Missouri health plan · 2026

UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) · 95426MO0410006

UnitedHealthcare Insurance Company offers this marketplace health insurance plan (Plan ID 95426MO0410006) so you can compare premiums, coverage levels, and provider access against other health plan insurance options. Use the modules below to decide whether this is the best health insurance plan for your household or if another insurance health plan fits better.

Metal level: Silver Plan type: EPO CSR: 73% AV Level Silver Plan Issuer: UnitedHealthcare Insurance Company
Telehealth Data pending HSA eligible No Dental Child Vision Child

Issuer actuarial value: 73.06%. Expect to pay roughly 26.94% of covered costs out of pocket, based on issuer reporting.

2026 cost summary

Key premiums & cost sharing

Rates mirror the latest CMS import (Tue, 02 Dec 2025 06:13 GMT). Personalize costs with your ZIP, age, and subsidies in the plan finder.

Monthly premium

$374 – $1930

Before subsidies

Estimate after subsidies

Deductible

N/A

N/A

See deductible details

Max out-of-pocket

$8,350

$16700 per group

Review MOOP rules

Office visits

Primary care $50.00
Specialist $100.00
HSA Not eligible

Drug tiers

Generic $10.00
Preferred brand $85.00 Copay after deductible

View formulary tiers

$661 / mo before subsidies

≈ $7935 per year before tax credits.

Start with this unsubsidized premium, then apply marketplace tax credits to see your final monthly payment.

  • Ideal for shoppers comparing Bronze vs. Silver budgets.
  • Update your Marketplace application to apply premium tax credits.

$1892 / mo before subsidies

≈ $22704 per year before tax credits.

Pre-subsidy rate for a couple with one dependent. Switch to Silver CSR plans if you qualify to reduce these numbers.

  • Compares well against PPO vs HMO networks when planning for childcare and telehealth needs.
  • This Silver tier qualifies for CSR if household income is ≤250% FPL.

$2299 / mo before subsidies

≈ $27591 per year before tax credits.

Pairs with cost-sharing reductions (CSR) when you select a Silver tier and qualify based on income.

  • Use this estimate before adding childcare, dental, or vision extras.
  • CSR Silver variants can lower deductibles dramatically for eligible incomes.
  • This Silver tier qualifies for CSR if household income is ≤250% FPL.

$1449 / mo before subsidies

≈ $17382 per year before tax credits.

Shows the combined pre-subsidy rate for two adults. Add dependents or subsidies in your application to refine it.

  • Great for households deciding between PPO and HMO networks.
  • Telehealth and HSA perks (when offered) apply to both members.
Issuer profile See benefits

Preventive Care/Screening/Immunization

No Charge

Emergency Room Services

$1,800.00

Durable Medical Equipment

30.00%

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Enrollment guidance

Stay on top of 2026 ACA deadlines

Open Enrollment window

Marketplace enrollment for 2026 coverage typically runs Nov 1 – Jan 15 (dates may vary slightly in Missouri). Submit changes before the deadline to avoid a coverage gap.

  • Enroll by Dec 15 for Jan 1 starts.
  • Finalize plan switches before the window closes.

Special Enrollment Periods

You can change plans mid-year if you experience a qualifying life event (move, childbirth, marriage, loss of other coverage).

  • Report the event within 60 days.
  • Keep documentation handy for Healthcare.gov or your state exchange.

CSR & subsidy reminders

Premium tax credits and cost-sharing reductions (CSR) update annually when you re-submit your marketplace application.

  • Enter accurate income to maximize Advanced Premium Tax Credits.
  • 73% AV Level Silver Plan plans like this one keep deductibles and copays lower if you qualify.

Thinking about switching?

Before you leave your current plan, compare networks, drug coverage, and total cost using the cards on this page.

  • Match provider networks so ongoing care isn’t disrupted.
  • Confirm prescriptions stay on-formulary or budget for tier changes.

Top covered benefits

How this plan handles key care scenarios

Preventive Care/Screening/Immunization

No Charge

Emergency Room Services

$1,800.00

Durable Medical Equipment

30.00%

Premium snapshot

Plan identifiers & filings

Track the official identifiers, documents, and filing dates tied to this plan. Open the marketing or formulary links whenever you need the latest PDF from the issuer.

Network stats

Provider access snapshot

Review the network branding plus the number of in-network clinicians we track from issuer filings. Counts update with each CMS import (Tue, 02 Dec 2025 06:13 GMT).

All providers in Missouri 128
PCPs in Missouri 2
Telehealth support Data pending
Nationwide providers 505
128 doctors statewide 2 PCPs
Providers Missouri All US states
All 128 505
PCP 2 11
Allergy N/A N/A
OB/GYN N/A N/A
Dentists N/A N/A

Drug coverage overview

3,742 drugs tracked

Inspect tier distribution plus authorization, step therapy, and quantity-limit counts sourced from HealthPorta’s formulary import.

Tier Covered drugs
NON-PREFERRED-BRAND 1,436
PREFERRED-GENERIC 1,399
ZERO-COST-SHARE-PREVENTIVE 481
SPECIALTY 426
Prior authorization Drugs
Required 673
Not Required 3,069
Step therapy Drugs
Required 52
Not Required 3,690
Quantity limits Drugs
Has Limit 1,739
No Limit 2,003

Customer highlights

What stands out for members

  • Issuer: UnitedHealthcare Insurance Company · Plan ID 95426MO0410006 · 2026 filing.
  • Download the latest formulary directly from the issuer here.
  • Review marketing brochures and SBC PDFs via the issuer marketing repository.
  • Variant 95426MO0410006-04 (73% AV Silver Plan) currently displayed.
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Benefits

Covered services & limitations

Everyday care

Office visits, preventive care, labs, imaging, and home health.

Chiropractic Care

30.00%

Diabetes Education

30.00%

Home Health Care Services

30.00%

Laboratory Outpatient and Professional Services

$35.00

Other Practitioner Office Visit (Nurse, Physician Assistant)

30.00%

Preventive Care/Screening/Immunization

No Charge

Primary Care Visit to Treat an Injury or Illness

$50.00

Rehabilitative Occupational and Rehabilitative Physical Therapy

$50.00

Rehabilitative Speech Therapy

$50.00

Specialist Visit

$100.00

Urgent Care Centers or Facilities

$75.00

X-rays and Diagnostic Imaging

$65.00

Hospital & urgent

Emergency room, inpatient stays, ambulance, and surgeries.

Chemotherapy

$750.00

Delivery and All Inpatient Services for Maternity Care

$2,500.00

Dialysis

$500.00

Durable Medical Equipment

30.00%

Emergency Room Services

$1,800.00

Emergency Transportation/Ambulance

$1,800.00

Hospice Services

30.00%

Inpatient Hospital Services (e.g., Hospital Stay)

$2500.00 Copay per Day

Inpatient Physician and Surgical Services

No Charge

Mental/Behavioral Health Inpatient Services

$2500.00 Copay per Day

Mental/Behavioral Health Outpatient Services

$50.00

Outpatient Facility Fee (e.g., Ambulatory Surgery Center)

$900.00

Outpatient Rehabilitation Services

$50.00

Outpatient Surgery Physician/Surgical Services

$250.00

Radiation

$100.00

Skilled Nursing Facility

$2500.00 Copay per Day

Substance Abuse Disorder Inpatient Services

$2500.00 Copay per Day

Substance Abuse Disorder Outpatient Services

$50.00

Transplant

$2,500.00

Pregnancy & family

Maternity, newborn, pediatric dental and vision extras.

Basic Dental Care - Child

30.00%

Hearing Aids

30.00%

Major Dental Care - Child

30.00%

Prenatal and Postnatal Care

No Charge

Routine Eye Exam for Children

No Charge

Well Baby Visits and Care

No Charge

Pharmacy & drugs

Generic, brand, specialty, and mail order tiers.

Generic Drugs

$10.00

Non-Preferred Brand Drugs

40.00% Coinsurance after deductible

Preferred Brand Drugs

$85.00 Copay after deductible

Specialty Drugs

50.00% Coinsurance after deductible

Wellness & extras

Vision, dental, therapies, prosthetics, weight management.

Accidental Dental

30.00%

Basic Dental Care - Adult

Coverage details pending

Dental Check-Up for Children

No Charge

Infusion Therapy

$100.00

Major Dental Care - Adult

Coverage details pending

Nutritional Counseling

30.00%

Orthodontia - Adult

Coverage details pending

Orthodontia - Child

50.00%

Prosthetic Devices

30.00%

Routine Dental Services (Adult)

Coverage details pending

Weight Loss Programs

Coverage details pending

Additional benefits

Other plan-specific services and limitations.

Abortion for Which Public Funding is Prohibited

Coverage details pending

Acupuncture

Coverage details pending

Allergy Testing

30.00%

Bariatric Surgery

Coverage details pending

Cosmetic Surgery

Coverage details pending

Eye Glasses for Children

30.00%

Gender Affirming Care

$900.00

Habilitation Services

$50.00

Imaging (CT/PET Scans, MRIs)

$300.00

Infertility Treatment

Coverage details pending

Long-Term/Custodial Nursing Home Care

Coverage details pending

Private-Duty Nursing

30.00%

Reconstructive Surgery

$900.00

Routine Eye Exam (Adult)

Coverage details pending

Routine Foot Care

$100.00

Treatment for Temporomandibular Joint Disorders

30.00%

Variant attributes

UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) · Variant 95426MO0410006-04

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2026

CSR Variation Type

73% AV Level Silver Plan

HIOS Product ID

95426MO041

Metal Level

Silver

Plan ID (Standard Component ID with Variant)

95426MO0410006-04

Plan Marketing Name

UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)

Plan Variant Marketing Name

UHC Silver-E Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)

Issuer & service area

Issuer-provided metadata for this variant.

Issuer Actuarial Value

73.06%

Issuer ID

95426

Issuer Marketplace Marketing Name

UnitedHealthcare

Market Coverage

Individual

Multiple In Network Tiers

No

National Network

No

Network ID

MON011

Out of Country Coverage

No

Out of Service Area Coverage

Yes

Out of Service Area Coverage Description

Plan covers eligible expenses provided by a Network Physician or other provider or facility within the Network Area. The Network Area may include select Network providers located in a neighboring state. The plan also covers emergency health care services received outside the service area.

Service Area ID

MOS011

State Code

MO

URL for Summary of Benefits & Coverage

Open link

Cost sharing & actuarial values

Issuer-provided metadata for this variant.

Begin Primary Care Deductible Coinsurance After Number Of Copays

0

Drug EHB Deductible, In Network (Tier 1), Default Coinsurance

0.00%

Inpatient Copayment Maximum Days

3

Medical Drug Deductibles Integrated

No

Medical Drug Maximum Out of Pocket Integrated

Yes

Medical EHB Deductible, In Network (Tier 1), Default Coinsurance

30.00%

SBC Scenario, Having a Baby, Coinsurance

$0

SBC Scenario, Having a Baby, Copayment

$3,100

SBC Scenario, Having a Baby, Deductible

$0

SBC Scenario, Having Diabetes, Coinsurance

$0

SBC Scenario, Having Diabetes, Copayment

$700

SBC Scenario, Having Diabetes, Deductible

$0

SBC Scenario, Treatment of a Simple Fracture, Coinsurance

$10

SBC Scenario, Treatment of a Simple Fracture, Copayment

$2,500

SBC Scenario, Treatment of a Simple Fracture, Deductible

$0

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group

per group not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person

per person not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual

Not Applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group

$16700 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person

$8350 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual

$8,350

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group

per group not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person

per person not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual

Not Applicable

Enrollment & documents

Issuer-provided metadata for this variant.

Formulary ID

MOF029

Formulary URL

Open link

Plan Brochure

Open link

SBC Scenario, Having a Baby, Limit

$60

SBC Scenario, Having Diabetes, Limit

$0

SBC Scenario, Treatment of a Simple Fracture, Limit

$0

URL for Enrollment Payment

Open link

Additional attributes

Issuer-provided metadata for this variant.

Begin Primary Care Cost-Sharing After Number Of Visits

0

Child-Only Offering

Allows Adult and Child-Only

Composite Rating Offered

No

Drug EHB Deductible, Combined In/Out of Network, Family Per Group

per group not applicable

Drug EHB Deductible, Combined In/Out of Network, Family Per Person

per person not applicable

Drug EHB Deductible, Combined In/Out of Network, Individual

Not Applicable

Drug EHB Deductible, In Network (Tier 1), Family Per Group

$5000 per group

Drug EHB Deductible, In Network (Tier 1), Family Per Person

$2500 per person

Drug EHB Deductible, In Network (Tier 1), Individual

$2,500

Drug EHB Deductible, Out of Network, Family Per Group

per group not applicable

Drug EHB Deductible, Out of Network, Family Per Person

per person not applicable

Drug EHB Deductible, Out of Network, Individual

Not Applicable

Dental Only Plan

No

Design Type

Not Applicable

EHB Percent of Total Premium

1

First Tier Utilization

100%

Import Date

10/15/2025

Limited Cost Sharing Plan Variation - Estimated Advanced Payment

$0.00

HSA Eligible

No

New/Existing Plan

Existing

Notice Required for Pregnancy

No

Is a Referral Required for Specialist?

No

Medical EHB Deductible, Combined In/Out of Network, Family Per Group

per group not applicable

Medical EHB Deductible, Combined In/Out of Network, Family Per Person

per person not applicable

Medical EHB Deductible, Combined In/Out of Network, Individual

Not Applicable

Medical EHB Deductible, In Network (Tier 1), Family Per Group

$0 per group

Medical EHB Deductible, In Network (Tier 1), Family Per Person

$0 per person

Medical EHB Deductible, In Network (Tier 1), Individual

$0

Medical EHB Deductible, Out of Network, Family Per Group

per group not applicable

Medical EHB Deductible, Out of Network, Family Per Person

per person not applicable

Medical EHB Deductible, Out of Network, Individual

Not Applicable

Plan Effective Date

1/1/2026

Plan Level Exclusions

Some exclusions may apply. See the applicable Certificate of Coverage for details.

Plan Type

EPO

QHP/Non QHP

Both

Source Name

HIOS

Plan ID

95426MO0410006

Unique Plan Design

Yes

Wellness Program Offered

No

Copay & coinsurance

Pharmacy cost sharing by tier

Drug tier Pharmacy type Copay amount Copay option Coinsurance rate Coinsurance option Mail order

Questions & answers

Frequently asked questions

How do I choose the right ACA plan in Missouri?

UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) (95426MO0410006) is a Silver EPO from UnitedHealthcare Insurance Company in Missouri for the 2026 coverage year.

Compare it against other options with the HealthPorta plan finder to confirm premiums, deductibles, and network access fit your household.

Does UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) support telehealth or virtual urgent care?

The issuer has not published telehealth details yet. Review the Summary of Benefits and Coverage to confirm if virtual visits are included.

Is UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) HSA-eligible and does it include dental or vision coverage?

It is not marked as HSA-eligible, so confirm with the issuer before relying on tax-advantaged savings.

Dental add-ons: Child.

Vision add-ons: Child.

Does UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) support mail-order prescriptions?

Mail order coverage is not listed for this plan, so confirm with the issuer before relying on home delivery.

Is there out-of-country coverage for UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)?

No, out-of-country services are not covered for this plan.

Does UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) cover care outside the service area?

Yes, you have limited out-of-area coverage. See the plan documents for referral and prior authorization rules. Details: Plan covers eligible expenses provided by a Network Physician or other provider or facility within the Network Area. The Network Area may include select Network providers located in a neighboring state. The plan also covers emergency health care services received outside the service area.

How do I enroll in or manage payments for UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)?

Use the issuer portal https://sso.uhc.com/ext/sp/ACS.saml2 to pay premiums or start enrollment, then return to HealthPorta for benefit comparisons.

Disclaimer: Based on the Tue, 02 Dec 2025 06:13 GMT HealthPorta import from CMS issuer filings. Data is best-effort and should be validated with the issuer directly. Sources: CMS.gov and the HealthPorta Healthcare MRF API.
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