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Medicare Advantage in Missouri

Last Updated on

October 6, 2016

As a Medicare beneficiary in Missouri, you may have several Medicare Advantage options. Not every Medicare Advantage plan providing coverage in Missouri is offered in every Missouri county, so you will need to check the availability of Medicare Advantage plans where you reside.

How Medicare Advantage works in Missouri

Medicare Advantage, also known as Part C, provides a different way to receive your Medicare Part A and Part B benefits. Instead of receiving your Medicare benefits from the federal government, private insurance companies contracted with Medicare provide these same benefits (with the exception of hospice care, which remains covered under Part A). While all Medicare Advantage plans are required to have the same level of coverage as Original Medicare, many offer extra benefits. For example, some plans also help pay for routine vision, dental, or prescription drug coverage.

Missouri beneficiaries, and beneficiaries throughout the United States, are eligible to enroll in Medicare Advantage if they:

  • Have both Part A and Part B.
  • Live in the coverage area of the plan in which they want to enroll.

Generally, individuals who have end stage renal disease (ESRD) are not eligible to enroll in a Medicare Advantage plan. There may be exceptions. For example, if you have had a successful kidney transplant, and you still qualify for Medicare benefits (based on your age or a disability), you may enroll in a Medicare Advantage Plan.

You may enroll in a Medicare Advantage plan during the following periods:

  • Initial Coverage Election Period (ICEP): This is when you’re first eligible to enroll in a Medicare Advantage plan.
    • You can enroll in a Medicare Advantage plan when you’re first eligible for Medicare (after you enroll in Part A and Part B). In this case, the ICEP is a seven-month period that starts three months before the month you turn 65, includes your birth month, and ends three months after your birth month.
    • If you delay enrolling in Medicare Part B (for example, if you have employer-sponsored group health coverage), your ICEP is the three-month period before your Part B start date.
  • Annual Election Period: This is the period when you can enroll in a Medicare Advantage plan, add or drop prescription drug coverage offered by a stand-alone Medicare Part D Prescription Drug Plan, or disenroll from a Medicare Advantage plan and return to Original Medicare. The Annual Election Period occurs from October 15 to December 7 each
  • Medicare Advantage Disenrollment Period: During this period individuals can drop Medicare Advantage coverage and return to Original Medicare. You cannot make other types of changes (except adding stand-alone Medicare Part D prescription drug coverage if you drop a Medicare Advantage plan). The disenrollment period is January 1 to February 14 each year.
  • Special Election Period: Outside of the regular enrollment periods described above, you may be able to make changes to your Medicare coverage during a Special Election Period if certain circumstances in your life or Medicare coverage change. For example, you may move to a location outside your Medicare Advantage plan’s service area and need to change Medicare Advantage plans or return to Original Medicare.  You may enroll in a Medicare Advantage plan or change Medicare Advantage plans if you lose your current coverage.

Types of Medicare Advantage plans in Missouri

If you’re enrolled in Medicare Part A and Part B, you may be able to enroll in any one of several Medicare Advantage plans; however, their availability depends on where you live. You must live within the plan’s service area.

Here’s an overview of the main types of Medicare Advantage plans:

  • Health Maintenance Organization (HMO): In most HMO plans, you’re required to use providers within the plan’s network in order to receive benefits. However, coverage is provided if you need emergency care or have the plan’s authorization to go outside its network for specific care. You will select a primary care doctor who will coordinate your care, including referrals to specialists.
  • Preferred Provider Organization (PPO)*: With a PPO plan, you’ll pay less out-of –pocket if you receive your care from providers who participate in the plan’s preferred network. Although you have coverage if you use providers outside the plan’s network, you will have higher out-of-pocket costs. You are not required to select a primary care physician to coordinate your care.
  • Health Maintenance Organization Point-of-Service (POS): HMO-POS plans are a hybrid of standard HMO and PPO plans. As with an HMO, you’ll select a primary care doctor. However, you’ll  have an option of using out-of-network providers just as you would in a PPO.  Your out-of-pocket costs may be higher than what you would pay if you received services from a network participating provider.
  • Private Fee-for-Service (PFFS): These plans allow private health insurers to set their own payment terms. With many PFFS Private Fee-for-Service plans, you can see any provider that will accept the plan’s payment terms. The provider must agree to treat you on a case-by-case basis. Some plans include PFFS networks of participating providers.
  • Special Needs Plan (SNP): Special Needs Plans limit membership to certain groups of beneficiaries who have particularized conditions or health care needs, such as people who have congestive heart failure, live in a nursing home, or are have both Medicare and Medicaid. Special Needs Plans include prescription drug benefits.
  • Medical Savings Account (MSA): This is a high-deductible health plan with a medical savings account. Every year, you deposit money into a medical savings account that can be used to pay for medical expenses, tax-free. Members pay all health costs until they reach the deductible. These plans don’t provide prescription drug coverage.

Many types of Medicare Advantage plans include prescription drug coverage. Any of the above types of Medicare Advantage plans may include drug benefits, except for Medicare Savings Account plans. If your Medicare Advantage plan doesn’t include prescription drug coverage and you desire this coverage, you may have several options:

  • You might be able to enroll in a stand-alone Medicare Part D Prescription Drug Plan.
  • You can switch to a Medicare Advantage plan that includes prescription drug coverage.
  • You can disenroll from a Medicare Advantage plan, return to Original Medicare, and sign up for a stand-alone Medicare Part D Prescription Drug P

To make any of the changes described above, in most cases you are limited to certain Medicare election periods.

If you enroll in a Medicare Advantage plan, you’ll need to keep paying your Part B premium in addition to the premium, if any, of your Medicare Advantage plan. Your costs in Medicare Advantage will vary, depending on the plan.

Comparing Medicare Advantage plans in Missouri

Because Medicare Advantage plans often offer additional benefits beyond the benefits of Original Medicare, you will want to review the benefits of plans available where you live to determine which plan or plans offer benefits of value to you. Just as Medicare Advantage plans may offer different benefits, so, too, they have different costs.  You may find that Medicare Advantage plans have different monthly premiums, deductibles, copayment and coinsurance provisions.  It’s wise to take the time to research and compare Medicare Advantage plans where you live to make sure you select the plan that best meets your coverage needs.  To narrow your research to Medicare Advantage plans available where you live in Missouri, you may enter your zip code in the plan finder located on this page.

Learn more about how Medicare plans work in Missouri including:

 

* Out-of-network/non-contracted providers are under no obligation to treat Preferred Provider Organization (PPO) plan members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.