What Are Medicare Advantage Plans in Missouri?
Medicare Advantage (MA) plans in Missouri are bundled alternatives to Original Medicare offered by private insurance companies that have been approved by Medicare. Most plans also include Medicare Part D (prescription drug) benefits, and many offer extra services like hearing, vision and dental care.1
What You Need to Know
The average cost for an MA plan in Missouri is $9.59, which is less than half the cost of the national average of $21.
Most MA plans include Medicare Part D (prescription drug benefits).
Missouri Medicare members can contact CLAIM, which provides free, unbiased advice on Medicare and related programs.
What Types of Medicare Advantage Plans Are Available?
You can choose among several types of MA plans. Most plans use a network of physicians and healthcare facilities that have contracted with the insurance company. Your options may include:
- Health maintenance organizations (HMOs): With this plan type, you are typically required to seek treatment from in-network providers unless it’s an emergency. If you visit an out-of-network provider, you may be responsible for the costs. Usually, you need a referral from your primary care physician to see a specialist. This is the most common type of MA plan.
- Preferred provider organizations (PPOs): With these plans, you pay less if you seek care from an in-network provider, but you can visit out-of-network providers as well. You typically don’t need a referral to see a specialist.
- Special needs plans (SNPs): These plans serve Medicare members with specific healthcare needs. There are three types of SNPs:
- Chronic condition special need plans (C-SNPs): This type of plan is for Medicare beneficiaries who have chronic health conditions, including diabetes, end-stage renal disease (ESRD) and cancer.
- Dual eligible special need plans (D-SNPs): This option is for people who are eligible for both Medicare and Medicaid.
- Institutional special need plans (I-SNPs): These plans are for nursing home residents and people who need nursing care at home.
- Private fee-for-service (PFFS) plans: With this plan option, you can see any healthcare provider who accepts the terms of your plan. Some PFFS plans have a provider network, and you pay less if you see someone in-network.
- Medical savings accounts (MSAs): This plan pairs a medical savings account with a high-deductible MA plan. Your deductible is the amount you pay for Medicare-covered services before your plan starts to pay. The plan adds funds to your MSA, and you can use those funds to pay for out-of-pocket costs. If you run out of funds in your MSA before you reach your deductible, you’re responsible for out-of-pocket costs until you reach your deductible.2
More than a third of eligible Missouri residents, or about 500,000, have signed up for a Medicare Advantage plan.
What Are Prescription Drug Options with Medicare Advantage?
Most MA plans include Medicare Part D (prescription drug coverage). If you choose an MSA plan and certain PFFS plans without Part D coverage, you can buy a separate Part D prescription drug plan. If you opt for an HMO or PPO without prescription benefits, you can’t buy a separate plan.3
Important: If you don’t buy Part D coverage when you’re first eligible, you may be required to pay an ongoing late enrollment penalty if you purchase Part D later.4
How Do You Choose a Medicare Advantage Plan?
To choose a Missouri MA plan, consider the following:
- Premiums: This is the monthly amount you pay for a plan. Plan premiums vary; some have a $0 premium, while others cost more.
- Other costs: Plans also have other out-of-pocket costs. Your deductible is the amount you pay for Medicare-covered services before your plan starts paying. Coinsurance is a percentage you pay for covered services and medical items after you’ve met your deductible. Copayments are a set dollar amount you pay for healthcare services and supplies and may apply before and/or after you’ve met your deductible.5 Finally, the out-of-pocket maximum is the most you’ll pay out of pocket for covered care each year.6
- Plan benefits: While all plans cover Medicare Parts A and B, and many include Part D, they vary when it comes to extra benefits. Plans may offer vision, dental and hearing care. Almost all offer telehealth, and some offer other perks like fitness programs and transportation to medical appointments.7
Check the Costs
If you are considering a Medicare Advantage plan, be sure to look carefully at the costs, including deductibles, coinsurance, copayments and the out-of-pocket maximum, as well as the benefits.
When and How Do You Enroll in a Medicare Advantage Plan?
You can only enroll in MA plans at specific times, which are referred to as enrollment periods. They are:
- Initial enrollment: This period lasts for seven months, starting three months before the month you turn 65 and ending three months after that month.
- Open enrollment: Also referred to as an annual election period, it lasts from October 15 to December 7. During this period you can enroll in, switch or drop an MA plan.
- Medicare Advantage open enrollment: From January 1 to March 31 you can switch MA plans or drop your MA plan and go back to Original Medicare.
- General enrollment: If you start Medicare Part B between January 1 and March 31, you also can enroll in an MA plan. The coverage typically starts on July 1.8
- Special enrollment: Certain life events and changes to your insurance entitle you to a special enrollment period. These include, but aren’t limited to:
- Moving out of your plan’s service area
- Losing or gaining coverage from Medicaid or an employer or union
- Medicare terminating its contract with your MA plan
- Being diagnosed with a health condition better served by an SNP9
To enroll in a plan, contact the insurance company you’re interested in or use the Medicare Plan Finder to compare plans and sign up.
Who Has Signed Up for Medicare Advantage?
Some 500,000 Missouri residents are signed up for MA plans. The state has a penetration rate of 36%, which means over one-third of eligible MIssourians have signed up for an MA plan.
How Much Do Medicare Advantage Plans Cost in Missouri?
The average cost for an MA plan in Missouri is $9.59, which is less than half the national average of $21.10
St. Louis residents have access to 36 MA plans from nine insurance providers. Twenty-three plans have a $0 premium and the rest range from $19 to $73 per month.
Springfield residents have access to 34 plans from 10 insurance providers. Twenty-two plans have a $0 monthly premium and the rest range from $19 to $73 a month.
What If You Want to Change Your Medicare Advantage Plan?
What Are Medicare Resources in Missouri?
Missouri has several resources for Medicare members.
- CLAIM is Missouri’s Medicare assistance program. It offers free, unbiased advice on Medicare and related programs. You can request assistance by calling CLAIM at 1-800-390-3330 or by attending one of the in-person CLAIM events held regularly throughout Missouri.
- If you have a complaint about your MA plan, you can file it online with the Department of Insurance or by calling 1-800-726-7390.
- If you have limited income and assets, you can apply for MO HealthNet, which is Missouri’s Medicaid program. It provides free and low-cost healthcare to those who qualify.
To decide whether an MA plan is right for you, consider the premium and out-of-pocket costs, benefits, and whether your preferred healthcare providers are in-network. You can easily compare plans using the Medicare plan finder. Then, if you’re satisfied with your options, choose an affordable plan that meets your healthcare needs.