TABLE OF CONTENTS
Medicare Advantage Plans, called Medicare Part C, are bundled plans that have been designed to be an all-in-one alternative to Original Medicare by providing the same coverage as Parts A and B. These plans frequently include additional benefits, like prescription drug coverage and may even provide benefits Original Medicare doesn’t offer, such as hearing, vision and dental.
Medicare Advantage Plans are offered by private insurance companies, which means the coverage, costs and additional benefits offered can vary from plan to plan. Plans also vary by location, so it’s important to research the plan options available in your area to ensure you get the best Missouri Medicare Advantage Plan available.
Compare ratings of insurance companies offering Medicare Advantage Plans in Missouri:
|Insurance company||Medicare rating||AM Best rating||BBB rating||J.D. Power ranking|
|Aetna||4 stars||A||A+||6th out of 9|
|Cigna||4 stars||A-||Not rated||8th out of 9|
|Humana||4 stars||A-||A+||2nd out of 9|
|UnitedHealthcare||3.5 stars||A-||A-||4th out of 9|
You have choices in Medicare coverage. While you can opt to stick with Original Medicare, a Medicare Advantage Plan – also known as Part C – may be a better alternative for you.
|Original Medicare||Medicare Advantage Plans|
|Original Medicare covers your Part A hospital insurance and Part B medical insurance.||Medicare Advantage Plans combine Part A, Part B, and additional benefits.|
|You can add Part D prescription drug coverage.||Prescription drug coverage is usually included.|
|You’re able to use any medical provider in the U.S. that accepts Medicare.||You’ll usually need to use doctors in your plan’s network.|
|You can buy supplemental coverage to manage out-of-pocket costs, including your coinsurance.||Your Medicare Advantage Plan may have lower out-of-pocket costs than Original Medicare.|
|Vision, hearing, dental, and other benefits aren’t covered.||Your plan may offer additional benefits, including vision, hearing, and dental.|
Medicare Advantage Plans cover benefits from Original Medicare Part A (hospital insurance), Part B (medical insurance), usually Part D (prescription drug coverage), and sometimes additional benefits that Original Medicare doesn’t cover. Each Medicare Advantage Plan insurer sets the rules about how you receive and pay for these benefits.
|Hospital and skilled nursing facility inpatient care||Home health care||Prescription drug coverage (if included in your plan)|
|Medically necessary outpatient services, such as:
||Preventive services, such as:
||Additional benefits (depending on your plan), such as:
With 135 Medicare Advantage Plans available in Missouri, you likely have a few options in your area. To help you choose the best plan for you, consider what is most important to you before selecting a plan. There are several factors to keep in mind:
With only 22% of Missouri residents choosing a Medicare Advantage Plan, Plan C isn’t as popular in the state as it is elsewhere in the country. This may be because there are fewer plans available in Missouri than in many other states, but these plans are still an option worth exploring.
|Number of Medicare Advantage Plans available||Medicare Advantage Plan types available||Medicare Advantage Plans rated 3.5 or higher by NCQA|
In Missouri, the most common Medicare Advantage plans available are HMOs or PPOs, although there are also a few SNPs and regional PFFS plans available. Seniors eligible for Medicare may choose from plans provided by multiple private insurers, although the choices available vary by county.
HMOs typically require that you receive all services from in network providers:
PPOs include a preferred network of providers, but you have the option of choosing doctors or hospitals from outside of the network for a higher cost.
PFFS plans don’t require a primary care physician or referrals for specialists:
SNPs are only for people with specific conditions and characteristics, and include care coordination and targeted benefits tailored to meet your specific needs:
You’re eligible for Medicare when you turn 65 or if you’re younger and have a qualifying disability. A qualifying disability means at least one of the following applies:
When you become eligible for Medicare, you are also eligible for Medicare Advantage Plans. There are specific times of the year when you can enroll for the first time in a Medicare Advantage Plan: during your Initial Enrollment Period and the Open Enrollment Period.
Medicare Advantage Open Enrollment occurs between January 1 and March 31 of each year. This period is only for beneficiaries already in a Medicare Advantage Plan, and you can change plans or switch to Original Medicare. You cannot switch from Original Medicare to Medicare Advantage during Medicare Advantage Open Enrollment.
There are exceptions to these enrollment periods called Special Enrollment Periods. Certain events or circumstances may make you eligible to change your Medicare Advantage Plan outside of the open enrollment periods, such as if you move outside of your existing plan’s service area or to a location with new plan options you didn’t have before. If you think you may qualify for a Special Enrollment Period, call 1-800-MEDICARE and explain your situation.
|Enrollment period||When it happens||Medicare plans you can choose||What you can do|
|Initial Enrollment Period||Three months before you turn 65, the month you turn 65, and three months after||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan||Sign up for Medicare Part A and Part B. Complete your Part B enrollment to avoid a late enrollment penalty.|
|General Enrollment Period||January 1 – March 31||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan. If you enroll in Medicare during this period, your MAP enrollment is April through June.||Sign up for Medicare if you missed your IEP|
|Open Enrollment Period||October 15 – December 7||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan||Join, switch, or drop a plan|
|Medicare Advantage Open Enrollment Period||January 1 – March 31||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan||If you’re enrolled in a Medicare Advantage Plan, you can change your plan or switch to Original Medicare|
|Special Enrollment Period||When you have a qualifying event||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan||Make changes to your plan|
Most Medicare Advantage HMO and PPO plans and all SNP plans provide prescription drug coverage like you would get from Medicare Part D. Some PFFS plans may provide prescription drug coverage, but not all do. Evaluate a plan’s prescription drug coverage when deciding which Missouri Medicare Advantage Plan to use.
Prescription drug coverage may vary by cost, coverage, and convenience among Medicare Advantage Plans. Your monthly premium may include a premium for the drug coverage in the plan. There is usually a copayment or coinsurance amount that you have to pay for each prescription after you reach your annual deductible.
Some plans use different cost tiers with different costs for different drugs. For instance, you may pay less for generic drugs than brand-name drugs or less for brand-name drugs within different tiers. If your plan uses tiers, the formulary will list all covered drugs and their tiers. Verify your preferred or local pharmacies are included in the plan’s network.
|Resource||Contact||How they help|
|Financial Help for Missouri Medicare Enrollees||(844) 309-3504||This page explains how Missouri’s regulations and policies are likely to affect your bottom line|
|Missouri Consumer Assistance||N/A||A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services|
|Missouri Department of Health & Senior Services||(573) 751-6400
|The Missouri Department of Health & Senior Servives strives to be the leader in promoting, protecting and partnering for health|
|Missouri Department of Social Services||(573) 751-4815||The Missouri Department of Social Services is responsible for coordinating programs to provide public assistance, health care coverage, child welfare services, and specialized assistance to troubled youth|
|Missouri Insurance Department||(573) 751-4126
|The Missouri Insurance Department protects policyholders and serves the greater public interest through the effective regulation of the U.S. insurance marketplace|
|Missouri Medicaid Audit & Compliance||(573) 751-3399||MMAC is responsible for administering and managing Medicaid (Title XIX) audit and compliance initiatives and managing and administering provider enrollment contracts under the Medicaid program|
|Missouri Senior Medicare Patrol Project||(888) 515-6565||The mission of the Missouri Senior Medicare Patrol Project is to empower and assist Medicare beneficiaries to prevent, detect, and report healthcare fraud, errors, and abuse through outreach, counseling, and education|
|Missouri State Pharmacy Assistance Program (MORx)||N/A||MORx is Missouri’s State Pharmacy Assistance Program|
|Resource||Contact||How they help|
|Christian County Health Department||N/A||A guide to Medicare resources in Christian county|
|Clay County Public Health Center||(816) 595-4200||The Clay County Public Health Center is a local public health department created in 1953 to protect the health of all people in the county by implementing population based prevention programs and services|
|Clay County Senior Services||(816) 455-4800
|Clay County Senior Services supports and values the well being of senior adults by serving as the resource delivery agency and providing a broad range of services to promote wellness — physical, emotional, and intellectual|
|Kansas City Health Department||(816) 513-6008
|The Kansas City, Missouri Health Department (KCHD) addresses core public health needs and the root causes of diseases to increase the health, wellbeing, and longevity of everyone in the region|
|Missouri Directory of Local Public Health Agencies||(573) 751-6170
|This site is a helpful directory of local public health agencies in Missouri|
|Springfield Health Department||(417) 864-1658||The Springfield Health Department seeks to protect and improve their community’s health through education, collaboration, and prevention|
|St. Louis Health Department||(314) 612-5100
|The Department of Health is responsible for the health and safety of the community of St. Lewis|
|Taney County Health Department||(888) 707-4725 (Forsyth office)
(888) 294-9530 (Branson office)
|TCHD proudly serves Taney County through a variety of health, wellness, and safety programs|
|Resource||Contact||How they help|
|American Hospital Association – Medicare Advantage||1-800-424-4301||The AHA provides education for health care leaders and is a source of information on health care issues and trends.|
|CMS.gov – Medicare Advantage Applications||N/A||This page provides important information on the application process for Part C Medicare Advantage plans.|
|Medicare.gov – Medicare Advantage Plans||1-800-633-4227||This government website provides information on the Medicare Advantage program.|