Medicare in Missouri

Jory Cross by Jory Cross | Licensed since 2012
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This article was updated on: 09/16/2018

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If you’re a Missouri resident with Medicare, you may have many Medicare plan options, depending on where you live. Learn about the different ways you can receive your Medicare benefits, including Original Medicare, Medicare Advantage, Medicare Part D, and Medigap.

About Medicare in Missouri

Beneficiaries in Missouri have two options when it comes to how to get their Medicare benefits. The first is Original Medicare, Part A and Part B. This is the federally-run health insurance program for those age 65 and older and younger residents with certain disabilities or conditions. If you have Original Medicare, keep in mind that your benefits work the same no matter where you live. Medicare Part A covers inpatient care you get in a hospital, skilled nursing facility, or hospice setting. Medicare Part B covers outpatient care, including (but not limited to) doctor visits, durable medical equipment, preventive services, and ambulance transportation.

Missouri beneficiaries may decide to enroll in a Medicare Advantage plan, also called Medicare Part C, through a Medicare-approved insurance company. These plans must cover the same benefits as Original Medicare (with the exception of hospice care), but may include additional benefits such as routine vision and dental services, or prescription drug coverage. Costs and availability may vary for these types of plans.

Whether you choose Original Medicare or Medicare Advantage, you’ll still be enrolled in the Medicare program. These are just two ways to get your Medicare Part A and Part B benefits.

Medicare coverage in Missouri

Certain types of Medicare insurance are only available through Medicare-approved health insurance companies. This includes not only Medicare Advantage plans, but also prescription drug coverage and supplemental coverage.

Here are the types of Medicare plan options you may have available as a Missouri beneficiary:

  • Medicare Part D: This is Medicare prescription drug coverage. Original Medicare beneficiaries can enroll in this coverage through a stand-alone Medicare Prescription Drug Plan. Medicare Advantage enrollees can get this coverage through a Medicare Advantage Prescription Drug plan.
  • Medicare Advantage: As mentioned above, Medicare Advantage plans are offered through Medicare-approved insurance companies.  Plan details and costs can vary by location. Medicare Advantage Prescription Drug plans include prescription drug benefits. These plans will cover Medicare Part A, Part B, and Part D benefits under a single plan. You still need to pay a Medicare Part B premium when you’re enrolled in Medicare Part C.
  • Medicare Supplement: Also known as Medigap, these plans cover out-of-pocket health-care costs that Original Medicare does not, such as deductibles, copayments, and coinsurance. Some of these plans also include coverage for emergency health care in foreign countries. Most states, including Missouri, offer up to 10 standardized plan types, and each kind of plan is marked with a letter. Plans of the same letter offer the same benefits, regardless of location or the insurance company you purchase from. For example, benefits for Plan G sold in Missouri would be the same as for Plan G sold in California. However, keep in mind that costs may vary, even for plans with the same coverage.

Local Medicare resources for Missouri

  • Medicare Savings Programs in Missouri: Medicare beneficiaries with low incomes may be able to get help paying for out-of-pocket costs like Medicare Part A and Part B premiums, copayments, coinsurance, and deductibles. If you have limited income, contact the Missouri Department of Social Services, Family Support Division to find out if you qualify for one of these programs.
  • Missouri State Health Insurance Counseling and Assistance Program (SHIP): Community Leaders Assisting the Insured of Missouri (CLAIM) is the official State Health Insurance Assistance Program (SHIP) in Missouri. This program has volunteers available to educate beneficiaries on a wide range of Medicare topics and provides free counseling.

How to apply for Medicare in Missouri

The Original Medicare enrollment process is the same in Missouri as in any other state. To qualify for Medicare, you must be either a United States citizen or a legal permanent resident of at least five continuous years. Residents may be enrolled automatically at age 65 if they already receive benefits through the Social Security Administration (SSA) or the Railroad Retirement Board (RRB). Disabled residents may be automatically enrolled before age 65 if they have received Social Security disability benefits, or certain disability benefits from the Railroad Retirement Board for more than 24 months. Those who receive Medicare because of disability will be automatically enrolled in the 25th month of receiving disability benefits. You may also be automatically enrolled if you have amyotrophic lateral sclerosis (Lou Gehrig’s disease); in this case, your Medicare coverage would begin the first month that your disability benefits begin. If you qualify for Medicare because you have End-Stage Renal Disease (ESRD), you will need to enroll manually.

Provided that you are eligible for Medicare, you can enroll manually if you don’t qualify for automatic enrollment. You can enroll by:

  • Visiting the Social Security website.
  • Calling Social Security at 1-800-772-1213 (TTY users should call 1-800-325-0778), Monday through Friday, 7AM to 7PM.
  • Applying in person at a Social Security office.
  • Calling the Railroad Retirement Board if you worked for a railroad. You can reach the RRB at 1-877-772-5772 (TTY users call 312-751-4701), Monday through Friday, 9AM to 3:30PM.

If you’re not automatically enrolled, or you don’t manually enroll in Medicare when you are first eligible for it, you could face a financial penalty for late enrollment if you choose to enroll down the line.

If you’re looking to enroll in a Medicare plan through a Medicare-approved insurance company, enrollment works differently. You may apply by contacting the plan directly, by contacting Medicare, or through an insurance broker like eHealth. The eligibility rules will depend on the type of Medicare insurance plan you’re enrolling in.

You might want to weigh all of your Medicare options when in the market for a Medicare plan. If you’re interested in learning about your Medicare plan options in Missouri, I can help you research some plans in your location. You can take a look at my profile below to learn more about my experience. Then, if you like, feel free to set up a one-on-one phone appointment or have me email you some customized plan information. If you prefer to browse plans now, the Compare Plans button lets you see which plans are available in your zip code.

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