Medicare in Missouri

Resources for Missouri Medicare Beneficiaries 

Are you ready to learn about the different parts of Medicare, the various enrollment periods and applications, or comparing and selecting a Medicare plan? Let’s get started. 

Medicare Basics         Choosing the Right Medicare Plan         Enrolling in Medicare

When making decisions regarding Medicare in the Show-Me State, getting guidance can be helpful. As a resident of Missouri, you have access to a variety of resources that can be of assistance. One of these resources is the State Health Insurance Program (SHIP), sometimes known as CLAIM, the State Health Insurance Assistance Program. CLAIM has counselors located across the state who work in collaboration with local nonprofit organizations, public health agencies, and Area Agencies on Aging (AAAs) specific to your county to deliver Medicare information. 

Medicare Plan Options in Missouri  

As a person who lives in Missouri, you have a few Medicare options to choose from. People who are 65+ or those who have a qualifying disability for Medicare can sign up for Original Medicare. If you want more coverage, a Medicare Advantage plan may be better. There are many plans to choose from, including Prescription drug plans and Medicare Supplemental Insurance. 

Original Medicare (Parts A & B)  

Let’s jump into the basics, starting with Original Medicare. This program is split into two parts, Medicare Part A, which covers hospital insurance, and Medicare Part B, which covers medical insurance. Different deductibles apply for different services under each Medicare Parts A and B. For instance, before Original Medicare begins to pay, Part A has an inpatient hospital deductible per benefit period (each time you are admitted), while Part B has an annual deductible. Considerations if deciding to keep Original Medicare include: 

• If you want the flexibility to choose and access medical professionals who accept Medicare anywhere in the United States, original Medicare in Missouri is a fantastic alternative. 
• There are no waiting periods, copays, networks, or restrictions on coverage due to a pre-existing condition. 

Medicare Advantage (Part C)  

Medicare Part C, or Medicare Advantage, is a commercial insurance option to Original Medicare. These plans cover at least what Medicare Parts A and B does and typically offer more. Most treatments are provided by a network of providers, which may require you to select a primary care doctor, get a referral to see a specialist, and have prior authorization for some services, treatments, and drugs. There are also Preferred Provider Organizations (PPO), Health Maintenance Organization-Point Of Service (HMO-POS), and Private Fee For Service (PFFS) plans. 

Missouri Medicare Advantage will likely cover more and is a good choice. To learn more about Medicare Advantage, explore our Medicare Part C Resource Page. 

Medicare Prescription Drug Plan (Part D)  

Many Medicare Advantage plans automatically include Medicare Part D prescription drug coverage. You can also add a stand-alone Prescription Drug Plan (PDP) to your Original Medicare or a Medicare Supplement Insurance policy. Private insurance companies approved by Medicare offer coverage for Part D on their own. Depending on the plan you choose, you may have to pay a deductible, copay, or share of the cost of each of your medications.  

Medicare Supplement Insurance (Medigap)  

Some Medicare-eligible Missouri residents buy Medigap. These programs supplement Original Medicare. Covered gaps include medical care outside the U.S., Medicare Parts A and B deductibles coinsurance. Medigap excludes Medicare Advantage. You can’t have both Medicare Advantage and Medigap. If you have a Medicare Advantage plan and desire a Medigap policy, the new Medigap policy start date should begin the day after the Medicare Advantage plan’s end date.  

Because Original Medicare does not cover all of your medical expenses, the Missouri Department of Insurance (MDI) provides information on how Medicare Supplement Insurance coverage can help you save money. 

Medicaid 

Medicaid has existed as a public insurance program since 1965. It assists low-income individuals in obtaining health care, including children, parents, pregnant women, the elderly, and individuals with impairments. Both the state and federal governments contribute funding to the program. According to federal regulations, each state administers its own Medicaid program. The federal rules are extensive, so states have much freedom to create and administer their own programs. Consequently, Medicaid eligibility and benefits can and sometimes do vary substantially between states. 

How and when to sign up for Medicare in Missouri 

Most Americans can sign up for Medicare once they reach the age of 65.  

The following events also trigger Medicare eligibility: 

• You are under the age of 65 and have been receiving Social Security disability benefits for at least 24 months. In another case, you may be eligible for if you were a railroad worker and receiving benefits from the Railroad Retirement Board. 
• You’ve been diagnosed with End-Stage Renal Disease (ESRD). 
• You’ve been diagnosed with Lou Gehrig’s disease, also known as Amyotrophic Lateral Sclerosis (ALS). 

Medicare Advantage Enrollment Periods in Missouri and nationwide  

Here is a quick overview of the Medicare enrollment timeframes in which you can elect or change your Medicare Advantage plan.   

We’re almost done, Missourians. Let Healthpilot show the “Show Me” State exactly how we can help. We would be more than happy to do the heavy lifting for you. After you respond to a few questions, we will recommend the best plan for your unique healthcare goals and needs. And then you can skip the tedious phone call (if you really want too) and jump to enrolling online safely and securely. 

As long as you are a Healthpilot customer, we take care of this for you each and every year. Enrollment windows don’t need to be committed to memory when Healthpilot is on your side. 

See your recommended plan

Key Stats

Some interesting facts about Medicare coverage in Missouri:   

• In Missouri, 1,248,427 people are Medicare eligible. This means that 20% of people have Medicare, which is just a little bit more than the national average of 19%. 
• In Missouri, about 47% of people who have Medicare are enrolled in a private Medicare Advantage program. Above the average of 45% for the country. 
• The average monthly premium for a Medicare Advantage plan in Missouri went from $7.86 in 2022 to $7.67 in 2023. A 2.4% savings in average premium price. 
• The cheapest stand-alone Medicare prescription drug plan in Missouri costs $5.80 per month. 
• We also promised you a fun fact about Missouri, so here it is: Many strange things happened during the 1904 Olympic marathon held in St. Louis. The winner had a car ride for most of the race, the runner who came in fourth took a nap during the marathon, and a pack of dogs chased another runner. Crazy! 

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