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:
|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 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:
|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.
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**
*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