Missouri Medicare Guide

Schedule a free consultation with one of our licensed Missouri Medicare Advisors or give us a call at (888) 604-0055 to get started.

This guide will help you understand the basics of Medicare in Missouri, including how and when to enroll, what your Medicare options are, and rules and programs specific to Missouri. 

Use this table of contents to jump to specific sections of the Missouri Medicare guide:

• A Snapshot of Medicare in Missouri

• Medicare Eligibility and Enrollment Steps

• Missouri Medicare Advantage Plans

• Missouri Medicare Supplement Plans

• Missouri Medicare Part D Plans

• Get help paying for Medicare in Missouri

A Snapshot of Medicare in Missouri

Missouri has 1.3 million Medicare beneficiaries, making up 20% of the state’s total population. Most beneficiaries are on Medicare due to age, but about 15% are on Medicare due to disability. 15% of Missouri Medicare enrollees also receive full or partial Medicaid benefits. 

Medicare beneficiaries have an important choice to make: stick with Original Medicare or switch to Medicare Advantage. We’ll explain more about the pros and cons of both later on. In Missouri, 56% of Medicare beneficiaries are on Original Medicare and 44% are on a Medicare Advantage plan.

Missouri Medicare Eligibility and Enrollment Steps

US citizens 65 and older are eligible for Medicare. Some individuals who are under 65 years old and have certain disabilities like ALS or End-Stage Renal Disease are also eligible.

Medicare Enrollment Steps

1. Enroll in Original Medicare (Part A & Part B) 

If you’re eligible for Medicare because of age, you are able to enroll during your Initial Enrollment Period (IEP). Your IEP is a seven-month window of time that starts three months before the month you turn 65 and lasts until three months after. Some people choose to delay their Part B enrollment because they are still working and receiving employer coverage. If you choose to delay, just be sure you’re eligible for a Special Enrollment Period. Learn more about getting started with Medicare here.

2. Compare additional coverage options

After enrolling in Part A and B, you can choose to stay on Original Medicare, with the option to add a Medicare Supplement and/or Part D plan. You can also switch to Medicare Advantage, which includes Part A, Part B, and often also Part D benefits. Choosing your path is a personal decision that you should make based on your unique health and financial situation. We’ll explain the pros and cons and are also here to help! If you have questions about your Medicare options, give us a call at (888) 604-0055 to get free, personalized advice from our licensed Missouri Medicare Advisors. 

3. Get the most value from Medicare

There are two key things you should do to ensure you’re getting the most value fromMedicare. 

1. Use your plan

Share your insurance information with your pharmacy, schedule your annual wellness visit, and make sure you’re using any extra benefits that may come with your plan. 

2. Shop around each year

We have a saying at Chapter, “Marry your Medigap and date your drug (and Advantage) plan.” You have an opportunity every fall during the Medicare Open Enrollment Period to change your Part D and Advantage plans. During this time, review your needs and the plans available to be sure you’re always getting the most value from Medicare. 

Missouri Medicare Advantage Plans

There are 99 Medicare Advantage (MA) plans available in Missouri, but insurance carriers, pricing, and availability vary by county. For example, Saint Louis County, MO has 46 Medicare Advantage plans from ten different insurance carriers and Jasper County has 39 plans offered by eight insurance carriers.

Medicare Advantage plans combine Part A, Part B, and often Part D coverage. Many MA plans have no or low additional premiums (you do still have to pay your Part B premium). They also tend to come with extra benefits that may include: 

• Dental, vision, and hearing coverage

• Flex cards

• Meals

• Fitness perks

• Transportation services

Getting more coverage and benefits with no (or a low) monthly premium sounds nice. So, why doesn’t everyone choose to switch to Medicare Advantage? There are some big downsides to MA plans, including:

• Limited networks

• Frequent pre-authorization requirements for covered services

• Higher out-of-pocket costs (when compared to Original Medicare + Medigap)

Missouri Medicare Supplement Plans

There are ten different Medicare Supplement (Medigap) plans available to Medicare beneficiaries. Pricing may vary from one insurance carrier to another, but each plan of a type (e.g., every Plan N) is the same. 

Many Medicare beneficiaries choose to add Medigap coverage alongside Original Medicare to help cover the 20% of costs that Original Medicare doesn’t pay. 

Medigap plans are ideal for people who value choice and financial predictability because of key benefits, including:

• No networks - you can see any doctor who accepts Medicare nationwide

• No prior authorization requirements for covered services

• Lower out-of-pocket costs

The best time to enroll in a Medigap plan is during the Medigap Open Enrollment Period. This is a six-month window that starts when your Part B takes effect. During this time, you are guaranteed acceptance into any Medigap plan, regardless of your medical history. Outside of the Medigap Open Enrollment Period and a few other special guaranteed issue periods, insurance carriers may ask you questions about your health history (underwriting questions), and can deny you coverage.

Missouri is one of a handful of states with a Medigap Anniversary Rule. This rule allows Medigap plan holders to switch insurance companies each year during the 30 days before or after your policy’s start date. If you change to a same-lettered plan (e.g., From Plan G with one insurance company to a Plan G with a different company), the new insurer cannot deny you coverage or impose a waiting period. 

If you change to a plan with fewer benefits, (e.g., from a Plan G to a Plan N), you may or may not be subject to medical underwriting (questions about your health history). If you want to switch to a plan with more extensive benefits, you will likely be subject to underwriting questions and may be denied coverage.  

Missouri Part D Plans

Original Medicare does not include prescription drug coverage. Most Medicare Advantage plans provide prescription coverage. Missouri Medicare beneficiaries on Original Medicare can enroll in a stand-alone prescription drug plan. There are 23 Missouri Part D plans, but pricing and availability varies by county. 

If you don’t currently take any prescriptions, we still recommend enrolling in one of the lower-premium Part D plans to avoid the Part D penalty. 

If you have questions about your Medicare options or want to compare plan benefits and pricing, schedule a free consultation with one of our licensed Missouri Medicare Advisors or give us a call at (888) 604-0055. 

Get help paying for Medicare in Missouri

Missouri Medicare enrollees with low income and resources can apply for three programs to get help paying for Medicare-related costs.

Missouri Medicaid

Medicaid is a joint federal and state program. Missouri’s Medicaid program is called MO HealthNet. Missourians over 65 with low income and resources could be eligible for various MO HealthNet programs, including four levels Medicare Savings Programs.

Missouri Medicare Savings Programs

Missouri also has Medicare Savings Programs for residents on Medicare who have low income and resources. Missouri has three levels of Medicare Savings Programs : 

• Specified Low-Income Medicare Beneficiary (SLMB) pays for members’ Part B premiums. 

• Qualified Individual-1 (QI-1) pays for members’ Part B premiums. 

• Qualified Medicare Beneficiary (QMB) pays the Medicare Part B premium (and sometimes Part A premium). The QMB program also pays for Medicare copayments and deductibles. 

• Qualified Disabled and Working Individuals (QDWI) pays the Medicare Part A premium for those who lost their free Medicare Part A due to employment

For more information about the eligibility requirements and application process for Missouri Medicare Savings Programs click here.

Medicare Extra Help

If you have limited income and resources, you may be eligible for Extra Help. Extra Help is a federal program that helps pay for costs associated with prescription drug coverage, including premiums, deductibles, and coinsurance.

You automatically qualify for Extra Help if you:

• Receive full Medicaid coverage from Missouri

• Missouri pays your Part B premium

• Are eligible for Supplemental Security Income (SSI)

If you don’t automatically qualify for Extra Help, you may still be eligible. Get help determining if you're eligible from one of our licensed Missouri Medicare Advisors.

Supplemental Security Income (SSI) Benefits

Eligible US citizens receive monthly payments from the SSI program. You’re considered eligible if you meet the following criteria:

• You are 65 and older, blind, or have a disability

• You have limited income and limited resources

You can apply for SSI Benefits online or by calling 1-800-772-1213 / TTY 1-800-325-0778.