Missouri offers multiple Medicare options to U.S. citizens or permanent residents who are at least 65 years old or meet certain eligibility requirements, such as having ESRD, ALS, or being disabled for at least 24 months and drawing SSDI. Original Medicare has two parts. Part A is also called hospital insurance and covers hospital stays, home health, hospice, and skilled nursing care facilities, while Part B is medical insurance that covers doctor’s visits, outpatient services, emergency care, labs, diagnostic testing, preventative care, and medical supplies. Medicare Advantage, also known as Part C or MA, is an alternative to Original Medicare, with plans sold by private insurers that can provide additional coverage for gym memberships, dental, vision, hearing, and transportation to medical appointments, along with prescription drug coverage. Lastly, Medicare Part D is prescription drug coverage that can be added to Original Medicare or Medicare Advantage, and plans are offered by private insurance companies but regulated by Medicare.
Original Medicare vs. Medicare Advantage costs in Missouri
Original Medicare and Medicare Advantage are two different types of coverage, and their costs may differ. Especially because Medicare Advantage is a type of coverage that is sold by private insurance companies.
Original Medicare Costs and Coverage
As already explained Original Medicare has two parts: A and B. Part A covers hospital, home health, hospice, and skilled nursing care facilities, while Part B covers doctors’ visits, outpatient services, emergency care, labs, diagnostic testing, preventive and medical supplies, and some medications. You are responsible for the remaining deductibles, copay, coinsurance, and out-of-pocket expenses since Original Medicare covers only 80% of the services. It is a good option if you want more flexibility, as it has broad coverage throughout the U.S. However, it does not cover prescriptions, so enrolling in a stand-alone drug plan is important. If you have several health conditions, pairing your Medicare with a Medigap may be a good option. Part A is usually premium-free for most Medicare beneficiaries, while the average cost for Part B is $164.90 per month.
People who qualify for part A free premium need to work a minimum of ten years or forty quarters. You are also eligible for zero premium if you can get it through your spouse’s coverage who has fulfilled this requirement even if you did not. However, if you still don’t qualify, you have to buy Part A. In 2023, if you have worked from 30 to 39 quarters your premium will be 278$, and if you have worked lesser than that you need to pay the full price which is 506$.
Also, you need to be careful about your IEP (initial enrollment period). If you don’t enroll when you are first eligible you will be subject to late enrollment penalties. You become eligible for Medicare coverage three months before your 65th birthday, and the period ends three months after you are 65.
If you have to pay premiums for Part A and enroll late, you’ll be charged a penalty of 10 percent of either $278 or $506, in addition to the monthly premium. However, unlike Part B penalties, the penalty for Part A is not perpetual. You’ll have to pay the penalty for twice the number of years you could have paid premiums but didn’t. So, for example, if you delayed enrollment for three years, you’ll pay penalties for six years. If you worked for less than 7½ years in total, you’ll have to pay a premium penalty of more than $50 per month in 2023. If you delayed enrollment for three years without qualifying for a special enrollment period, you’ll have to pay the penalty for six years. As Part A premiums increase annually, the penalty will also increase each year.
Medicare Advantage Costs and Coverage
Medicare Advantage Plans, also known as Part C, provide additional benefits beyond Original Medicare and are available in Missouri. However, plan options are based on ZIP code, and networks may be limited to certain areas. These plans typically have copayments, deductibles, and out-of-pocket maximums that you are responsible for, with monthly premiums starting at $0 and averaging $7.67 in Missouri for 2023. The Missouri Medicare Advantage Program offers four types of plans: HMO, PPO, PFFS, and SNP. The best plan is one that suits your needs in terms of costs, provider options, and accessibility.
An HMO plan, for example, doesn’t provide coverage beyond its network, so if you seek out-of-network medical services you will have to pay full-pocket costs. PPO, on the other hand, is more flexible which means you can seek services out-of-network but you will still pay out-of-pocket. So, it is recommended to stay in your provider’s network.
In 2023, the maximum out-of-pocket limit for Medicare Advantage plans has increased to $8,300. However, the majority of plans are expected to maintain out-of-pocket caps that are lower than the government’s maximum.
One important note also is to be eligible for MA plans you will have to be enrolled in Part A and B, and still have to pay Part B’s monthly premium alongside your Part C premium if a plan has one. Additionally, most of the plans include prescription drug coverage (Part D).
Medicare Advantage Plans are best for individuals on a fixed income or in good health who don’t want to pay for unused coverage. Eligibility requires enrollment in Medicare Part A and Part B. One downside is the limited choice of providers and service areas, which may require prior authorizations and referrals for certain procedures.
How to Compare Best Medicare Advantage Plans?
Medicare Advantage Plans offer a variety of cost components including premiums, deductibles, copays/coinsurance, and out-of-pocket costs. Premiums are monthly payments for coverage, while deductibles are the amount you must pay before your insurance plan starts covering costs. Copays are fixed amounts you pay for a specific service, while coinsurance is a percentage you pay after paying deductibles. Out-of-pocket costs have a maximum dollar amount that is the most you will pay for your Medicare-covered benefits in a year.
The plan’s coverage area is connected to the specific region where the plan is provided. Original Medicare offers extensive coverage across the United States and its territories, while a Medicare Advantage Plan may have more limitations, possibly only covering a specific state or ZIP code region.
Medicare Advantage Plans are evaluated using a star rating system ranging from 1 to 5, which measures their performance in areas such as quality of care and customer service, as determined by Medicare.
Benefits are the components of the plan that contribute to medical expenses, such as dental coverage, while provider choice relates to the ability to choose a preferred provider and potentially receive discounted costs if the provider is in-network.
Also, make sure to read about Tips For Finding Affordable Medicare Coverage in Missouri.
So for the best comparison always check what each plan offers in your living area and make a comprehensive list of pros and cons. If you are not sure which plan is the best option for you the second good option is to contact Medicare licensed insurance agents at Missouri Medicare advisors. We will help you to find a plan that best suits your specific needs and budget!