If you live in Missouri and are age 65 or older – or if you soon will be turning age 65 – you may want to learn 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. Let’s learn about the different parts of Medicare.
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.
- 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.
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 age 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. You must be enrolled in original Medicare to purchase Part D.
Medicare Advantage (Part C) 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:
- Aetna Medicare
- Anthem Blue Cross and Blue Shield
- Anthem HealthKeepers
- Essence Healthcare
- Healthy Blue
- Lasso Healthcare
- WellFirst Health
It’s important to note that plan options vary by county. What’s available to you depends on the ZIP code where you live in Missouri.
To be eligible for Medicare in Missouri, you must be:
Your initial Medicare enrollment period begins three months before you turn 65 years old and continues for 3 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 1 through March 31, you may enroll in a Medicare plan or Medicare Advantage plan.
- Medicare Part D enrollment. From April 1 through June 30, you may enroll in a Part D plan.
- Medicare open enrollment. From October 15 through December 7, 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 Social Security Administration. The application is quick and doesn’t require any documentation up front.
This article was updated on November 13, 2020, to reflect 2021 Medicare information.
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