Introduction to Medicare Advantage in Missouri (Medicare Part C)

Medicare Part C, also sometimes known as “Medicare Replacement”, are alternate names for what most seniors know as Medicare Advantage. These comprehensive insurance plans are one of many ways in which senior citizens can protect themselves from the costly gaps in their Original Medicare coverage. The word “replacement” is probably the most accurate description, seeing as how a Medicare Advantage policy will effectively replace your Medicare benefits.

Federal Regulations for Medicare Advantage

Thankfully, replacing Original Medicare with a Medicare Advantage policy will not leave you with inferior coverage. There are protective laws in place which will guarantee your basic Medicare coverage (Medicare Parts A and B) no matter what Medicare Advantage policy you get. In general, most policies are sold with additional benefits, such as those which provide coverage for the costly gaps in Original Medicare, as well as additional benefits which will be discussed below.

Medicare Advantage Enrollment In Missouri

Missouri seniors are middle-of-the-road when it comes to Medicare Advantage. Around 31% of Medicare-qualified retirees have replaced their federal benefits with an Advantage plan. Of those, different people prefer many different types of Medicare policies. You can get an idea of the breakdown in this chart:

Plan Type Enrollment Percentage
HMO Plans 59%
Local PPO Plans 13%
Special Needs Plans 11%
Regional PPO Plans 9%
Private Fee-For-Service Plans 5%
Other (Cost Plans, MSA’s, etc.) 3%

Plan Coverage & Cost

Your health and specific location will play a significant role in what you eventually pay for a Medicare Advantage policy. Based on our data, we have a list of estimated rates which seniors near you might be paying for their policies:

Most Popular Medicare Advantage Plans in Missouri

If you are looking for an unbiased review of a Medicare Advantage plan, check out Medicare’s Overall Star Rating report. Each year around open enrollment time, Medicare publishes this report that assigns a “star” value for every company providing Medicare related products and services. The reports are based on information Medicare collects on all companies plus customer surveys. For Medicare Advantage companies, Medicare evaluates their use of screenings and vaccines, management of chronic illness, customer experiences and complaints, changes in performance levels, and customer service. The more stars, the better the performance. Check it out.

Helpful Medicare Advantage Tips & Tricks

Doctor/Provider Network Restrictions

Original Medicare is accepted nearly everywhere – Medicare Advantage, however, is not. Your insurance company will determine which doctors and hospitals are allowed into your provider network. They will also set restrictions on how and where you can get your medical care. Lastly, even if your preferred doctor or facility is in your provider network now, that doesn’t mean you will have access to them for the life of your policy. Your provider can change the rules of your provider network at any time.

Where you generally need to get your care and services from for:

  • HMO Plans – Medicare Advantage plans that are organized as HMOs each have comprehensive networks. These networks consist of nearly every conceivable medical specialty providers and all the facilities required to support you like hospitals, labs, imaging centers, and more. As a member of an HMO, you will be obliged to use the network’s physicians and facilities for your care.
  • PPO Plans – Preferred Physician Organizations (PPOs) also have networks and some are just as extensive as an HMO. Unlike HMOs however, a PPO does not limit you to using only network providers. You can use any healthcare provider you like providing they accept your insurance plan. If you use a provider out-of-network, expect to have a higher copay.
  • PFFS Plans – Private Fee For Service (PFFS) have no restrictions on which healthcare providers you use so long as they accept your plan. However, these plans generally have lower reimbursement schedules than other plans and many providers do not accept their plans. You should always confirm your plan is accepted when making an appointment with a provider.
  • Special Needs Plans – If you qualify for a Special Needs Plan (SNP) your group will provide you with a list of providers you have to use. These will generally be members of the Medicare SNP network and will be specialists who handle your particular condition. Exceptions to this rule include emergencies and out-of-state care.

Doctor/Providers List

Finding a doctor who accepts your Medicare Advantage plan:

  • HMO Plans – With an HMO you won’t have to worry about finding a doctor who accepts your coverage. You may or may not be able to choose your HMO primary care physician, but he or she is responsible for referring you to additional HMO resources like specialists and labs if required.
  • PPO Plans – PPOs normally will have online directories of physicians and facilities that belong to the PPO’s network. These listings typically include a short bio and some even have patient reviews. If you already have a doctor who is outside the network, just call and confirm that he or she will accept your plan. If they do, your Medicare Advantage plan will provide the coverage.
  • PFFS Plans – Finding a doctor who accepts PFFS plans can be difficult. Many doctors will not accept these plans because of the low payment terms. Once you have found a doctor, you still have to confirm that they accept your plan each time you make an appointment. By law, a physician can reject your insurance any time before service is rendered. That means they may have accepted it last month but no longer do this month.
  • Special Needs Plans – If you have a chronic condition or one of the other qualifying conditions that allow you membership in a SNP, your group will provide you with a list of providers in their network.

Almost all Medicare Advantage plans have an online directory of healthcare providers that works similarly to Medicare’s physician search for physicians who accept Original Medicare.

Drug, Vision and Dental Coverage

One of the features of Medicare Advantage plans that is so attractive is the option to add extra benefits that are not available with Original Medicare. Dental care is one of those benefits. Most Medicare Advantage plans have participating dental offices that will offer basic dental service. This is usually limited to a routine exam, including x-ray costs, cleaning, and fillings.

Other than eye exams associated with diabetes and age related macular degeneration, Medicare offers no eye care. Many Medicare Advantage plans do offer basic eye care. This benefit typically consists of an annual eye exam, lenses, glasses, and contacts. Optical shops that participate in these programs often offer discounts for additional services to plan members.

Enrollment Options & Best Time To Enroll

When applying for Medicare Advantage, enrolling at the right time is key. If you can get in during the Initial Enrollment Period, you should have a fairly easy time getting covered. The longer you wait, however, the more difficult things can become. Enrolling outside of the IEP may require you to answer health questions before your provider will decide to accept you. And if you have a serious pre-existing condition, such as End Stage Renal Disease, you many have a harder time still. But your local licensed insurance agent or your state department of insurance can help you find coverage under extenuating circumstances. For more info, be sure to take a look at our Medicare Advantage Enrollment Options page.

  • Initial Enrollment Period: Within your first 6 months of Medicare enrollment, you can enroll in a Medicare Advantage policy.
  • Annual Enrollment Period (AEP): From October 15th through December 7th each year, you are free to change or cancel your Medicare Advantage and part D drug plan.
  • Special Enrollment Period (SEP): Any sort of special circumstance in which you may need to change or get new coverage outside of a regular enrollment period, such as moving out of your service area, losing your employer/plan coverage, or your provider ceasing coverage in your area.

What Medicare Advantage Plan Is Best For Me?

To get the best Medicare Advantage plan for you, it’s important to think about what your medical needs will be in the future. With a good idea of what you will need, you can research the plans that will best fit those needs. Don’t confine your comparisons of plans to just premium or copay costs. Take into consideration financial stability and the length of time the company has served your area.

Getting it right the first time is important. Unlike other insurances, if you want to change plans you may have to wait thanks to special enrollment periods. Do your homework and you’ll find a plan you like and can afford.

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