Medicare Advantage Plans in Missouri

Coverage under a Medicare Advantage Plan in Missouri is a popular choice among many Medicare beneficiaries. Below are some of the reasons you may find a Medicare Advantage plan in Missouri so compelling.

Medicare Advantage (MA) plans, also known as Medicare Part C:

  • Bundle Medicare Part A and Part B out-of-pocket, and sometimes Medicare Part D, under one plan
  • May include prescription drug coverage
  • Set annual limits on out-of-pocket costs for covered healthcare expenses
  • Often include additional coverage beyond Original Medicare, such as dental, vision and hearing services, and wellness programs

Nearly 40% of state residents enrolled in Medicare Part A and B in Missouri have also selected certain Medicare Advantage plans in Missouri.

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Popular Medicare Advantage Plan Types in Missouri

Best network freedom: Medicare Advantage PPO

  • Extensive network of health care providers
  • Flexibility to go outside network with higher coinsurance and copays
  • No referrals needed to visit specialists
  • Monthly premiums range from $0 to $100

Best for lowest out-of-pocket: Medicare Advantage HMO Plan

  • Lower out of pocket cost when you adhere to confines of HMO network
  • Referrals from primary care physician required
  • Monthly premiums generally $0

Best for low income or health conditions: Medicare Advantage D-SNP

  • Plan exclusive to beneficiaries with limited incomes or chronic health conditions
  • Eligibility for D SNP: dually eligible recipients (have both Medicare and Medicaid)
  • Plan coordinates programs to lower your out of pocket costs (coinsurance, copayments, deductibles and premiums)

Florida Enrollment facts:

Number of Medicare Advantage members in Missouri: 486,636

Number of MA members by type of Medicare Advantage plan:

  • Local HMO: 242,444
  • Local PPO: 100,548
  • Regional PPO: 45,464

Percentage of Medicare Advantage members in Missouri: 39%

Number of Medicare Advantage members nationwide: 29.5 million in 2022

Percentage of Medicare Advantage members nationwide: 42%

How much does Medicare Advantage in Missouri cost?

Zero-premium insurance plans are common for HMO plans and some PPO plans as well. But the actual cost of a Missouri Medicare Advantage plan will vary between counties.

The average premium for a Medicare Advantage Prescription Drug (MAPD) plan premium in Missouri in 2022: $46.92

Overall, Missouri has one of the lowest rates for average premiums of all the states: $20.

How much do Advantage Plans cost in Missouri?

PPO Plan $0.00 to $46.92

HMO Plan $0.00

When can I enroll in a Medicare Advantage plan?

Initial Enrollment Period

  • First time you can sign up for Original Medicare along with other Medicare-approved health plans
  • Seven-month window
  • Best to sign up during the three months before the month you turn 65 to avoid delayed start date

You must have Part A and Part B to enroll in Medicare Part C. Before you apply for a Medicare Advantage plan in Missouri, be sure to pay your Part B premium and, if required, your Part A premium.

Open Enrollment Period – aka Annual Election Period

  • October 15 – December 7
  • Join, switch or drop a Missouri Medicare Advantage plan.
  • Health insurance is effective January 1 for applications received by December 7.

Medicare Advantage Open Enrollment Period

  • Accessible only to Missouri Medicare Advantage plan members
  • Can switch to another Missouri Medicare Advantage plan
  • Can drop an MAPD plan and sign up for a stand-alone Part D plan to avoid a lapse in prescription drug coverage

Special Enrollment Periods – Special Circumstances

Certain life events may qualify for a Special Enrollment Period (SEP). During an SEP, you can make changes to MA plans and prescription drug plans.

Special circumstances include:

  • Moving out of the plan’s service area
  • Relocating to an area that offers new plan options
  • Leaving an employer or union group health insurance plan
  • Becoming eligible for both Medicaid and Medicare coverage

5-star Special Enrollment Period

Medicare maintains a 5-star rating system to help you compare the quality and performance of Medicare Advantage plans, Part D plans and Medicare Cost Plans. Star ratings are based on feedback from members and healthcare providers. Once during the 5-star Special Enrollment Period, which is held December 8 through November 30, you can switch to a 5-star plan.

Special Enrollment Periods if you get “Extra Help”

During January to March, April to June, and July to September, you can:

  • Join, switch or end your MA plan or prescription drug coverage if you are eligible for Medicare and Medicaid
  • Join, change or drop your Medicare drug plan if you are enrolled in Medicare drug coverage that is paid for by Extra Help

Once during the calendar year, you can:

  • Enroll in an MAPD plan or a stand-alone drug plan if you are enrolled in the State Pharmaceutical Assistance Program (SPAP)
  • Enroll in an MAPD plan or a stand-alone drug plan if you are losing your eligibility for SPAP

Ready to Learn More?

We help educate Medicare beneficiaries on their Medicare Advantage options and help them go through the process of reviewing and comparing plans. We work with most of the nation’s top-rated Medicare Advantage carriers. Give us a call today, or request a quote online to learn more about plan options.

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