Macon County residents who buy health insurance through HealthCare.gov are paying twice as much each month on average as they did a year ago, and insurers have asked to raise 2027 rates.
Macon County residents who picked a marketplace plan during last winter's open enrollment were paying an average of $162 a month after federal tax credits, according to county data the Centers for Medicare & Medicaid Services released this year. A year earlier the figure was $81.
The change came after the larger premium tax credits Congress put in place in 2021 expired at the end of 2025, according to CMS's 2026 open enrollment report. The basic credits remain, but they are smaller.
The tax credits still cover most of the bill for most local buyers. Of the 765 Macon County residents who selected a plan for 2026, 706 qualified for a credit, and the average credit was $892 a month against an average full premium of $985, according to the CMS data. But those who pay $10 a month or less fell from 474 people to 220.
Open enrollment for 2027 coverage runs Nov. 1 through Jan. 15. People who want coverage to start Jan. 1 must pick a plan by Dec. 15, according to HealthCare.gov.
Fewer people signed up locally this year. Macon County plan selections dropped from 819 for 2025 to 765 for 2026, a decline of 6.6 percent. Statewide, Missouri selections fell 12.3 percent, from 417,000 to 365,734. Every county bordering Macon lost enrollees, from 1.2 percent in Linn County to 17.2 percent in Monroe County.
The jump in what people pay hit the whole region. In every county touching Macon, the average monthly bill after tax credits rose at least 85 percent. Here are 2026 enrollment and the average monthly bill after credits, 2025 to 2026:
- Adair: 1,257 enrollees, $73 to $169
- Chariton: 407 enrollees, $101 to $214
- Knox: 246 enrollees, $100 to $185
- Linn: 502 enrollees, $78 to $189
- Macon: 765 enrollees, $81 to $162
- Monroe: 536 enrollees, $83 to $201
- Randolph: 1,174 enrollees, $70 to $164
- Shelby: 260 enrollees, $104 to $229
Missouri's statewide average after tax credits went from $91 to $173.
Local buyers also moved to cheaper coverage. Macon County bronze plan selections rose from 303 to 429, while silver plans fell from 458 to 296. Bronze plans carry lower monthly premiums but higher deductibles. Nationally, the silver share of plan selections fell from 56 percent to 43 percent, according to CMS.
Rural enrollment fell faster than city enrollment across the country. CMS reported rural consumers dropped 10 percent for 2026, compared with 4 percent in non-rural areas. Nationwide plan selections totaled 23.1 million, down 1.2 million, or 5 percent.
The next round of price changes is still being settled. Four companies told the Missouri Department of Commerce and Insurance they plan to sell individual health plans in Macon County in 2027, according to the department's carriers-by-county list, current as of July 31. Three sell on HealthCare.gov: Ambetter from Home State Health, Anthem Blue Cross and Blue Shield, and UnitedHealthcare. A fourth, Ambetter Health, sells only off the exchange. All seven neighboring counties show the same four companies.
Those companies proposed statewide average increases for 2027 of 10.28 percent for Ambetter from Home State Health, 12.67 percent for Anthem, 16.51 percent for UnitedHealthcare, and 11.32 percent for Ambetter Health, according to the department's proposed rate filings as of July 31. The department notes the carrier list is not binding and may change, and the proposed rates are averages that vary by plan, age, and location.
The Missouri Department of Commerce and Insurance had not responded by publication time to questions sent Friday morning about whether 2027 rates are final and whether the July 31 list of companies selling plans in Macon County still stands.
A rate increase does not translate directly into a bigger bill for people who get a tax credit. The credit is figured from the premium of the second-lowest-cost silver plan in the marketplace that applies to each household, which may not be the plan the household picks, according to HealthCare.gov. People who don't qualify for a credit pay the full premium.
CMS also ended tax credits or coverage for nearly 1.5 million people nationwide during 2026 open enrollment after finding they were ineligible or had been enrolled without their authorization, according to its report.
The largest age group among Macon County marketplace customers is 55 to 64, with 228 people this year, down from 243. The CMS data count people who picked a plan during open enrollment; some may not have paid a first premium.
Marketplace plans are separate from Medicare. The Chronicle reported Thursday that Medicare plans covering at least 254 Macon County residents end Dec. 31.
Plans and prices for 2027 can be compared at HealthCare.gov or by calling the marketplace at 1-800-318-2596, which HealthCare.gov lists as open 24 hours a day, seven days a week, except holidays. Missourians with insurance questions can call the Department of Commerce and Insurance consumer hotline at 800-726-7390.