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Springfield, Missouri

Medicare Advantage - Missouri

Medicare Advantage – Missouri is an additional name for Medicare Part C. Medicare Advantage plans in Missouri are offered by private insurance companies and offer a wide variety of benefits. A major selling point of these plans is that many of them offer $0 monthly premiums. However, it’s important to understand how these plans work to make sure they will work for you.

Defining Medicare Part C

Part C replaces the coverage of Original Medicare in every State as well as Missouri Medicare coverage. Individuals who enroll in a Part C plan will no longer receive their benefits directly from the federal government, but from a private insurance company instead. These companies have been approved by the Medicare program to offer Part C plans. Part C plans must contain at least as much coverage as Parts A and B offered. Most of them offer additional coverage.

There are different types of Part C plans, which is a very important thing to understand. Some plans provide coverage outside of the plan’s network while others do not. This is an important differentiating factor as it could cost individuals much more if they do not receive care from an in-network provider. Even if the plan allows for coverage outside of the network, it is at a lesser rate and the member will still pay more out-of-pocket.

In 2022, there are 126 Medicare Advantage plans available in Missouri, compared to 122 plans in 2021. The average Medicare Advantage monthly premium in 2022 is $8.04, a slight increase from 2021.

Medicare Part C Coverage

As we mentioned, Part C must offer the same benefits found in Parts A and B. Unlike Original Medicare in Missouri and Medicare supplements, Medicare Advantage plans often come with additional benefits like coverage for routine dental, vision, and hearing care as well as prescription and over-the-counter drug coverage. Benefits vary by plan.

If the Medicare Advantage plan does not offer prescription drug coverage, members will still need to enroll in a stand-alone Part D prescription drug plan. (For instance, Private Fee-for-Service (PFFS) Part C plans do not offer prescription drug coverage.) No matter which Part C or Part D plan you choose, you’ll need to look at its drug formulary to make sure your medications are covered under the policy.

Nearly all Medicare Advantage plans offer transportation assistance to and from doctor’s offices, as well as meal benefits. Telehealth is a common benefit, but it is also now more widely accepted as part of Original Medicare. The Part B give-back program is found in some of the plans, which reduces the Part B premium. (Even though Part C bundles the coverage of Parts A and B, Plan C members still have to pay the Part B premium.)

A select few Part C plans are also including long-term care benefits, but these are not yet common.

All of these benefits, paired with the low (or no) monthly premium make these plans very attractive. But of course, there are limitations that you’ll need to consider. It’s best to compare Medicare Advantage plans to Medicare supplement plans before you decide.

The Cost of Medicare Part C in general and Missouri

There are many Part C plans that offer $0 monthly premiums. The average plan cost is $23 per month. Location is a prime factor in determining cost, as well as what type of Part C plan you choose. In some areas of the country, there are no Part C plans available.

Part C Eligibility

Medicare beneficiaries must already be enrolled in Medicare Parts A and B before applying for Part C coverage. The only thing that can disqualify someone from enrolling in a Part C plan is if they have End-Stage Renal Disease (ESRD).

If an individual is diagnosed with ESRD while enrolled in a Medicare Advantage plan, they may be able to select a different plan within the same insurance company. Also, if their current plan leaves their service area, they have a one-time right to choose a new policy.

Also, individuals with ESRD can join an ESRD Special Needs Plan if one is available to them. After a successful kidney transplant that cures the ESRD, the person qualifies for Medicare Advantage coverage.

Cartoon artwork Medicare Part C The Basics​

Comparing Medicare Part C to Original Medicare

Original Medicare – Parts A and B – have no provider networks. As long as the provider accepts Medicare assignment (which most do), the beneficiary is free to choose whichever provider they want.

Under a Medicare Advantage plan, the beneficiary will need to choose a provider within the plan’s network. Two of the Part C plan types are Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs). HMO plans offer no benefits outside of the plan’s network, except for in emergency situations. PPOs do offer out-of-network coverage, but it will be at a lesser rate and the member will pay more out-of-pocket for those services.

Medicare Advantage Disenrollment

Plans with a Single Grace Period may disenroll individuals who miss one or more premium payments. Plans that have a Rollover Grace Period allow their members to stay enrolled if they owe more than one month’s premium but pay for at least one premium during the grace period. If this occurs, a new grace period will begin. Insurance companies will send notifications to members who have failed to pay their premiums, but will disenroll any member who fails to make a payment during the grace period. Once an individual has been disenrolled from a plan, they will have to submit an application for coverage.

How to Enroll in

Medicare Advantage

After you have applied for Medicare Parts A and B, you should work with a licensed agent to first decide if a Medicare Advantage plan is right for you. We’ll discuss the pros and cons of these plans and make sure you understand all your options.

If you choose to enroll in a Part C plan, we will look at different plans and carriers to find you the best coverage for the most competitive rate. We’ll submit the application for you and will always be available to answer your questions when coverage begins.

Medicare Advantage plans in Missouri

There are four main Medicare Advantage plans available in the state of Missouri, listed below:

  • Medicare Advantage PPO plans
    Medicare Advantage PPO plans are offered by private insurance companies. Like other Preferred Provider Organization plans, these have a network of doctors, other health care providers, and hospitals.
    You’re not required to use someone within the network. However, if you use this network, you pay less. If you go outside of the network for health care, you pay more.
  • Medicare Advantage HMO plans
    Medicare Advantage HMO plans are offered by private insurance companies. Like other Health Maintenance Organization plans, you have a network of healthcare providers, doctors, and hospitals. You will most likely have to choose a primary care physician and this doctor will have to be the one who refers you to see a specialist.
    Only in urgent and emergency situations are you able to receive coverage outside of the plan’s network unless you are paying out of pocket.
  • Medicare Advantage Private fee-for-service
    Medicare Private Fee-for-Service plans are a type of Medicare Advantage plans provided by private insurance companies.
    They are required by Medicare to provide the same level of coverage as Medicare Missouri. However, Private Fee-for-Service (PFFS) plans offer additional benefits not provided by Medicare Missouri.
  • Medicare Advantage Special Needs plans
    Medicare Advantage Special Needs plans are a set of Medicare Advantage plans that serve individuals with unique needs.
    To be eligible for these plans you must be enrolled in Medicare Parts A and B and meet the specific eligibility requirements the plan has.
    There are three types of Special Needs plans in Missouri: Chronic-Condition Special Needs Plan, Dual-Eligible Special Needs Plan, Institutional Special Needs Plan

Questions to be advised on:

The Missouri Medicare Advisor website character Cam Meers discussing Questions to be advised on.

Since some Part C plans have a $0 premium, many people wonder how the plans are funded. An insurance carrier who agrees to offer Part C plans and pay for services rendered under those plans receives funding from the government. Instead of the Medicare program paying for the claims, the private insurance company is responsible for them. Some plans also require premiums, copays, and coinsurance costs.

No, Medicare supplements work with Original Medicare coverage to provide coverage for their members. Medicare Advantage plans operate independently from Original Medicare.
Medicare Part C is not mandatory. However, choosing to enroll in either a Medicare Advantage plan or a Medigap policy will help pay for some of the expenses that Original Medicare does not cover.
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