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Phone Number

(417) 633-7200


Springfield, Missouri

Medicare Missouri

Medicare in Missouri and Original Medicare – If you are just beginning your journey into Medicare, you may be feeling overwhelmed with everything there is to learn. There are very specific enrollment periods for Medicare, so if you are approaching your 65th birthday or you are retiring soon, you need to begin making decisions about your Medicare options. You’ll need to know terminology unique to Medicare and the differences between the types of plans available to you.

The first step is understanding what Original Medicare is and what kind of benefits it provides.

What is Medicare in Missouri?

Medicare in Missouri is the same “original” Medicare program established by the federal government in 1965 and was signed into law by President Johnson in 1965. Medicare Missouri provides healthcare coverage to eligible beneficiaries for both inpatient and outpatient services at medical facilities nationwide and is a fee-for-service plan that is managed by the federal government.

Since its inception in 1965, Medicare has consisted of the same two parts. Medicare Part A and Medicare Part B. For more than 50 years, Medicare has provided coverage for Seniors and Americans with disabilities.

With Medicare in Missouri, you can go directly to the doctor or hospital of your choice, bypassing prior authorizations or referrals. The government is responsible for paying its portion directly to your provider and you cover the left-over costs. The only qualification for care is that the doctor you choose accepts Medicare.

Part A and Part B Benefits and Cost

Inpatient services are covered under Medicare Part A. It helps to think of Part A as your “room and board” coverage for hospital visits. Most individuals receive premium-free Part A. The only requirement is that the individual (or their spouse) must have paid Medicare taxes through an employer for ten years. If that requirement has not been met, the premium for Part A will depend on how many years or quarters the individual did contribute to Medicare taxes.

Part A offers 80% coverage for eligible services after the deductible has been met. After an individual has been discharged from an inpatient facility for at least 60 days, a new benefit period begins.

Outpatient services are covered under Medicare Part B. This applies to doctor visits and many preventive services. Part B does have a monthly premium that is based on an individual’s income.

Like Part A, Part B offers 80% coverage for eligible services after the deductible has been met. This deductible applies one time per year.

Who is eligible for Medicare?

Medicare in Missouri is offered to individuals who are 65 and older, individuals who have been receiving disability benefits for at least 24 months, and individuals with End-Stage Renal Disease or Amyotrophic Lateral Sclerosis (Lou Gehrig’s disease).

When to Enroll in Medicare in State of Missouri

The Social Security Administration processes Medicare enrollment applications. Individuals can apply by phone, online, or in person.

There are three enrollment periods for Original Medicare.

Medicare Premiums

Original Medicare as well as Medicare in Missouri is not free. While many people do receive premium-free Part A, Part B does have a monthly premium. A standard premium for Part B is set each year. The amount an individual pays is based on their Adjusted Gross Income from two years prior. If their AGI is above a certain amount, the individual will pay a higher Part B premium.

The full cost of Missouri Medicare will involve other factors like an individual’s income, the type of plans chosen, and if any late enrollment penalties apply.

Medicare Supplement Plans Missouri 2022

Medicare supplement plans Missouri are secondary payers to Medicare Missouri.

Since Parts A and B do not cover 100% of healthcare expenses, Medicare supplement plans helps you pay the remaining costs. As long as the provider accepts Medicare assignment, they will also accept a one of the Medicare supplement plans Missouri.

Medicare supplement plans in Missouri are sold to individuals only. While spouses can have the same plan, they each have to carry their own policy. Some insurance companies offer household discounts if both people are on the same plan with the same carrier.

Want more help understanding

Medicare in Missouri?

We are available to help you understand more about your Missouri Medicare benefits, as well as the other aspects of Medicare like Medicare supplements, Medicare Advantage plans, and prescription drug coverage. These are all things you will want to learn about so that you can reduce your out-of-pocket healthcare expenses that aren’t covered by Medicare Missouri.

To learn more about these additional plans, we’ve created a large library of resources right here. When you’re ready, you can give us a call and one of our licensed agents will talk with you about your unique situation and needs. We can compare plans available in your area and help you choose the best option.

If you choose to let us help you with enrollment, we will continue to help you throughout your Medicare journey. Every year, we will review your current plans and make sure they are still the best ones for you. Throughout the year, we’ll be here to answer any questions that come up.

Questions to be advised on:

The Missouri Medicare Advisor website character Theresa Plastridge discussing Questions to be advised on.
The Medicare program was established to provide healthcare benefits in retirement. Prior to the program, retirees who lost coverage provided by their employer’s group health policy had limited options for health insurance.
An easy way to check if you are enrolled in Original Medicare is to look at your Social Security check deductions. If you have been collecting Social Security benefits, you are automatically enrolled in Medicare when you turn 65 and the premiums will be taken directly from your Social Security benefits. You may also check online at MyMedicare.gov or call the Social Security Administration directly.
Individuals who have been receiving disability benefits for 24 months are eligible for Medicare at any age. The same applies to those with ESRD or ALS. Otherwise, you must be 65 to enroll in Medicare.
Individuals must be a citizen of the United States or a resident of the United States for a minimum of five years to be eligible for Medicare. Individuals younger than 65 with no disabilities who also do not have ESRD or ALS are also not eligible.
You will need proof of your U.S. citizenship or legal residency, your birth certificate, and your driver’s license.
No, you won’t have to choose a primary care physician for Original Medicare. However, you do want to choose providers who accept Medicare assignment to keep your out-of-pocket costs as low as possible.
No, you don’t need a referral to see a specialist. However, your out-of-pocket costs will be lower if you choose a specialist that accepts Medicare assignment.
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