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.
Coverage and Benefits
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.
As a citizen in Missouri you can rely on Medicare to cover your medical costs once you pass the age of 65. Medicare is available to all, but Medicare Part A is free for anyone with 40 quarters or 10 years of work throughout their lifetime. Enroll into Medicare and you will automatically be enrolled in Medicare Part A. Part A offers coverage including hospice care, home health care, inpatient services and some nursing facility care as well. For even more coverage you can opt to pay a bit extra for Medicare B as well. With Medicare B you’ll receive additional preventative services, some outpatient care, additional services from doctors and better medical equipment to take home.
Beyond those two basic parts of Medicare you also have Medicare Part C, known as Medicare Advantage. This is a care policy that adds additional coverage on top of Parts A and B coverage options. You can enjoy coverage for things like dental, vision or prescriptions, but you must choose what coverage you want, and you’ll pay for each option that you choose. You can only get Part C coverage if you already have Parts A and B first. The same is true for Medicare Part D, a prescription drug coverage program that can help you cover the cost of your prescriptions.
|Medicare Part A (Hospital Coverage)
||Medicare Part B (Medical Insurance)
|Medicare Part C (Medicare Advantage)
||Medicare Part D (Drug Coverage)
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|
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.
While Medicare Parts A and B offer decent coverage, these basic policies often aren’t enough for seniors in Missouri. That’s because the cost of quality health care is higher than ever before, and it’s only expected to increase further in the future. Medicare can leave patients with huge bills left over for their services, and some people simply can’t afford them.
For those that are having trouble affording their medical costs, a supplemental health insurance policy like Medigap, a Medicare supplement program, can help step in and cover additional costs that Medicare isn’t covering. This program is quite affordable and will help make healthcare more affordable for the seniors that need it frequently.
The right supplement insurance policy will help you fill your Medicare coverage gaps, so you’re spending less money on the healthcare costs that Medicare isn’t covering for you. There are different policies available but basically the policy you want is the one that’s going to help you save as much as possible on your healthcare costs. The more healthcare needs you have, the higher quality policy that you want to pay for.
Not everyone needs a supplemental Medicare insurance plan, but if you do, you have two options available to you. Medicare Advantage and Medicare Supplement, also known as Medigap. Medicare Advantage is a more complex and privately-owned insurance option that offers more coverage options. Medigap is an affordable and simple supplemental policy that helps you get your Medicare coverage while paying less out of pocket. Both policies work well for specific people, but there are key differences between each of the plans that you should understand.
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:
Top Medicare Supplement Plans in the Area
|Type||Starting From||Part A Deductible||Part B Deductible||Excess||Nursing||Travel|
|F||$145||$0||$0||100% Covered||100% Covered||100% Covered||Request Info|
|C||$131||$0||$0||Not Covered||100% Covered||100% Covered||Request Info|
|G||$121||$0||$147||100% Covered||100% Covered||100% Covered||Request Info|
|B||$124||$0||$147||Not Covered||Not Covered||Not Covered||Request Info|
|N||$98||$0||$147||Not Covered||100% Covered||100% Covered||Request Info|
|D||$128||$0||$147||Not Covered||100% Covered||100% Covered||Request Info|
|A||$69||$1||$147||Not Covered||Not Covered||Not Covered||Request Info|
|L||$91||$304||$147||Not Covered||75% Covered||Not Covered||Request Info|
|K||$58||$608||$147||Not Covered||50% Covered||Not Covered||Request Info|
|M||$121||$608||$147||Not Covered||100% Covered||100% Covered||Request Info|
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.
More Information on Medigap Supplement vs. Medicare Advantage
The most obvious difference between an Advantage plan and a Medicare Supplement plan is how the insurance takes care of medical claims. With Medigap the claim isn’t paid for initially by the insurance company but is paid after Medicare pays its portion of the insurance cost. Medigap then pays a portion of the remaining bill after Medicare has paid and you are left with the remaining balance if there is one. The best Medigap policies with the highest premiums won’t leave any additional costs at the end.
With Medicare Advantage, the plan takes over all of your insurance benefits and the insurance company pays for your healthcare costs directly. Medicare will come back and compensate the insurance company for some of those costs, and you’ll be left to cover some of the costs yourself as well. These costs are often more variable and difficult to predict.
Even though Medicare Supplement and Medicare Advantage are both issued through a private insurance company, they deliver very different benefits to policy holders. Medigap delivers just the set benefits offered by Medicare but helps pay some of the remaining costs that you would normally have to deal with. That means the policy covers things like inpatient and outpatient care, hospital stays, and hospice care. The plan you choose will cover an additional portion of those items, so you are left paying less out-of-pocket in the end.
With Medicare Advantage, the insurance policy covers the basics covered by standard Medicare, but you have the option to add on additional coverage as well. You could have prescription coverage added or get help paying your dental costs. Each of these items comes with its own added cost which makes it more difficult to know exactly how much you are going to be paying for your coverage.
Pricing between the two policies works very differently with Medigap being the simpler of the two. Generally, with Medigap you just pay your premium amount each month and then any medical costs that aren’t covered. If you have a comprehensive Medigap policy, you pay the premium each month and all costs are covered for you. With Medicare Advantage you pay a monthly premium, but you have more co-pays, more out-of-pocket expenses and more expenses that can change depending on the situation. If you don’t get sick often the premiums for an Advantage plan are often lower, but if you do get sick often you should expect to spend more money than you would with a Medigap policy.
We just explained the key differences between the two policy types, but there are others to be aware of as well. Below is a chart that outlines the most important questions and answers related to Medigap and Medicare Advantage. If you have any additional or you would like help choosing a policy that fits your needs, contact our team of specialists today and we’ll assist you any way that we can!
|Questions||Medicare Advantage||Medicare Supplement|
|How does each plan cover my expenses?||With Medicare Advantage your insurance provider creates estimates for medical costs in Missouri and sets up premiums, co-payments, and all the other costs associated with your plan. Medicare will pay a portion towards those costs for you and you cover the rest yourself.||With a Supplement plan you pay a monthly premium and the plan covers some of your remaining costs that Medicare doesn’t cover. Depending on how comprehensive your plan is, you can be responsible for the remaining costs.|
|Is Medicare Part B still my responsibility to pay for?||Yes||Yes|
|What do I have to pay to have the plan?||The costs are variable with an Advantage plan. You will pay a premium, but you have complex co-payments and added costs to think about. This makes it difficult to know what to expect to pay with an Advantage plan.||You pay a premium and medical costs not covered by Medicare or your Medigap policy.|
|What coverage will I receive from the policy?||Medicare Parts A and B coverage and additional coverage items that come with your policy outside of standard Medicare. This can include anything, but often has prescription coverage and sometimes dental or vision.||The same coverage that basic Medicare provides. Your plan just pays more of the remaining costs that Medicare won’t pay for you.|
|Will budgeting for my healthcare be easy with this policy?||Budgeting for a Medicare Advantage policy is difficult because costs fluctuate highly depending on the care you need.||Budgeting is simple; you pay the same monthly premium, then you pay any costs not covered by the plan.|
|Can my plan be cancelled by the insurance company?||No, there is no guaranteed long-term coverage. Your policy holder can cancel your plan eventually if they choose to.||Yes, there is guaranteed long-term coverage. You can keep your policy as long as you make the monthly payments and your insurer stays in business.|
|Do I need to be approved to get on this plan?||Yes, there is an approval process that often includes medical background checks and sometimes a physical.||No, if you are approved to get Medicare you are approved for a Medigap policy as well.|
|Is there a network of doctors and facilities I need to work with?||Yes, you will be forced to work within a network of specific doctors and hospitals.||No, you are free to attend different doctors and hospitals as long as they accept Medicare.|
|Which of the plans is the right one?||An Advantage plan may be right for you if you are rarely sick and you live in an urban area where many different doctors and hospitals are available.||Medigap might be right for you if you are frequently sick or you have few providers to choose from in your area. Often people in rural areas prefer Medigap policies.|
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.
Choose at least one topic area you are interested in: Select All
Help with my Medicare options & issues
Other insurance programs
Complaints about my care or services
General health & health conditions
Claims & billing
Health care facilities & services in your area
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.