If you live in Missouri and are age 65 or older — or if you soon will be turning age 65 — it’s a good idea to start learning about your Medicare health coverage options, even if you’re not yet ready to retire.
Medicare is a federal program that helps pay the costs of health care for seniors and people of any age who have certain disabilities or health conditions. There are several parts.
- Medicare Part A is specifically for inpatient services you receive in a hospital, skilled nursing facility or hospice care, as well as some limited home health services. Most people don’t pay a premium for Part A. This is because it’s funded through a payroll tax you or your spouse likely paid during your working years.
- Medicare Part B is for outpatient services and medical supplies you may receive when you see a regular doctor or specialist. You typically do pay a premium for Part B.
Original Medicare (parts A and B)
Together, Part A and Part B make up what’s known as original Medicare. You get original Medicare directly from the federal government. While original Medicare helps pay for a lot of health services, it only pays a portion.
You still have to pay significant out-of-pocket costs when you seek care. Plus, original Medicare doesn’t cover prescription drugs, dental, hearing, or vision care.
Medicare supplement (Medigap)
You can help pay for costs original Medicare doesn’t cover by purchasing a Medicare supplement plan. These are also called Medigap plans. New rules that went into effect in 2020, however, prevent Medigap coverage from covering the Part B deductible.
People who turn 65 on or after January 1, 2020, may not have the same Medicare supplement options that were available to people who enrolled in earlier years.
Medicare Part D
Medicare Part D is another type of supplemental Medicare coverage. It is specifically for helping pay the costs of prescription drugs. Part D plans are sometimes called Medicare prescription drug plans, or PDPs. You must be enrolled in original Medicare to purchase Part D.
Medicare Advantage and Medicare Part D prescription drug plans are subject to change every year. Updated plan information for 2021 should become available on October 1, in advance of Medicare’s Annual Election Period beginning October 15. Healthline.com will provide updated 2021 plan information once it is announced by the Centers for Medicare & Medicaid Services (CMS).
Medicare Advantage plans offer an “all in one” alternative to getting original Medicare plus supplemental coverage. These plans are available from private insurers as a full replacement.
Medicare Advantage plans include all the same coverage as original Medicare and then some, usually including prescription drug benefits. They frequently also include dental, vision, and hearing benefits, as well as health and wellness programs.
While Medicare Advantage plans all must cover the same benefits, how they cover them varies. Plans can be structured in different ways, such as Health Management Organizations (HMOs) or Preferred Provider Organizations (PPOs), so it’s important to understand plan specifics when shopping for Medicare plans in Missouri.
Medicare Advantage Plans in Missouri
The following companies offer Medicare Advantage plans in Missouri:
- UnitedHealthcare of the Midlands Inc.
- Coventry Health Care of Missouri Inc.
- Essence Healthcare Inc.
- Sierra Health and Life Insurance Company Inc.
- Care Improvement Plus South Central Insurance Co.
- CHA HMO Inc.
- HealthKeepers Inc.
- Humana Insurance Company
- Aetna Life Insurance Company
- Blue-Advantage Plus of Kansas City Inc.
- Missouri Valley Life and Health Insurance Company
- Anthem Insurance Companies Inc.
- Cigna Healthcare of St. Louis Inc.
- Home State Health Plan Inc.
- Union Pacific Railroad Employees Health Systems
- CompBenefits Insurance Company
These plans are listed in order from highest to lowest Medicare Missouri enrollment. It’s important to note that plan options vary by county. What’s available to you depends on where in Missouri you live.
To be eligible for Medicare in Missouri, you must:
Your initial Medicare enrollment period begins three months before you turn 65 and continues for three months after. It usually makes sense to enroll in at least Part A at this time since most people qualify for it without a premium.
If you choose to continue working and are eligible to continue your employer-sponsored group health plan coverage, you may want to weigh your options when deciding whether to enroll in Part B or other Medicare coverage. If you choose to wait, you may qualify for a special enrollment period later.
Medicare enrollment periods
In addition to your initial enrollment period, you may enroll in various parts of Medicare during these periods, too:
- Late enrollment. From January 1st through March 31st, you may enroll in a Medicare plan or Medicare Advantage plan.
- Medicare Part D enrollment. From April 1st through June 30th, you may enroll in a Part D plan.
- Plan change enrollment. From October 15th through December 7th, you may enroll in, drop out of, or change your part C or Part D plan.
- Special enrollment. Under special circumstances, you may qualify for a special enrollment period of 8 months.
When shopping for Medicare plans in Missouri, keep these considerations in mind:
- What costs can you expect to pay? How much are the premiums? How much can you expect to pay when you see a doctor or fill a prescription?
- Are there requirements for choosing doctors? Does the plan require you to choose a primary care physician and get referrals for specialty care?
- How wide is the provider network? Does it include physicians and facilities that are convenient to you? If you already have relationships with providers, are they part of the plan network?
- What if you still work? If you choose to continue working, how do your Medicare options compare to coverage offered through your employer?
- What if you’re married? Does your spouse qualify for Medicare coverage as well? If one of you is younger than age 65, you may need to consider other options.
Check out these resources to learn more about enrolling in Medicare in Missouri:
Ready to begin your enrollment? Start with these action items.
- Review your Medicare plan options. The list of plans above is a good starting point. You can also reach out to an agent who can help you narrow your plan options down to ones that best fit your needs.
- Fill out the online application. You can apply at the U.S. Social Security Administration. The application is quick and doesn’t require any documentation up front.
The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.