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(417) 633-7200

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Springfield, Missouri

Missouri Medicare Advantage Plans

Senior couple in the park sitting on a bench as they discuss Medicare Advantage Plans
Senior couple in the park sitting on a bench as they discuss Medicare Advantage Plans

Medicare Advantage plans can be a great way to get your healthcare insurance in retirement. They offer more benefits than Original Medicare and come at an affordable monthly premium. Missouri residents have many Medicare Advantage plans they can choose from, so it’s important to understand how these plans work so you can pick the one that will fit your healthcare needs.

How Medicare Advantage Plans Work

Medicare Advantage plans replace your Orignal Medicare coverage through the federal government. Instead of having Medicare Parts A and B, you’ll enroll in Medicare Part C, also known as Medicare Advantage. Part C plans are offered by private insurance companies, so Part C plan holders get their coverage through the insurance company, not the federal government.

Every Medicare Advantage plan will offer at least the same coverage as Original Medicare, but they typically cover much more than that. Some include benefits for routine dental, vision, and hearing services, as well as prescription drug coverage.

Types of Medicare Advantage Plans

Since Medicare Advantage plans are offered by private insurance companies, every plan is different. And, not all plans are offered in every state. The first thing you need to find out when choosing a Medicare Advantage plan is what type of plan it is. There are five different types of Medicare Advantage plans.

  1. Health Maintenance Organizations
  2. Preferred Provider Organizations
  3. Private Fee-for-Service
  4. Special Needs Plans
  5. Medical Savings Accounts

Each of these types of Medicare Advantage plans has its own set of rules and regulations, so you’ll need to understand the limitations of each before you enroll.

Happy senior couple sitting on couch with dog discussing their options for Medicare Advantage Plans.
Since Medicare Advantage plans are offered by private insurance companies, every plan is different.

Health Maintenance Organizations

HMOs are one of the more common kinds of Medicare Advantage plans in Missouri. They usually come with the lowest monthly premium, some even have a $0 premium. HMO plan members are limited to a small network of providers and facilities. There is no coverage for any services received outside of the HMO network, except for in emergency situations.

Preferred Provider Organizations

PPOs are very similar to HMOs and are also one of the more popular plans in Missouri. While PPO members also have a network of providers, the network is generally larger than HMO networks. Also, PPO plans do offer some coverage outside of their network, though the member may pay more in out-of-pocket expenses.

Private Fee-for-Service

PFFS plans are less common among Part C plans in Missouri. There is no network for these plans. Providers who accept a PFFS plan have agreed to the plan’s payment terms. Providers may choose to discontinue the relationship at any time, so PFFS plan members must verify this before every visit.

Special Needs Plans

SNP enrollment is limited to individuals with unique circumstances. There are some available for people with chronic conditions, people who are institutionalized, and people who are eligible for both Medicare and Medicaid. SNP plans are tailored for these individuals so that they may receive the care they need.

Medical Savings Accounts

MSAs are also not quite as popular as HMO and PPO plans, but they can be an excellent choice, especially for individuals who are relatively healthy and are financially secure. These plans have a high deductible that members must meet before their coverage begins. However, these plans usually have a set amount that is deposited into a special savings account each year. This “allowance” can be used to help pay the deductible or for any qualified healthcare expense, much like an HSA in employer-sponsored insurance plans.

One other thing to note about Medicare Advantage plans. They do not all have prescription drug coverage. If the plan does not have this coverage, make sure you are eligible to enroll in a separate Part D plan. Medicare Advantage plans that include prescription drug coverage are often referred to as MAPD plans.

Medicare Advantage Plans in Missouri

We mentioned that because Medicare Advantage plans are not standardized, they are not available everywhere. There may be counties in Missouri that have no Medicare Advantage plans available, and there may be some that have a large number to choose from. Generally speaking, the more rural counties have fewer options. This is because there are fewer providers in those areas.

 There are about 100 different Medicare Advantage plans with prescription drug coverage offered in Missouri. Some of the more popular ones include:

  • CoxHealth MedicarePlus (PPO)
  • Essence Advantage (HMO)
  • Essence Dual Advantage (HMO D-SNP)
  • NHC Advantage (HMO I-SNP)
  • United Healthcare Dual Complete (HMO D-SNP)
  • AARP Medicare Advantage (HMO-POS)

As you can see, there are many, many plans to consider in Missouri. That’s why it’s important to work with an independent agent to help you with your Medicare benefits. We can look at all plans, find out which ones you are eligible for, and then help you choose a plan based on your needs.

If you live in Missouri and are curious about your Medicare Advantage options, give our office a call today. We’ve got knowledgeable, licensed agents ready to assist you on your Medicare journey.

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