Medicare in Missouri

Medicare is a government-run health care program for seniors aged 65 and over and people with specific disabilities. Missouri currently has more than 1.2 million people enrolled in Medicare plans, representing about 19% of the state’s population. Medicare Advantage plans represent 486,636 of the total Missouri enrollees, which is 32% of total Medicare participants. An additional 960,200 Medicare beneficiaries participate in the Medicare Part D Prescription Drug Coverage option. Each year the state’s Medicare program costs $7.7 billion.

Original Medicare has two parts to provide full coverage to seniors. Part A is responsible for nursing home care, some home health care and hospital stays. For most seniors who paid Medicare payroll taxes for enough years or who had a spouse who did, Part A is available at no cost. Part B covers preventative care, outpatient appointments and medical supplies. The standard premium amount for Medicare Part B in 2022 is $170.10.

Medicare Parts A and B do not cover prescription drugs, but seniors can add Part D coverage for this need. Seniors also can opt for Medicare Advantage plans, also known as Medicare Part C, instead of Original Medicare. These Medicare-compliant plans come from private insurance providers rather than the government. They include the same benefits as Part A and B, except for hospice care, and add additional coverage options such as dental care or prescription drug coverage. Medigap plans are Medicare supplement plans through private health insurance companies that help reduce out-of-pocket expenses for those enrolled in Original Medicare.

This guide provides information about Missouri’s Medicare program, including options older adults can use to make their coverage work. It also includes a list of resources that can help seniors make the right decisions about healthcare 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)

Original Medicare is administered by the Centers for Medicare & Medicaid Services (CMS) and is open to seniors aged 65 and over, along with those under 65 years old, but with certain disabilities or end-stage kidney disease. Part A covers inpatient hospital care, nursing home and skilled nursing care, hospice and home health care. Part B, or medical coverage, pays for medically necessary goods and services such as durable medical equipment, mental health services and emergency medical transportation. 

Unlike most private Medicare plans, Original Medicare’s provider network isn’t limited to the beneficiary’s geographic region, making it easier to obtain services while traveling within the country. In most cases, Medicare doesn’t pay for health services the individual receives outside the United States. 

Under this program, seniors pay for services as they receive them. They must pay an annual deductible, which is $1,556 for Part A and $233 for Part B in 2022. After they’ve paid this amount, Medicare covers all eligible services at 80%. Beneficiaries pay the remaining 20% out of pocket.

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)

Another way to get Medicare coverage in Missouri is with a Medicare Advantage plan. These plans come from private health insurance companies. They add benefits such as prescription drug coverage or dental coverage to what is already part of Original Medicare benefits. Medicare Advantage plans must follow all rules set forth by Medicare.

Medicare Part C has four common types of plans. These are Health Maintenance Organization (HMO) plans, Private Fee-for-Service (PFFS) plans, Preferred Provider Organization (PPO) plans and Special Need Plans (SNPs). Because these come from private insurance providers, the rules for eligibility, deductibles, copayments, coinsurance and premium costs will vary from one plan to the other.

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 April 2022. 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 2022 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.