- In 2019, there were 63 Medicare Advantage Plans in Missouri.
- 32% of the total Medicare population in Missouri was enrolled in Medicare Advantage Plans as of 2018.
- In 2018, Original Medicare spent an average of $10,205 per beneficiary in Missouri, which is 1% higher than the national average.
- Available Medicare Advantage Plans range from nine to 42 across Missouri’s 114 counties.
Although Medicare Advantage Plans are offered by private insurance companies instead of the federal government, all plans must follow Medicare’s coverage rules and provide you with the same rights and protections you get with Original Medicare. Missouri’s Medicare Advantage Plans have a range of costs and coverage levels, and plan availability varies depending on your location within the state and that area’s health insurance providers.
Medicare Advantage Plans in Missouri
Types of Medicare Advantage Plans
Missouri’s Medicare Advantage program includes several plan options, but insurance companies usually don’t serve every county. HMOs and PPOs are the two most common types of plans, so you’ll find a variety of these, but there are a limited number of PFFS plans available in Missouri and even fewer SNPs.
Health Maintenance Organizations (HMO)
HMOs are more restrictive than other Medicare Advantage Plans but often offer the lowest premiums and no or low deductibles. Most HMO plans require you to see health care providers within a defined network, except for emergency care or out-of-area urgent care or dialysis. Some plans, called HMO point-of-service plans, let you see out-of-network providers for some services, but you’ll pay more out of pocket. HMOs also require you to choose a primary care physician (PCP) and get referrals before seeing any specialists.
Preferred Provider Organizations (PPO)
PPO plans offer more flexibility than HMOs but typically have higher premiums and always have deductibles. There’s usually a network of health care providers, and you pay less when receiving care within this network. However, your plan will pay some of the cost if you see an out-of-network provider, unlike HMOs, which typically won’t cover non-emergency out-of-network services. PPOs don’t require you to choose a PCP, and you can see a specialist without getting a referral.
Private Fee-For-Service Plans (PFFS)
A private health insurer providing PFFS plans sets its own payment terms, and you can see any Medicare-approved provider that accepts these terms. If a PFFS plan has a network of providers, you can see any of them. These plans don’t require you to choose a PCP or get referrals for specialists. You get the greatest flexibility with PFFS plans, but premiums tend to be higher than with HMOs and PPOs, and not all health care providers accept these plans.
Special Needs Plans (SNP)
SNPs restrict membership to individuals with specific needs and have limited geographic service areas. SNPs fall into three categories: Dual Eligible SNPs only accept you if you’re eligible for Medicare and Medicaid, Chronic Condition SNPs only accept you if you have certain disabling or severe chronic conditions, and you only qualify for Institutional SNPs if you reside in a nursing home or similar institution. With an SNP, you’re required to receive all your care from a targeted provider network.
Enrollment and eligibility for Medicare Advantage Plans in Missouri
To be eligible for Medicare Advantage in Missouri, you must be enrolled in Original Medicare Parts A and B and not enrolled in Medigap insurance. You also must be at least 65 years old unless you have a disability or end-stage renal disease. You’re automatically enrolled in Original Medicare when you turn 65 if you receive Social Security benefits, and you’ll have to switch to Medicare Advantage.
After meeting eligibility requirements, you can join or switch to a Medicare Advantage Plan during the:
- Initial coverage election period. This is your first opportunity to join Medicare Advantage, and it runs three months before the month you turn 65, your birth month, and the three months following your 65th birthday.
- Open enrollment period. You can transfer from Original Medicare to Medicare Advantage, from Medicare Advantage to Original Medicare, or from one Medicare Advantage Plan to another between October 15th and December 7th, but only if you already receive Medicare benefits.
- Medicare Advantage enrollment period. You can change to another Medicare Advantage Plan or move back to Original Medicare between January 1st and March 31st, but only if you already have a Medicare Advantage Plan. You can’t switch from Original Medicare to Medicare Advantage during this period.
Prescription drug coverage
Medicare Advantage-Prescription Drug Plans (MAPDs) are Medicare Advantage Plans that include prescription drug coverage. Bundled drug coverage may be included with your premium, or it might require a separate premium. Many HMOs and PPOs cover prescription drugs, but you won’t be able to add separate Part D Medicare drug coverage if one doesn’t. Adding Part D will cause you to lose your Medicare Advantage Plan and revert to Original Medicare. PFFS plans sometimes include drug coverage, and you can add stand-alone Part D for those that don’t. SNPs always include prescription drug coverage as legally required.
Medicare Advantage Resources in Missouri
Having adequate health care coverage is immensely important as you age, making Medicare Advantage Plans in Missouri highly beneficial. Because you have so many options, you might find it difficult to choose a plan that best fits your needs, especially if you’re a first-time enrollee. To help you better understand your options and navigate the enrollment process, several state and local resources in Missouri provide free assistance to those who qualify.
Community Leaders Assisting the Insured of Missouri (CLAIM)
CLAIM is Missouri’s official State Health Insurance Assistance Program (SHIP), offered through a contract with the Missouri Department of Commerce and Insurance. CLAIM volunteers receive extensive training to become certified Medicare counselors and help you with Medicare Advantage applications, enrollment, claims, and appeals. You can set up a free one-on-one appointment, discuss your Medicare issue by phone, or attend a CLAIM event.
Contact Information: Website | 800-390-3330
Missouri Senior Medicare Patrol (SMP)
Missouri SMP helps you identify and report errors on your Medicare bills and identify deceptive health care practices, such as charging for services you were never provided or being provided inappropriate or unnecessary services. SMP volunteers provide education, outreach, and one-on-one counseling and help you prevent, detect, and report all types of health care fraud to protect you and the integrity of the Medicare program.
Contact Information: Website | 888-515-6565
SeniorAge Area Agency on Aging
The SeniorAge AAA serves 17 counties throughout southwest Missouri and offers Medicare educational programs and counseling. Trained navigators help you with Medicare Advantage enrollment, including virtual “New to Medicare” enrollment counseling, complimentary classes, and free annual assistance with your prescription drug coverage.
Contact Information: Website | 417-862-0762
Care Connection for Aging Services
Care Connection provides Medicare counseling to help you understand your eligibility and benefits in Medicare and Medicare Advantage. It partners with CLAIM, and its certified volunteers, care managers, and insurance counselors are trained to answer all your Medicare-related questions. Care Connection also directs the statewide Missouri SMP program. You can visit your local center, call, or email to speak with a certified counselor.
Contact Information: Website | 800-748-7826
Learn More From Our Sources
- Medicare | How do Medicare Advantage Plans work?
- Medicare | Health Maintenance Organization (HMO)
- Medicare | Preferred Provider Organization (PPO)
- Medicare | Private Fee-for-Service (PFFS) Plans
- Centers for Medicare & Medicaid Services | Special Needs Plans
- Medicare | How do I get Parts A & B?
- Medicare | Getting Medicare if you have a disability
- Medicare | I have End-Stage Renal Disease (ESRD)
- Medicare | Who can join a Medicare Advantage Plan?
- Centers for Medicare & Medicaid Services | How Medicare Prescription Drug Coverage Works with a Medicare Advantage Plan
- Medicare | Drug coverage (Part D)