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Medicare in Missouri


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The Missouri Landscape

In Missouri, a total of 1,194,124 residents have Medicare coverage, according to 2018 data from the Centers for Medicare & Medicaid Services (CMS). These Medicare beneficiaries chose their coverage from a variety of Medicare options that are generally available across the nation, including in the state of Missouri.

Original Medicare provides Part A (hospital) coverage and optional Part B (physician and professional health-care services). Medicare Advantage plans contract with CMS to provide medical coverage and, in many cases, prescription drug coverage to Medicare beneficiaries. Some examples of Medicare Advantage plans include preferred provider organizations (PPOs) and health maintenance organizations (HMOs) that contract with hospitals, physicians, and other health professionals to provide health-care services to plan members.

Here’s a quick rundown on these and other Medicare plan options in Missouri.

  • Original Medicare includes Part A and Part B. You can choose to have Part A and/or Part B coverage; most people pay a monthly premium for Part B coverage. Generally, you pay a deductible and coinsurance for your Part A and Part B services. Original Medicare does not cover prescription drugs in most situations.
  • A stand-alone Medicare Part D Prescription Drug Plan (PDP) can help you pay your prescription costs. A number of Medicare-approved private insurance companies offer Medicare Part D Prescription Drug Plans in Missouri, although plan availability may vary from county to county. You may enroll in a stand-alone Medicare Prescription Drug Plan to work alongside your Original Medicare coverage.
  • You can apply for a Medigap (Medicare Supplement) insurance plan to work alongside your Original Medicare coverage. A Medigap insurance plan may help pay your out-of-pocket costs for Original Medicare covered services.
  • You may be able to enroll in a Medicare Advantage plan offered in your Missouri county of residence. Medicare Advantage, also known as Medicare Part C, offers an alternative way to get to your Original Medicare coverage.
  • Medicare Advantage plans are offered by private insurance companies that contract with Medicare. Their benefits include all of your Medicare Part A and Part B benefits except hospice care, which Medicare Part A continues to cover. Many plans also include extra benefits such as routine dental, vision and fitness care. A number of Medicare Advantage plans provide prescription drug coverage as well, letting you get all of your Medicare benefits, plus possible added benefits, through a single plan. If you’re enrolled in a Medicare Advantage plan that does not provide prescription drug benefits, you can generally sign up for a stand-alone Medicare Part D Prescription Drug Plan.
  • Premium costs vary among these plans and may be as low as $0. Remember, you will need to continue to pay your Medicare Part B premium as well as the Medicare Advantage plan premium, if any.

To identify the plans that are available in your area, enter your zip code in the Medicare Plan Finder.

Medicare resources in Missouri

Missouri Department of Health and Senior Services: This state department oversees the office for Senior and Disability Services, which offers information, programs and services to seniors living in the state. The office also offers advocacy services for seniors who are not treated fairly and provides guidance for those seeking long-term care for themselves or a family member. You can get help through programs provided by Senior and Disability Services, such as the following:

  • Area Agencies on Aging and Services – This network of offices throughout the state provides local help to Medicare beneficiaries in Missouri. Local services include legal assistance and help with a variety of health-care issues.
  • Missouri CLAIM – This state program gives free local health insurance counseling to people with Medicare. Missouri CLAIM’s name stands for “Community Leaders Assisting the Insured of Missouri.” This office has also been the official location for the State Health Insurance Assistance Program (SHIP) since 1993. Missouri CLAIM is not directly connected with any insurance companies doing business in the state.
  • KEPRO – The official Quality Improvement Organization for the state of Missouri, KEPRO offers information and assistance to Medicare providers, beneficiaries, and their families. They help with beneficiary complaints, discharge appeals, and other Medicare-related issues.

Medicare statistical trends in Missouri

Listed below are some facts and trends regarding Medicare in Missouri as of 2018 according to CMS publications.

  • 783,019individuals were enrolled in Original Medicare Part A and/or Part B.
  • 411,105 people (34% of the total Medicare population in Missouri) were enrolled in Medicare Advantage plans and other Health plans.
  • Over 904,800 Medicare beneficiaries residing in Missouri were enrolled in Medicare Prescription Drug Plans (either stand-alone Medicare Part D Prescription Drug Plans or Medicare Advantage Prescription Drug plans).

Here are some CMS projections for 2018:

  • 24 Medicare Prescription Drug Plans and 68 Medicare Advantage plans available statewide.
  • 79% of beneficiaries enrolled in Medicare Prescription Drug plans in Missouri with access to plans with lower premiums than they paid in 2017.

Just enter your zip code in the Medicare Plan Finder to find plan options available where you live.

Statistical data from the Centers for Medicare & Medicaid Services,Medicare Enrollment Dashboard; and “2018 MA Part D Landscape State-by-State Fact Sheet”.

This website and its contents are for informational purposes only. Nothing on the website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.

The product and service descriptions, if any, provided on these eHealth Insurance Web pages are not intended to constitute offers to sell or solicitations in connection with any product or service. All products are not available in all areas and are subject to applicable laws, rules, and regulations.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply.
Benefits, premiums and/or copayments/co-insurance may change on January 1 of each year.

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