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Medicare Plans in Missouri – Coverage and Benefits

Are you a Missouri resident? Are you turning 65 years of age this year? If so, then you should be preparing yourself to enroll in the Medicare health coverage program offered by the federal government. The base program, sometimes referred to as Original Medicare, comes in two parts: Part A, and Part B. Between the two, the majority of your hospital visits, doctor appointments, and outpatient procedures will be covered. However, Medicare doesn’t cover everything; and these coverage “gaps” can become very expensive if you don’t protect yourself early on.

Part B of Medicare comes with required fees and premiums that you can learn more about by clicking here. For most seniors, Part A might be free, but qualifying for a waiver depends on your work history. Anyone who has worked for at least 40 quarters in their lifetime (a grand total of 10 years) won’t have to pay any premiums for Part A benefits. Any less than that, and there may be additional costs.

Medicare Part A (Hospital Coverage)

  • Inpatient care in hospitals
  • Skilled nursing facility care
  • Hospice care
  • Home health care
Medicare Part B (Medical Insurance)

  • Services from doctors and health providers
  • Outpatient care
  • Home health care
  • Durable medical equipment
  • Some preventive services
Medicare Part C (Medicare Advantage)

  • Includes all benefits and services covered under Part A and Part B
  • Usually includes Medicare prescription drug coverage (Part D) as part of the plan
  • Run by Medicare-approved private insurance companies
  • May include extra benefits and services for an extra cost
Medicare Part D (Drug Coverage)

  • Helps cover the cost of prescription drugs
  • Run by Medicare-approved private insurance companies
  • May help lower your prescription drug costs and help protect against higher costs in the future

Different Types of Medicare Plans in Missouri

Within the state of Missouri, there are more than one million retired people currently receiving Medicare benefits (1,040,491 to be precise). More than one quarter of those (26%, or 270,527 residents) have replaced Original Medicare with a Medicare Advantage insurance policy. Conversely, 267,218 beneficiaries (another 26%) instead prefer to supplement their Medicare with a Medigap supplement policy. And the remaining 48% are divided between relying on Original Medicare alone, or receiving supplemental coverage through an employer benefit program.

Naturally, finding supplemental coverage will be a challenge if you aren’t already receiving Medicare benefits. For more information on when and how to enroll in Medicare, click the provided link.

Is Supplemental Medicare Coverage Worth the Extra Expense?

For most seniors, purchasing supplemental coverage can be very cost effective in the long run. If you are still in your 60’s and in fairly good health, it may seem as though your Original Medicare benefits will cover all of your medical needs. However, medical emergencies can happen at any time, and their likelihood will only increase with age. And if one of those emergencies fall under any coverage gaps, you could be facing costs as high as:

Medicare Part A Costs Medicare Part B Costs
  • $1,184 (as of 2014) Part A Annual Deductible for access to Basic Hospital Services
  • $296/day for an Inpatient hospital Stay between 61-90 days long
  • $147 Annual Deductible (as of 2014) for basic Part B Medical Coverage
  • 80/20 Coinsurance costs for all Medicare coverage; Medicare pays 80%, you pay 20% Out-of-Pocket

When you’re spending your golden years on a fixed income, large and unexpected medical bills can wreak havoc on your budget. But having these coverage gaps protected by some form of supplement is the best way to keep your finances secure.

Supplementing your Benefits with a Medigap Policy

A Medigap supplement policy is a supplemental form of health insurance underwritten by a private company working in tandem with the government to fill the gaps in Original Medicare coverage. All ten policies (Plans A, B, C, D, F, G, K, L, M, and N) are tailored to give you the most complete coverage at an affordable cost. And whether you’re in Missouri or Montana, you will get the exact same benefits from whichever plan you choose. The only variables you have to consider are price, and the insurance provider underwriting your policy.

Below, the chart explains what sort of benefits you can expect from each plan:

[chart category=”supplement” name=”planTypes” state=”MO” zipcode=”63116″]

Supplementing your Benefits with Medicare Advantage

Medicare Advantage is a unique type of health insurance policy which also goes by the names “Medicare Part C” or “Medicare Replacement”. The latter is probably the most accurate, due to the fact that it does effectively replace your Medicare benefits. Legally, whatever Advantage plan you are thinking about purchasing must offer “equal or greater” coverage than Original Medicare. Additionally, many insurance companies offer additional benefits, such as vision care or dental, with relatively low additional costs. That, and the convenience of having all of your Medicare benefits under one single policy, is what makes Medicare Advantage plans so appealing for some.

For others, however, there are drawbacks. Although Advantage policies might be priced competitively in certain markets, such low prices come from the fact that their networks are extremely limited. If you don’t mind switching doctors, then you may be in a unique position to take advantage of the reduced costs. However, if you’d prefer to keep your own doctors and providers, you have to take that into consideration before purchasing a policy.

Signing up for Medicare Advantage will likely require you to join an HMO or PPO network of doctors and health care facilities. If you receive medical care outside of your plan’s Health Maintenance or Preferred Provider Organization, you may have to pay out-of-pocket for that treatment.

[chart category=”advantage” name=”topHMOPlans” zipcode=”63116″ state=”MO”]

[chart category=”advantage” name=”topPPOPlans” zipcode=”63116″ state=”MO”]

More Information on Medigap Supplement vs. Medicare Advantage

If you’re still confused on the difference between Medigap and Medicare Advantage, don’t fret. Although both policies intend to serve a similar purpose, they are very different programs. Below, we’ve highlighted some of the major discrepancies between the two:

Questions Medicare Advantage Medicare Supplement
How are the plans funded? Medicare will pay your insurance company a fixed amount based on average healthcare costs for your region. You may also be required to pay a premium based on your location and insurance company. Your monthly premium takes care of the majority of your expenses.
Do I continue paying for Part B? Yes Yes
What does it cost me? Some plans offer a zero-dollar premium (because the government subsidy covers the full cost). Other plans may cost up to 0-0 monthly. While each plan does require a monthly premium, many of them are affordably priced.
What does the plan cover? Depending on your plan, it will cover at least the same benefits offered by Medicare parts A & B. Possibly other benefits; but the more benefits you sign up for, the higher your out-of-pocket expenses may be. All eligible expenses are split between Medicare, and your Medicare Supplement plan. If you have a comprehensive plan, such as Plan F, 100% of eligible expenses not covered by Medicare will be covered by your supplement insurance.
Can I budget my health care expenses? It’s challenging; the more often you require medical care, the more often you may be required to pay out-of-pocket. Budgeting is much easier with a Medicare supplement. You have fewer out-of-pocket expenses, and one simple monthly premium.
Can my plan be cancelled? Yes. Unfortunately, your health insurance company has the legal right to review their Medicare Advantage services annually and decide whether or not they wish to continue providing coverage. No – not unless you fail to pay your monthly premium, or your insurance company goes bankrupt. Only under such extenuating circumstances could your plan be cancelled.
Are pre-approvals or pre-certifications required? Unfortunately, yes. These Plans usually require pre-certification or other qualification for some specific types of care. No pre-approvals are required. If you qualify for Medicare, you will qualify for a Medicare supplement plan.
Can I use any doctor or hospital? Usually, you choose from a network of pre-approved providers. These networks can fluctuate over time. Yes. You are free to choose any doctor and/or hospital in the U.S. which accepts Medicare.
Can drug, vision, or dental coverage be included in the policy? Yes. No. These forms of coverage must be purchased separately.
Who is this plan type generally best suited for? If you are relatively young, healthy, live in an urban area, and have a limited income, a Medicare Advantage plan could work for you. If you live in a rural area without easy access to provider networks, if you like to budget your finances, or if you want comprehensive coverage, you might prefer a Medicare supplement plan.

Helpful Medicare Resources in Missouri

You can take advantage of the directory below to learn more information. Hopefully, this article has been informative enough to get you started. The local experts in the Medicare field can be reached by using the contact information below. Take advantage of their expertise in your search for the right supplemental coverage.

[chart category=”general” name=”usefulContacts”]

Important Medicare-Related Healthcare Terms

  • HMO: Health Maintenance Organization, this refers to a network of doctors and hospitals with a plans’ network.
  • PPO: Preferred Provider Organization, this refers to a network of doctors and hospitals with a plans’ network.
  • Co-Pay: Amount of money charged per visit to doctor, specialist, etc.
  • Co-Insurance: A percentage required by the policyholder to pay out-of-pocket. For example, 80/20 coinsurance means the insurance company will cover 80% of the charges, and the policyholder pays the remaining 20% of the charges.
  • Deductible: This is the amount of money required out-of-pocket by the policyholder before the insurance will kick-in and pay for any remaining charges. For example, a policy with a $1,000 deductible means that you must pay full healthcare costs out-of-pocket up to $1,000 before the plan will start coverage.

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