Assisted living facilities primarily help residents with non-medical needs. Although minor and infrequent medical services, such as first-aid for a wound, can sometimes be met on-site by nurses. These communities may sometimes also be called ALFs, residential care facilities, retirement homes, or long-term care facilities.
The financial options available to help pay for senior care is dependent on, among other things, the type of care that is required. If you are just beginning the research process on how to pay for long-term care, it is helpful to have an idea about the type of care you or your loved one currently requires, as well as to anticipate future needs. In addition, it is important to be familiar with the associated eldercare terminology.
Can using home care technology help your family save money caring for an aging loved one? The answer is most certainly “Yes”. Our goal is not to provide a comprehensive list, but rather to make sense of those that are available on the market today and can reduce the care hours required by elderly persons. As such, they can reduce a family’s out-of-pocket care costs or reduce the hours they spend providing care themselves.
Medicare Advantage (Part C), a privately offered alternative to Original Medicare (Parts A and B), has grown in popularity over the years. Despite the growing popularity of Medicare Advantage, some seniors face obstacles that prevent them from truly understanding how it works and who it benefits. Common mistakes about Medicare Advantage include misunderstanding its differences from Original Medicare, getting it confused with other forms of private Medicare insurance (like Medigap or Part D), or not understanding how to look up or evaluate plans.
Medicare Advantage offers an alternative way for eligible seniors or disabled persons to get their Medicare benefits. While it shares several similarities with Original Medicare, Medicare Advantage also has key differences. One primary difference is the federal government directly pays for health services under Original Medicare, while private insurance companies administer Medicare Advantage plans. These companies must receive approval from the Centers for Medicare and Medicaid Services to provide Medicare Advantage (MA) plans and have rules that guide how they do certain things. Qualified Medicare recipients who opt for Medicare Advantage in place of Original Medicare receive bundled Part A and Part B coverage, with the exception of hospice care which remains covered under Original Medicare. They usually get Part D prescription coverage and other health-related services. .
Missouri had more than 1.2 million Medicare recipients in 2020, with nearly 500,000 or about 39% of them opting for Medicare Advantage instead of Original Medicare. This percentage was nearly on par with the national average that year, which was 38%. In 2021, Medicare beneficiaries with MA plans jumped to 43% in Missouri. By 2022, Missourians enrolled in Medicare had increased to 1,259,244 and those with MA plans jumped to 48%. The average monthly Medicare Advantage premium dropped slightly in 2022 to $8.04 compared to $8.93 in 2021. The number of available MA plans increased slightly from 122 to 126.
This guide provides details on Medicare Advantage and the different MA plans available in Missouri. It also offers a comprehensive list of the top 10 providers in the state. Readers will also find information on how Medicare Advantage works, where to find MA plans, eligibility requirements and when to sign up.
The Top 10 Medicare Advantage Plans in Missouri
Medicare recipients comparing Medicare Advantage plans in Missouri will find several types of plans available and numerous insurers providing them. Most areas of the state have multiple plan options, so it’s essential to compare these options to ensure an ideal fit. To help qualified recipients make their comparisons, the table below outlines details of the top 10 Medicare Advantage providers in Missouri.
The table bases provider popularity on total enrollment, calculated by adding enrollment numbers from all the plans each provider offers. However, it also considers the provider’s Medicare star rating. These ratings look at each plan’s performance combined with information gleaned from member satisfaction surveys. The table also provides a range of costs for each provider’s plans to compare affordability. This table’s details are accurate as of April 2022. For current information about these and other MA plans in Missouri, visit Medicare.gov.
HMO, PPO, PFFS
Blue Medicare Advantage
Anthem Blue Cross and Blue Shield
Blue Cross Blue Shield of Michigan
Wellcare by Allwell
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.
Coverage Available With Medicare Parts A & B?
Coverage Available With Medicare Advantage?
Durable Medical Equipment
*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.
Initial Coverage Election Period
3 Months Before One’s 65th Birth Month
3 Months After One’s 65th Birth Month
Annual Election Period (AEP)
Medicare Advantage Open Enrollment Period
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.
Community Leaders Assisting the Insured of Missouri, or CLAIM, is Missouri’s State Health Insurance Assistance Program (SHIP). CLAIM has over 450 partners and trained and certified volunteer Medicare counselors who provide confidential Medicare benefits counseling services. Counselors answer questions, educate seniors about their Medicare options, help them apply for and enroll in Medicare plans, file claims, organize health care bills and make appeals. Additionally, counselors can help seniors apply for available programs that may help pay for Medicare Parts B and D. The CLAIM website also has pages explaining the state’s Medicare options, supplements and related programs.
The Missouri SMP, or Senior Medicare Patrol program, works to protect Missouri Medicare and Medicaid participants from health care fraud. Program volunteers provide Medicare beneficiaries with one-on-one counseling services, education and outreach designed to empower seniors to recognize, prevent and report any type of health care abuse, mistakes or fraud. Volunteers can help seniors recognize errors on their medical bills and protect themselves from Medicare-related identity theft.
Seniors can call the SMP hotline at 888-515-6565, call the program’s main line at 660-747-5447 or email [email protected]. They can also mail an inquiry to 106 W. Young, P.O. Box 1078, Warrensburg, MO 64093.
The Missouri Department of Health and Senior Services website has a page with a list of links to various Medicaid and Medicare resources. Seniors can visit this site to find answers to frequently asked questions about open Medicare enrollment, learn about Medicare Advantage and Medicare supplemental Medigap policies, get updates on the latest Medicare news and more.
The Missouri Department of Insurance is a state agency dedicated to helping residents understand their insurance options, consumer rights and the laws regulating insurance. Seniors can visit the website to find information about Medicare and Medigap policies, long-term care insurance and other senior resources within the state. Insurance consumers can visit the site to learn how to file complaints and appeal an insurance company’s denial of a claim. The website also has an insurance shopping tool to help consumers identify their needs and compare plans and costs.
To reach the Missouri Department of Insurance, seniors can call 573-751-4126, visit the office in person at 301 W. High St., Room 530 in Jefferson City or mail questions and inquiries to P.O. Box 690, Jefferson City, MO 65102-0690.
Local Medicare Advantage Resources
Area Agencies on Aging
Area Agencies on Aging, such as Senior Age, are located throughout Missouri, and most have care coordinators available to help seniors enroll in Medicare plans and understand their benefits. Seniors unable to visit an office in person may be able to receive a home visit from a care coordinator to assess and discuss their needs. Missouri AAAs may also provide general benefits counseling, “New to Medicare” classes and comprehensive information about Medicare enrollment and related resources on their website.
VOYCE is an advocacy and resource nonprofit serving 21 counties in and around St. Louis. The organization’s mission is to help seniors and their loved ones receive high quality, long-term care. The website’s list of resources includes the national site to help Medicare recipients compare nursing homes, and it has a Medicare page linking to resources explaining recent Medicare changes, how to complete enrollment forms and more. Other services VOYCE offers include a helpline that connects callers to a licensed long-term care expert who can provide advice about Medicare and other financing options.
Individuals can contact VOYCE by calling 314-919-2403 or 866-918-8222. Seniors can also email VOYCE through its online inquiry form, or visit the office Monday through Friday at 680 Craig Road, Suite 245 in St. Louis.