The insurance director would enforce the coverage rules and adopt regulations for later federal preventive-care recommendations. These duties would apply to the director of Missouri's Department of Commerce and Insurance and to the health carriers and plans covered by the section. The director would enforce the rules using recommendations and guidance in effect on December 31, 2025, along with related federal rules or guidance. New rules would have to follow Missouri's rulemaking process. This section and that process are nonseverable, meaning the rulemaking authority would be invalid if the specified legislative review powers were held unconstitutional. Regulations would cover recommendations and guidelines issued after December 31, 2025. Rules proposed or adopted after August 28, 2026, would be invalid if the specified legislative review powers were held unconstitutional.

The Department of Commerce and Insurance would create an advisory committee to recommend updates to covered preventive care. The committee would advise the department, the General Assembly, and the governor about updates or changes to the preventive care described in the proposal. The director would appoint five members: three health care provider representatives and two health carrier or health plan representatives. Members would serve without pay or expense reimbursement and at the director's pleasure. The committee would meet at least once a year and send any recommendations by November 1 each year.