Medicare in Missouri

Medicare is the federally funded health insurance program for those aged 65 and over, along with younger people who are living with approved disabilities or permanent kidney failure. This program can significantly reduce beneficiaries’ out-of-pocket health care costs, making medical services more accessible to them as they age. The Original Medicare program features two parts. Part A, often referred to as hospital insurance, pays for inpatient services, home health care and nursing home care. Part B, or medical insurance, covers other expenses, such as outpatient care, certain medical supplies and preventative care. While Original Medicare doesn’t provide prescription drug coverage, beneficiaries can access this coverage by adding Part D prescription drug benefits to their plan.

As an alternative to Original Medicare, some beneficiaries opt for a Part C Medicare Advantage Plan, which provides the same coverage, plus some additional benefits, through private health insurance companies. There are several types of Medicare Advantage Plans available, each with its own rules regarding seeing in-network and out-of-network providers, getting referrals to see specialists and coinsurance or co-pay obligations.

In Missouri, approximately 1,299,041 people are eligible for Medicare in 2023, representing about 21% of the state’s nearly 6.2 million residents. This is 2.16% higher than the number of Missourians eligible for coverage in 2022, indicating growth in the state’s senior population. While this is significant, it falls slightly below the national growth of 2.66%.

Medicare Advantage Plans are popular in Missouri, with 51% of beneficiaries opting for Part C coverage as an alternative to Original Medicare. This is an 8.23% increase over the percentage of Medicare-eligible individuals with Medicare Advantage in 2022. Between 2022 and 2023, the number of people who had a Medicare Advantage Plan increased by 10.57%. By comparison, nationally, about 48% of Medicare-eligible people have a plan, an increase of 6.90% over the percentage of people who chose this coverage option in 2022. The number of U.S. residents with Medicare Advantage grew by 9.75% during this time frame.

This guide offers insights into Medicare in Missouri, encompassing Medicare Advantage Plans and various strategies that older adults can employ to optimize their coverage. Additionally, it features a compilation of resources aimed at aiding seniors in making informed decisions regarding their health care coverage. 

Options for Medicare Coverage in Missouri

Seniors who need Medicare coverage have coverage choices in Missouri. By understanding all of these options, seniors can choose the program that best fits their medical and financial needs. Original Medicare offers coverage that works well for many older adults, but some will need additional coverage options not provided in these plans. Missouri has several options that enrollees can purchase through private health insurance companies. 

Original Medicare (Parts A & B)

The Centers for Medicare & Medicaid Services administers the Medicare program in Missouri and throughout the nation, providing access to valuable health insurance coverage to older adults and those with certain health conditions. Cost-sharing obligations include annual deductibles along with monthly premiums.

Many beneficiaries get Part A hospital coverage for free, assuming they or their spouse had Medicare taxes withheld from their wages for at least a decade. For those not eligible for free coverage, monthly premiums range from $278 to $506. The monthly premium for Part B is $164.90, although this may be higher depending on the individual’s income.

Who Should Consider Original Medicare

Original Medicare may be a good option for those who:

• Travel frequently within the United States
• Don’t need extra benefits such as home-delivered meals and coverage for over-the-counter medication
• Want to choose their own prescription drug coverage

Medicare Advantage (Part C)

Medicare Advantage Plans provide an alternative to Original Medicare and often come with attractive benefits the original program doesn’t include, such as maximum out-of-pocket limits, $0 deductibles and low co-pays. These plans are available through private health insurance companies that follow rules set forth by Medicare. All Medicare Advantage Plans include all Part A and Part B benefits, but some include additional benefits, such as vision and dental coverage and prescription drug insurance. There are four basic types of plans, including HMOs, PPOs, PFFS plans and SNPs, but not all plan types are available in all regions.

Who Should Consider Medicare Advantage

Many seniors can benefit from Medicare Advantage plans. Seniors who might want this type of plan include those who:

• May qualify for lower premiums due to good overall health
• Need benefits not usually covered in Original Medicare, such as vision coverage
• Need to control their out-of-pocket costs
• Like the idea of shopping for a plan that is a good fit

The Top 10 Medicare Advantage Plans in Missouri

Missouri has several excellent Medicare Advantage plans available for seniors who prefer this option. The following table shows the top providers offering Medicare Advantage plans in Missouri based on the number of enrollees. The table shows plan costs and the types of plans available based on data from August 2023. Our Medicare Advantage Plans in Missouri page has more information about these plans and what they offer.

Medicare Prescription Drug Coverage (Part D)

Original Medicare doesn’t pay for most prescription drugs through Part A or B coverage. Instead, seniors purchase separate prescription drug policies, also called Part D coverage. Medicare contracts with private health insurance companies to provide this coverage. There are multiple plans to choose from with varying monthly premiums, which beneficiaries pay in addition to their Original Medicare premiums. While seniors don’t have to purchase prescription drug coverage when they’re first eligible for Medicare, not obtaining this coverage at this time may result in late enrollment penalties they pay for as long as they have Medicare if they enroll later. Most Advantage Plans include prescription drug coverage. 

Each prescription drug plan has its own formulary, or list of covered drugs. Formularies are typically split up into tiers. The tier a medication is in determines how much the insurance company pays and how much the beneficiary pays for it. Lower-level tiers are usually made up of generic and low-cost brand name drugs, while higher tiers are composed of more expensive brand name and specialty drugs. In most cases, the lower the tier, the lower the policyholder’s cost-sharing responsibility.

Who Should Consider Medicare Prescription Drug Coverage

Seniors who may benefit from prescription drug coverage include those who:

• Currently take prescription medication or expect to in the future
• Want to avoid late enrollment penalties
• Want to reduce out-of-pocket prescription drug expenses

Medicare Supplement Insurance (Medigap)

While Original Medicare provides coverage for many medical costs, seniors may still have significant out-of-pocket expenses. These may include copays, coinsurance and deductibles. Seniors may be able to reduce their cost-sharing obligations by purchasing a Medigap plan. These plans can only be used with Original Medicare. It’s illegal for private insurance companies to sell Medigap plans to those with Medicare Advantage plans.

In Missouri, there are 10 types of Medigap plans, eight of which are available to new enrollees. Plans are standardized, meaning policyholders get the exact same coverage from a given plan regardless of the health insurance provider they buy it from. For more information on Medigap plans, seniors can refer to the Best Medicare Supplement Companies of 2023 page.

Who Should Consider Medicare Supplement Insurance

Good candidates for Medigap may be those who:

• Have ongoing health issues and expenses
• Travel overseas often
• Want to access an expanded network of health care providers
• Expect to need health services not covered by Original Medicare

Medicare Resources in Missouri

Enrolling in Medicare can feel overwhelming and complicated. People who need Medicare help will find a number of resources available in Missouri to help with the enrollment process, assist with appeals and even aid with choosing the right plan. Many of these programs are available at no cost to older adults who need a little extra assistance understanding their Medicare options.