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 2023, there are 135 Medicare Advantage plans available in Missouri, compared to 126 plans in 2022. The average Medicare Advantage monthly premium in 2023 is $7.67, which is a decrease from $8.04 in 2022.
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
Part C Eligibility
Medicare beneficiaries must already be enrolled in Medicare Parts A and B before applying for Part C coverage to be eligible for it. 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.
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.