Medicare in Springfield, Missouri

If you’re living in Springfield, Missouri, and you are age 65 or older – or if you will soon be turning 65 – learning more about your Medicare health coverage options is a good idea. While it is never too early to begin planning your healthcare future, it is also never too late. By educating yourself about Medicare’s ins and outs as well as discussing health plans with one of our licensed Medicare experts, you can find a Medicare coverage plan that suits both your medical and financial needs.

Medicare Supplement Plans In Springfield

While Medicare Parts A and B are fairly comprehensive, they don’t quite cover everything and can leave you exposed to either a lack of coverage, sky-high out-of-pocket costs, or both. To prevent anything catastrophic from occurring with your care, you can enroll in a Medicare Supplement plan. Medicare Supplement plans are also referred to as Medigap plans because they fill in the gaps that Original Medicare can leave behind.

Medigap plans are standardized, which means they offer the same coverage everywhere in the nation. The only difference in plans is the price you pay, which depends on a range of factors, including your location, age, gender, and whether or not you smoke.

In Springfield, there are ten different Medigap plan options, plus two high deductible options. All Medigap plans are signified by a letter, and the plans range from A-N. While there are ten plans out on the market, only eight of these plans – plus one high deductible option – are available for new Medicare enrollees. This is because two plans – Plan F and Plan C – have been phased out for new beneficiaries as of January 2020.

Medigap Plan N in Springfield

To give you an idea of a Medigap plan in Springfield, let’s look at Plan N, one of the most popular supplement plans. Medigap Plan N covers inpatient deductibles, which fall under Medicare Part A. Plan N covers inpatient copays and coinsurance, minus a $50 copay. If you visit a doctor under this plan, you will be charged a $20 copay plus the Part B deductible. Lastly, under Plan N, you may have to pay excess charges if your doctor charges them. This cost-sharing keeps Plan N’s monthly premiums low.

If you live in Springfield, here are a couple of monthly premium price snapshots for Medigap Plan N:

65-year-old, male, non-smoking: $112-$247 per month

65-year-old, female, non-smoking: $101-$223 per month

Senior couple in Springfield Missouri enjoying a walk about the lake while discussing their medicare options. — From Springfield, Missouri to Honolulu, Hawaii, the enrollment window for Medigap plans is the same

When Can I Enroll in a Medigap Plan?

From Springfield, Missouri to Honolulu, Hawaii, the enrollment window for Medigap plans is the same: the Open Enrollment Period will start when you turn 65 or upon the effective date for your Medicare Part B. During this period, you can apply for any Medicare supplement plan that is available to you. Insurance companies cannot turn you down for any reason during your Open Enrollment window. If you are under the age of 65 and on Medicare due to a disability or health condition, the Open Enrollment window also applies to you.

Medigap Anniversary Rule

If you’re living in Missouri, you might have heard of the Medigap Anniversary Rule. This rule is special to Missouri and two other states. The Anniversary Rule allows Medigap beneficiaries to switch policies within 60 days of their policy anniversary. This rule allows you to compare plan premiums every single year so that you can always rest assured you’re on the plan with the lowest rate. However, there is one caveat to this rule, which is that you cannot switch plan letters, you can only switch to a plan of the same letter. So if you are on Plan G, you can only switch to another provider’s Plan G option. Nonetheless, this flexibility can save you money every single year.

Medicare Advantage in Missouri

While most Medicare beneficiaries ultimately choose a Medigap plan, the alternative to Medigap is Medicare Advantage. Some 35% of Medicare recipients in Missouri. Medicare Advantage plans are private health insurance plans that replace Original Medicare, thus replacing the need for a Medigap plan. Because of this replacement, you are not allowed to have both a Medigap plan and a Medicare Advantage plan at the same time. You may sometimes hear Medicare Advantage plans referred to as “Medicare Part C.”

Medicare Advantage plans are tied to networks, so if you enroll in an Advantage plan, you will have to agree to use that plan’s network of providers. Generally, these network’s will exist not just in Springfield proper but also in the surrounding area, so finding a provider near you shouldn’t be too difficult.

The two most common Medicare Advantage plans are Medicare Advantage HMO and Medicare Advantage PPO. HMO plans tend to have smaller networks, and you must use the providers within your network unless there is an emergency. PPO plans are larger networks, which means they have more flexibility. PPO plans allow you to see doctors outside of the network, so naturally, they are more expensive.

Typically, Medicare Advantage plans in Missouri will also come with coverage for prescription drugs. If your plan covers drugs, there is no need to enroll in a standalone Medicare Part D drug plan. Medicare Advantage plans usually cover all of your Part A, B, and D benefits, though to access any of these benefits, you will have to pay your own copays.

Lastly, some Medicare Advantage plans will include ancillary benefits such as vision exams or even gym memberships. If you are not comfortable with the network restrictions that come with Medicare Advantage plans, you should look into a Medicare supplement plan.