Medicare Advantage in Missouri

Medicare is government health insurance for seniors who are at least 65, some younger individuals with disabilities and people with end-stage renal disease. It’s comprised of several parts. Part A covers inpatient hospital care. Most people don’t pay a premium for Part A, although those who didn’t accrue enough credits via payroll taxes can pay a monthly fee for coverage. Part B covers outpatient medical care, such as physician appointments, and is subject to a monthly premium. Part D covers prescription drugs, and attracts an additional premium each month. Medicare Advantage combines most Medicare benefits under a single plan with one monthly premium.

Medicare Advantage Plans, also known as Medicare Part C, are managed by private insurance companies. However, plans must include certain basic elements and providers are regulated by the Centers for Medicare and Medicaid Services. Part C insurance must offer the same benefits as Original Medicare Parts A and B, except for hospice care. Although not mandatory, most providers also offer prescription drug cover. Plans often contain extra services not included in regular Medicare, such as dental, vision and hearing care, senior wellness education and nutrition programs.

Unlike Original Medicare, Medicaid Advantage enrollees must generally obtain health care services from an approved network of providers, as set by their insurer. As Part C providers can set their own deductible and copay amounts, seniors should compare policies before signing up. Insurers also limit annual out-of-pocket costs. This means seniors always know the maximum amount they may be liable to pay for health care each year, which may enhance their peace of mind.

As of July 2023, Missouri is home to around 1,299,000 Medicare-eligible individuals. Of these, almost 666,000, or 51%, are enrolled for Part C. Since 2022, the number of people who qualify for Medicare in Missouri has risen 2.16%. Previously, only 47% of roughly 1,271,000 potential beneficiaries joined Medicare Advantage. The situation in Missouri reflects the rising popularity of Part C policies across the country. Nationally, 51% of all Medicare-qualified people opt for private coverage through Medicare Advantage.

This guide offers an in-depth look at Medicare Advantage, delves into the coverage provided by Advantage Plans in Missouri, outlines the eligibility criteria for seniors and provides clear guidance on when and where to enroll.

The Top 10 Medicare Advantage Plans in Missouri

Many Medicare Advantage providers operate in Missouri, with most insurers offering a variety of plans to suit diverse budgets and requirements. The table below lists the 13 most popular Part C insurers in Missouri. Enrollment numbers combine the total enrollees for every plan offered by the different providers, and price ranges take into account the cost of differing policies. Further details are available from Medicare.gov, and all data is up-to-date in July 2023.

How Medicare Advantage Plans Work in Missouri

Medicare Advantage plans aren’t one type fits all. That’s why there are several types available. The Health Maintenance Organization (HMO) plans are generally the most commonly available plan type. Preferred Provider Organizations (PPOs) are usually the next most common. Both plan types are similar, but HMOs require members to stay within a provider network, while PPOs typically provide coverage in and out of a provider network. Private Fee-for-Service (PFFS) plans and Special Needs Plans (SNP) are generally available on a very limited basis. All plan types may differ in drug coverage, primary care providers and specialist accessibility.

What Medicare Advantage Plans Cover in Missouri

Medicare Advantage plans provide all the same benefits as Original Medicare, including Parts A and B coverage. Most MA plans also include prescription drug benefits, which Original Medicare doesn’t cover. Many MA plans also offer numerous additional benefits beneficiaries won’t find in Original Medicare. These perks might include coverage for hearing care and allowances for hearing aids, routine vision and dental care, over-the-counter medications and home health care. Some plans may cover nonemergency medical transportation and services that promote health and wellness, such as gym memberships, wellness programs such as SilverSneakers and limited home modifications.

*Select plans offer this coverage

** Most plans offer this coverage

Eligibility for Medicare Advantage in Missouri

Medicare Advantage eligibility begins with the same parameters as Original Medicare. Thus, applicants must be aged 65 or older or have a disability that qualifies them to join the program at a younger age. Applicants who’ve been receiving Social Security Disability Insurance payments for at least 24 months or are diagnosed with Lou Gehrig’s disease (ALS) or end-stage renal disease qualify. They must also be U.S. citizens or authorized noncitizens. 

Besides the general Medicare requirements, there are two primary Medicare Advantage eligibility requirements. Applicants must enroll in Original Medicare Parts A and B, and they must live within the service area of an MA insurance provider accepting new members during their application period. The beneficiary also can’t have Medicare Supplement Insurance, also called Medigap, and an MA plan. 

Continued eligibility can cause an MA plan to be inadvertently compromised. Some MA plans don’t allow beneficiaries to sign up for separate Part D prescription drug plans, even if the MA plan doesn’t include prescription coverage. Signing up for Part D when the MA plan doesn’t allow it typically results in the program switching the beneficiary back to Original Medicare. Enrollment periods are below: 

• Initial Coverage Election Period: This is the initial 7-month period, coinciding with one’s 65th birthday, during which everyone is eligible to enroll in a Medicare Advantage plan.
• Annual Election Period (AEP): Also referred to as the Open Enrollment Period, this the time of year when anyone over 65 can enroll in Medicare Advantage for the first time or change to a new plan.
• Medicare Advantage Open Enrollment Period: During this period, those who are already enrolled in Medicare Advantage can switch to a different plan or switch back to Original Medicare.

Additionally, Medicare Advantage plan participants can change their plan outside of these enrollment periods under certain qualifying circumstances, such as moving to a new state.

How to Find & Choose a Medicare Advantage Plan in Missouri

Navigating the many intricacies of Medicare Advantage plan types, insurers, and the specific plan options available by region can be a difficult and time-consuming task. Below are several resources we’ve created to help you through the process.

First is a downloadable PDF that you can use as a guide to help you compare plans as you research. Finally, we have listed a number of organizations that you can contact with experts that will help you determine whether Medicare Advantage is right for you and what plans you should consider.

State-Wide Medicare Advantage Resources

Local Medicare Advantage Resources