If you qualify for Medicare, there are several options you should make yourself aware of. The right company and plan for you depends on your individual situation. Benzinga’s guide to Missouri Medicare companies can help you understand your health care options.
The Best Missouri Medicare Options:
- Best Overall in Missouri: Aetna
- Most Affordable in Missouri: Humana
- Best for Chronic Conditions: Essence
- Best for Combining Medicare with Medicaid: Anthem
- Best for Travel Coverage: UnitedHealthcare
What is Medicare?
Medicare is a health insurance program offered by the federal government. You may qualify for this health insurance option if you:
- Are 65 or older
- Have a disability
- Need dialysis or a transplant due to end-stage renal disease
Medicare is also different from other health insurance options because it is broken up into several parts.
Part A: This part of Medicare is hospital insurance. It covers inpatient hospital stays, hospice care, care in a skilled nursing facility and some home health care.
Part B: Medicare Part B covers your medical insurance needs. This refers to outpatient care, medical supplies, preventive care and other types of medical service.
Part C: Part C is Medicare Advantage, also known as MA plans. These plans are offered by private insurance companies as an alternative to Original Medicare.
Part D: Medicare Part D plans are supplemental plans that add drug prescription coverage to other Medicare plans.
Legalities of Medicare in Missouri
Medicare is a government-controlled health plan. Generally, with Original Medicare you can visit any doctor you’d like as long as their office accepts Medicare insurance.
Medicare Advantage plans often come with more restrictions. These plans are not offered by the federal government, so they are not required to meet the same standards as Original Medicare plans. Your Medicare Advantage insurance company can restrict the doctors and specialists that are covered by your plan. It may also require you to receive a referral from your primary care doctor before your plan will cover a specialist visit.
Medicare Advantage insurance companies can limit your prescription drug coverage. The plans may deny coverage for brand-name drug treatments. If generic drug treatments do not work for you, your insurance company may decide that you are eligible for brand-name drug coverage.
If you think you might need to carry a Medicare Supplemental Insurance plan, you should know that this is not an option if you have a Medicare Advantage plan. Medicare Supplemental Insurance plans are also referred to as Medigap policies. These plans are also offered by private insurance companies and can fill in gaps in your Medicare coverage.
Types of Medicare Advantage Plans
Insurance companies may offer different types of Medicare Advantage plans. Here’s a quick overview of the most common options.
HMO: These Medicare Advantage plans offer coverage for both Part A and Part B Medicare insurance. Part D coverage is also often included in Medicare Advantage HMO plans. These plans may also include vision, hearing and dental coverage.
You should also be aware of the requirements that usually come along with Medicare Advantage HMO plans. These plans only cover visits to doctors and hospitals that are within the plan’s network. There may be an exception to this requirement if you visit an out-of-network provider in an emergency situation. HMO plans may also require a referral from your primary care doctor before it covers a visit with a specialist.
PPO: Medicare Advantage PPO plans also include both Part A and Part B insurance. It usually includes your Part D prescription drug coverage. There may also be an option to include vision, hearing and dental coverage.
PPO plans handle network coverage differently than HMO plans. With a Medicare Advantage PPO plan, you may visit any doctor and hospital you would like regardless of whether the provider is within the plan’s network. Be aware that your costs may vary depending on the plan’s network. If the provider you visit is not within the plan network, you may need to pay more for your visit.
These plans usually do not require referrals to visit a specialist. If you visit or think you may need to visit specialists often, this may be a better option for you. You will likely be able to visit a specialist sooner without the extra cost of visiting your primary care doctor for a referral.
PPO plans may also require you to pay a copayment or coinsurance for your health care services. Some health insurance to become familiar with before making your decision are:
Deductible: Your plan may require you to meet a deductible before the insurance company pays for your care. The deductible is the amount of money you must pay for your health care services. You should provide your insurance card to your doctor or hospital at each visit to ensure that the money you are paying is counted toward your deductible.
Coinsurance: After you’ve met your deductible, you may be responsible for a coinsurance payment for each health care service you receive. The coinsurance payment is a percentage of the total cost of your visit that you are responsible for paying your provider. Your insurance company will pay the remainder of the visit’s cost directly to the provider.
Copay: Similar to coinsurance, your copay is the amount you are required to pay to your health care providers after meeting your deductible. Copays are a set dollar amount that you are responsible for paying for your health care services. The cost of your visit will not affect your copay amount. You may have higher copays for specialist visits, however.
How to Sign Up for Medicare in Missouri
To sign up for Medicare Part A or Part B, there are 3 ways you can sign up:
- By enrolling online
- By calling Social Security at 800-772-1213 Monday through Friday from 7 a.m. to 7 p.m.
- By visiting a local Social Security office
If you’re interested in signing up for a Medicare Advantage plan, there are a few steps you should take:
Compare the health plans that are available to you. Medicare Advantage plans vary by state and even by county, so be sure to enter your location for the most accurate results.
Once you’ve found a plan that you like, visit the insurance company’s website. Some plans allow you to enroll online. If that is not an option, you can contact the company to request a physical enrollment form.
If you’d prefer, you can also enroll in Medicare Advantage plans by calling 1-800-MEDICARE (1-800-633-4227).
Average Cost of Medicare Advantage Plans in Missouri
Each insurance company sets its own costs and coverage for Medicare Advantage plans. Be sure to review the coverage and cost options available in your area before committing to your plan.
| Plan Name | Company | Plan Type | Health & Drug Costs |
|---|---|---|---|
| Humana Gold Plus H0028-014 | Humana | HMO | $72 |
| Essence Advantage | Essence Healthcare | HMO | $21.60 |
| Anthem MediBlue Plus | Anthem HealthKeepers | HMO | $17.76 |
| AARP Medicare Advantage Walgreens | UnitedHealthcare | PPO | $13.68 |
| Aetna Medicare Elite | Aetna Medicare | PPO | $239 |
Best Medicare Insurance Providers in Missouri
If you’re considering a Medicare insurance plan, you should become familiar with the insurance providers available in Missouri. No matter what type of coverage you’re looking for, there is sure to be an option for you.
- Member support
1. Best Overall in Missouri: Aetna
Aetna Medicare offers a wide range of coverage options across the U.S. They can offer you both HMO and PPO Medicare Advantage plans. Most of Aetna Medicare’s plans include the option for vision and dental coverage.
Some of the benefits of this insurance company lie within their additional resources. You can expect to find local healthy living resources as well as prescription drug deliveries if you choose a plan with Aetna. You can also take advantage of their 24/7 on-call nursing services.
- Medicare Advantage Plans
2. Most Affordable in Missouri: Humana
Humana offers affordable insurance to Missouri Medicare Advantage subscribers. With Humana, you can expect the option for a $0 deductible, allowing you to take advantage of your insurance coverage as soon as your coverage begins.
You can also expect the option for a $0 drug deductible with Humana. Humana offers coverage that includes vision, dental, hearing and even fitness benefits. You can pay as little as $0 copay for a primary doctor visit and $35 for a visit with a specialist.
Overall, Humana is a great option if you’re looking for an affordable Medicare Advantage plan.
3. Best for Chronic Condition Coverage: Essence Healthcare
If you have a chronic or disabling condition, you’ll want a healthcare plan that caters to the level of care you need. Essence Healthcare offers a variety of plans to meet these needs. You can choose among HMO plans that offer $0 monthly premiums with higher maximum out-of-pocket costs.
Or, you can choose to pay a monthly premium to lower your maximum out-of-pocket costs. Out-of-pocket costs are the total amount of money you will pay for your health care services, including your copay and coinsurance payments.
After you have met the maximum out-of-pocket costs limit, Essence Healthcare will stop requiring you to pay copay or coinsurance payments to your service providers. With these plans, you can also expect $0 health plan and drug deductibles.
- Submiting and tracking claims
4. Best for Combining Medicare With Medicaid: Anthem
If you are eligible for Medicaid in addition to Medicare, you may want to choose an insurance company that allows you to benefit from both programs. In this case, you’ll want to look for plans that cater to individuals who have dual eligibility.
Anthem offers several plans to choose from, most of which include drug coverage. If you’re dual eligible, you have the option to choose from plans that may offer you lower out-of-pocket costs.
- Same day coverage available
5. Best for Travel Coverage: UnitedHealthcare
If you like to travel, you may want to opt for a Medicare Advantage plan that includes travel coverage. UnitedHealthcare offers many benefits to its customers, including the option for hearing, vision and travel insurance. You may be able to benefit from video doctor visits, which can be helpful if you experience a non-threatening medical issue while you are traveling.
Many UnitedHealthcare plans also offer nurse hotlines to answer any questions that may come up whether you’re at home or on the road.
Which Medicare Option is Right for You?
With such a wide variety of Medicare options, it can be difficult to decide which plan to enroll in. Know that the best Medicare option is the one that works for you. Before reviewing your options, it can be helpful to make a list of your medications and the doctors you visit.
When you search for plans, you can get an estimated cost of all of your medications by entering the name and strength of your prescriptions. You can also check to see if the doctors you visit are within each plan’s network. When you enter this information, you can get a better understanding of what costs and coverage each plan can offer you.
Frequently Asked Questions
1) Q: What are the different parts of Medicare?
Medicare has 4 parts named Parts A, B, C, and D. Part A provides hospitalization coverage while Part B provides outpatient coverage, like doctor visits. Parts A and B make up Medicare’s core coverages. Part C is provides private-market Medicare plans, called Medicare Advantage Plans. Part C coverage often includes additional benefits. Medicare Part D provides coverage for prescription drugs. Get a Medicare Insurance Quote through the top providers here.
2) Q: Is Medicare free?
Because there are 4 parts to Medicare, there can be different cost structures. Most people won’t have to pay for Medicare Part A (hospitalization). Eligibility for premium-free Part A is based on your work history during which you paid Medicare taxes. Many people do pay a monthly premium for Medicare Part B, however, which covers outpatient medical services, like doctor visits. Deductibles also apply to services covered under Medicare Parts A and B, so you’ll pay a part of the annual cost.
Medicare Parts C and D are optional coverages and have premium costs of their own. Medicare Part C refers to Medicare Advantage Plans that offer additional coverage in exchange for a monthly premium. Part D, the prescription plan, reduces the cost of medications but also requires a monthly premium. Subsidies may be available for low income households to help reduce overall Medicare costs.
3) Q: Do I need to sign up for Medicare?
If you signed up for Social Security before age 65, you were enrolled in Medicare automatically but benefits will begin at age 65. In most cases, there are penalties for not enrolling at age 65, so it pays to sign up on time. Click here to get a medicare quote in minutes from the best providers.
If you have employer coverage, you may be able to delay Medicare coverage while your work plan is still in force. However, the size of the employer determines whether you’ll pay a penalty for not enrolling at age 65. Employees (and their spouses) of companies that offer group health insurance to 20 or more people are usually exempt from late sign-up penalties if they are covered by the employer’s plan.
About Ashley Hart
Ashley Hart is a personal finance writer passionate about helping people feel empowered to take control of their finances. She has more than eight years of writing experience, focused on insurance.