Understand Medicare in Missouri

Medicare, the United States federal medical insurance program, provides coverage for almost 750,000 people in Missouri who qualify for Medicare.  You can get Medicare if you’re 65 or older or have a qualifying disability.

Your disability typically qualifies if you’ve received at least 24 Social Security or Railroad Retirement Board (RRB) disability insurance payments. You can also enroll in Medicare Advantage Plans if you have End-Stage Renal Disease (ESRD) or amyotrophic lateral sclerosis (ALS).

Most people have premium-free Part A but, if you have to buy it, the cost can reach up to $499 per month in 2022. Part B costs $170.10 per month but can be more if you have higher income.  There are 63 Medicare Advantage Plans in the state that are an alternative to Original Medicare.  Learn more about your Medicare options in Missouri.

Medicare Plans in Missouri

Compare ratings of Missouri’s Medicare plan providers:
Insurance company Medicare rating A.M. Best rating BBB rating NCQA rating J.D. Power ranking
Aetna 4 stars A A+ 2.5 to 4.5 stars 5 out of 10
Cigna 4 stars A- Not rated 2.5 to 4.5 stars Seventh out of 10
Humana 4 stars A- A+ 1.5 to 4.5 stars Third out of ten
UnitedHealthcare 3.5 stars A- A- 4 stars Fourth out of 10

Medicare Plan Options in Missouri

Residents of Missouri have multiple Medicare plans to choose from. Many are tiered to help Missouri seniors find the plan that is best suited to your lifestyle and medical needs. For example, seniors and individuals with disabilities who don’t need much coverage can apply for Original Medicare. Missouri’s Medicare Advantage program might be a better option if you need more comprehensive insurance. Some Medicare policies offer additional prescription drug add-ons or supplementary coverage.

Original Medicare (Parts A and B) Original Medicare is the basic Medicare plan, which is a fee-for-service form of insurance. It has two parts: Part A hospital insurance and Part B medical insurance. Part A covers hospital stays and periods spent at skilled nursing facilities, lab tests an individual has performed, and hospice care. Part B covers doctor’s office visits and home health care services. It may also cover some preventive care, such as screenings for cancers and mental illnesses, including depression. With Original Medicare, you’ll pay a deductible along with your share of the fees incurred during an inpatient or outpatient visit:

  • Original Medicare is a good choice if you want flexibility in choosing and accessing providers that accept Medicare anywhere in the U.S.
  • There is no cap on what you could spend for out-of-pocket expenses, and you must purchase drug coverage separately, so it’s a better choice for you if you don’t need much in the way of health care or prescription drugs.
  • If you don’t purchase a Medigap policy to supplement Original Medicare when you are first eligible, you may not be able to purchase one or may have to pay higher premiums, depending on your health status.
Medicare Advantage Plans (Part C) Medicare Advantage plans, also known as Part C, are an alternative to Original Medicare offered by private insurance companies. These plans include both Part A and Part B coverage, except for hospice care. Most services are provided by network providers, and you may need primary care physicians, referrals for specialists, and prior authorizations for treatment and medications. Medicare Advantage offers additional coverage for essential needs, such as prescription drugs, dental and vision care. Some Medicare Advantage Plans also cover gym memberships and transportation to and from medical appointments. Part C may also pay for adult day care services:

  • Medicare Advantage is a good choice if you want to have all of your health care and drug benefits bundled together in one plan and if you don’t mind being restricted in your choice of providers to save on costs.
  • There is a cap on what you can spend for out-of-pocket Medicare-covered expenses.
  • You also have access to services that Medicare doesn’t cover, like routine dental and vision exams.
Medicare Prescription Drug Coverage Plans (Part D) Many Medicare Advantage policies add Part D drug coverage automatically to their package, but you can also add Medicare prescription drug coverage to Original Medicare. Medicare prescription drug coverage is offered to all Medicare enrollees, but you may have to pay a penalty if you wait to enroll after being initially eligible. Medicare Part D plans may not all cover the same drugs or have the same costs as Medicare Advantage policies. Standalone Part D coverage is provided by Medicare-approved private insurers. Most plans require a deductible and a copay for each prescription drug:

  • Part D is a good choice if you have Original Medicare, or if you have a Medicare Advantage Plan ― not a health maintenance organization (HMO) or preferred provider organization (PPO) ― that doesn’t have prescription drug coverage.
  • You pay a penalty if you wait to enroll in a Part D plan, unless you have creditable coverage from an employer-sponsored group plan.
  • If you don’t require medications now, you can enroll in a low-premium Part D plan to avoid late enrollment penalties later.
Medicare Supplement Insurance Plans (Medigap) Some Missouri seniors purchase a Medicare Supplement Insurance policy, also known as Medigap. These plans are intended to fill in the gaps Original Medicare doesn’t cover. Some of these gaps include medical coverage while overseas, Part A and Part B copays, and excess Part B charges. Medigap doesn’t pay for anything related to Medicare Advantage. You cannot have a Medigap plan and a Medicare Advantage Plan at the same time.

  • Medigap is a good choice if you have Original Medicare and want help paying for out-of-pocket expenses you incur when you access your Part A and Part B benefits.
  • You pay a monthly premium, and most copays and coinsurance costs are covered.
  • If you have significant health care needs, want the freedom to see any Medicare provider without network restrictions, a Medigap plan offers predictable coverage and costs for Medicare-covered care.
  • Medigap doesn’t cover prescription drugs or other benefits like dental and vision.

Medicare in Missouri by the Numbers

People enrolled in Original Medicare  Average plan cost Annual state spending per beneficiary Spending per beneficiary compared to the national average
743,621 Plan A: $0 to $499 per month*

Plan B: $170.10 per month**

$10,205 1.00%

*Most people pay no premium, but this can vary depending on how long they paid Medicare taxes.

**This is the average number, but it can vary based on income.

Medicare Resources in Missouri

Getting support can help when you’re making Medicare decisions. Missouri has numerous locations where enrollees can receive help through the State Health Insurance Program (SHIP), also known as CLAIM. CLAIM has counselors throughout the state that work with local nonprofits and public health agencies, as well as Area Agencies on Aging (AAAs), to provide seniors with Medicare information.

Care Connection for Aging Services

Care Connection is a federal- and state-funded area agency on aging that serves residents in 13 counties in Missouri: Bates, Benton, Carroll, Cedar, Chariton, Henry, Hickory, Johnson, Lafayette, Pettis, Saline, St. Clair and Vernon. It provides Medicare counseling to help you understand your benefits and options with Original Medicare and Medicare Advantage. Trained care managers, insurance counselors and certified volunteers are available ot answer Medicare-related questions via phone or email or at your local center.

Contact information: Website | 800-748-7826

Community Leaders Assisting the Insured of Missouri (CLAIM)

CLAIM is Missouri’s official State Health Insurance Assistance Program (SHIP). It connects seniors with trained volunteers to help with Medicare and Medicare Advantage questions. Volunteers can help with Medicare questions, enrollment, applications, claims and appeals through free one-on-one counseling sessions.

Contact information: Website | 1-800-390-3330

Missouri Senior Medicare Patrol (SMP)

SMP helps Medicare beneficiaries living in Missouri to identify, prevent and report healthcare errors, fraud or abuse. You can get one-on-one counseling from trained volunteersor utilize the program’s education and outreach to help you understand your Medicare coverage and rights.

Contact information: Website |  888-515-6565

SeniorAge Area Agency on Aging

SeniorAge supports 17 local Area Agencies on Aging throughout southwestern Missouri. Each Area Agency on Aging provides local seniors with individualized counseling and group educational programs to help you understand your health care options. You can get help with Original Medicare or Medicare Advantage enrollment as well as prescription drug coverage.

Contact information: Website |  417-862-0762

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