Medicare Advantage Plans in Springfield, Missouri

Hero Park in Springfield, Missouri
Hero Park in Springfield, Missouri

Medicare Advantage Springfield, MissouriMedicare Advantage plans continue to increase in popularity across the United States, including in the state of Missouri. If you live in and around Springfield, you’ll have quite a few options to choose from. Today, we’re going to review what Medicare Advantage looks like in Missouri, which types of plans are available, and how to choose the best one for you.

Medicare Advantage Statistics in Missouri

Medicare Advantage (Part C) plans are specific to counties. Some counties have more options than others, and plans may vary from one county to the next. As of 2022, there are a total of 126 Medicare Advantage plans in Missouri. About 45% of all Medicare beneficiaries in Missouri choose Medicare Advantage over Original Medicare with a Medigap plan.

Every single Medicare beneficiary in Missouri has access to at least one Medicare Advantage plan that has a $0 premium, but the average premium is around $8 per month. Twenty-one of the 126 plans includes innovative benefits like health and wellness planning, decreased cost-sharing, and incentive programs.

Types of Medicare Advantage Plans in Missouri

If you decide to enroll in Medicare Advantage rather than keep Original Medicare, you’ll need to decide which type of Medicare Advantage plan you want. The type you choose will have a significant impact on your coverage, so do not make this decision quickly.

While there are actually seven different kinds of plans, the four most popular Medicare Advantage plans in Springfield, Missouri, are listed here.

Health Maintenance Organizations

HMO plans almost always have a $0 premium and very low out-of-pocket costs. In addition, most of them include prescription drug coverage. The only downside to HMO plans is that they typically have a small network of providers who participate in the plan. You’ll need to stay within the plan’s network; otherwise, you’ll have no coverage. There are no benefits for out-of-network services except in emergency situations. You must choose a primary care physician (PCP), and that person must grant you a referral if you want to see a specialist. (The specialist must also be an in-network provider.)

Preferred Provider Organizations

PPO plans are just as popular as HMO plans because they too have low monthly premiums, usually $0 per month. Generally, PPO networks are larger, so enrollees have a larger number of healthcare professionals to choose from. Plus, there are out-of-network benefits, which give you even more freedom – as long as you’re willing to pay a little more out-of-pocket. For example, you might have a $0 copay to see an in-network PCP but a $20 copay to see one who is out-of-network. PPO members do not have to choose a primary care physician, nor do they have to get referrals for specialists.

Special Needs Plans

Anyone who enrolls in Medicare Part A and Part B can enroll in a Medicare Advantage plan, as long as one is available where they live. Special Needs Plans, however, have additional eligibility requirements. There are three kinds of SNPs.

  1. C-SNP: for chronic conditions
  2. D-SNP: for dual-eligible individuals (Medicare and Medicaid)
  3. I-SNP: for institutionalized individuals

Each of the three kinds of SNPs tailors their benefits to meet the needs of the population they serve. They always include drug coverage and have quite a few extra benefits.

Private Fee-for-Service Plans

PFFS plans aren’t as popular as the other three kinds, but they can be beneficial in certain areas. Some PFFS plans have provider networks, but you can also choose to see any Medicare-approved provider who agrees to accept the plan’s payment terms. That means that they will agree to charge a certain amount for services. In addition, the PFFS plan sets the amount the patient will pay. Most of the time, prescription drug coverage is not included in PFFS plans, but you are allowed to enroll in a separate Part D plan to obtain drug coverage.

A room with seven doors to choose a Medicare Advantage Plans in Springfield, Missouri
How do you know which one to choose?

How to Choose a Medicare Advantage Plan in Springfield

Let’s say you’ve decided you’d like a Medicare Advantage PPO plan. That has narrowed your options, but you’ll still likely have a handful of PPO plans to choose from. How do you know which one to choose? There are ______ things to compare.

Premium: This is an easy one to start with. The premium is the dollar amount you will pay each month, regardless of if you use your plan or not. As we mentioned earlier, everyone has access to a $0 premium Medicare Advantage plan in Springfield, MO. However, remember that you’ll still need to pay your Part B premium.

Network: If you love your current healthcare providers, you should find an Advantage plan they participate in. If you’re OK with switching doctors or paying out-of-network prices, the network might not be as important to you.

Deductible: This is the amount you’ll pay before the plan starts to pay for services. Some plans have no deductible, while others have one that could be several hundred dollars.

Copayments/Coinsurance: The plan will have doctor’s office and specialist copays, and they are usually two different amounts. People who see a doctor frequently should pay attention to the copay since they’ll be paying it at every visit. Other coinsurance costs include inpatient hospital visits, ambulance transportation, diagnostics, etc.

Maximum Out-of-Pocket: Every Part C plan has a maximum out-of-pocket or MOOP. The MOOP is a cap on how much you have to pay before the plan begins to pay for services at 100%. If the plan has out-of-network benefits, you might have a MOOP for in-network services and a MOOP for out-of-network services.

Extra Benefits: Medicare Advantage plans have lots of bells and whistles. You should read through the summary of benefits to find out which ones are included in each plan and decide if any of them are important to you.

As you can see, choosing a Medicare Advantage plan is no easy task. But that’s why we’re here! Our Medicare advisors will help you sort through all your Medicare options in Springfield, Missouri, so you can find the plan that gives you the coverage you need. Call us today to schedule an appointment with one of our licensed insurance agents.

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