October 6, 2016
Original Medicare is available to eligible beneficiaries in Missouri as well as the other states. Some beneficiaries may choose to add other types of Medicare benefits, such as prescription drug coverage or a Medicare Supplement (Medigap) plan to Original Medicare. Alternatively, they may choose to receive their Part A and Part B benefits through a Medicare Advantage plan, offered by a private insurance company contracted with Medicare. You have options to consider when choosing how you receive your Medicare benefits. These alternatives are explained in greater detail below.
Original Medicare refers to both Medicare Part A and Part B together. Part A provides coverage for inpatient hospital stays, home health, and hospice care, whereas Part B covers medical services such as outpatient care, doctor’s visits/services as well as durable medical equipment. Medicare is a federal government program, created to provide insurance coverage for people who are 65 and older, U.S. citizens or legal permanent residents of at least five continuous years. It is also available to people under the age of 65 who have certain disabilities as well as to individuals who have end stage renal disease (permanent kidney failure) or Lou Gehrig’s disease.
You may ask yourself how you can enroll in the Medicare program. In some cases, enrollment happens automatically for beneficiaries about to turn age 65 and who have qualified to receive retirement benefits through either the Social Security Administration (SSA) or the Railroad Retirement Board (RRB). People under the age of 65 may also be eligible for Medicare, provided they receive SSA disability benefits or certain RRB disability benefits for 25 consecutive months.
Beneficiaries in Missouri who aren’t automatically enrolled in Medicare can visit their local SSA office to register, or they can enroll online. They can also do so over the phone:
A “Welcome to Medicare” packet will arrive by mail approximately three months before coverage begins. This includes your red, white, and blue Medicare card, as well as additional information about the program.
You may wish to consider a Medicare insurance plan offered by a Medicare-approved private insurance company in Missouri before making your final decision regarding how you receive your Medicare benefits.
Medicare Part C, also called Medicare Advantage, is the program that provides an alternative way to receive your Medicare Part A and Part B benefits. Instead of receiving your benefits directly through the federal government, you may be able to enroll in a Medicare Advantage plan. If you enroll in a Medicare Advantage plan, you remain enrolled in Original Medicare, Part A and Part B, as well. As such, you remain responsible for paying your Part B premium
Medicare Advantage plans are offered by Medicare-approved private insurance companies. They must provide the same coverage as provided by Original Medicare (except for hospice care, which remains covered through Medicare Part A). Many Medicare Advantage plans also provide additional benefits, such as routine vision, hearing, and dental care. In addition, Medicare Advantage plans often include prescription drug coverage: these are known as Medicare Advantage Prescription Drug plans (MA-PDs). If you enroll in a Medicare Advantage Prescription Drug plan, all of your medical and prescription drug coverage is delivered by one plan.
Perhaps you are interested in having Part D prescription drug coverage, but you don’t want to enroll in a Medicare Advantage Prescription Drug plan. If you have Medicare Part A and/or Medicare Part B, you may be able to enroll in a stand-alone Medicare Part D Prescription Drug Plan. Stand-alone Medicare Part D Prescription Drug Plans are offered by private insurance companies that contract with Medicare to provide prescription drug benefits to enrolled Medicare beneficiaries who live within the plan’s service area. Every stand-alone Medicare Part D Prescription Drug Plan has a formulary, which is a list of prescription medications covered by that plan. Formularies can vary by plan so it is important to check the plan’s formulary to see if your prescription drugs are covered by the plan. Also, the formulary may change at any time. You will receive notice from your plan when necessary.
If you decide to stay with Original Medicare (Part A and Part B), another option you may have is to sign up for a Medicare Supplement (Medigap) plan to help pay for Original Medicare’s out-of-pocket costs. Different Medigap plans pay for different amounts of those costs, such as copayments, coinsurance, and deductibles. Plan benefits are standardized across 10 plan types (labeled letters A through N), and each plan includes different benefits and level of coverage. In 47 states, including Missouri, Medigap plans offer the same standardized benefits for plans of the same letter type.
Medicare.gov offers a list of available resources that can help educate you on health resources in Missouri. Medicare-specific resources are included below:
Learn more about how Medicare plans work in Missouri including:
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