Missouri is one of the states where there are strong consumer protections in place for health insurance coverage. Private insurance companies offer Medicare Advantage Plans and Medicare Prescription Drug Plans while fully complying with the standards set by the government. These federal health insurance programs cover senior citizens and disabled individuals in the state.
According to the Centers for Medicare and Medicaid Services (CMS), the state had more than 1.2 million beneficiaries as per the 2019 data. Below are some important statistics that you must know regarding the Medicare trends in Missouri.
While these statistics will certainly convince you of Medicare’s popularity and reliability among the people of Missouri, you may feel a bit overwhelmed, especially if it’s your first time getting enrolled for a health insurance plan.
Whether you’ve celebrated your 65th birthday already or are looking forward to achieving that milestone, you must be equipped with basic knowledge regarding the Medicare health plans in Missouri. Even if you already have a Medicare health plan in place, you may benefit from additional plans. With the right information, you can maximize your health coverage and ensure a worry-free future.
Let’s see which options you have when it comes to Medicare health plans in Missouri.
This standard plan is managed by the federal government to provide access to and coverage for doctors, hospitals, and other healthcare facilities and providers who accept Medicare. This fee-for-service plan requires you to pay a certain fee to avail each service. In return, the plan covers your medications, hospital meals, and nurse care. In some critical cases, the plan may also cover in-home treatment costs.
The ‘insurance’ part of the health care plan covers the healthcare costs you incur when you’re not in the hospital. This may include the expenses of doctor visits, ambulance services, lab tests, and therapy sessions.
For hospital and medical insurance, people typically take Part A and B together. Please note that these plans do NOT cover dental care, custodial care, and prescription care.
Unlike the above two, this health plan is managed by private insurance companies picked by Medicare. This alternative plan offers basic benefits from the Original plans (part A and B) as well as some extra privileges, including dental care, health and fitness sessions, and eye checkups.
Medigap is a supplementary plan that covers extra medical costs and out-of-pocket expenses that aren’t covered by the standard plans. With this plan in place, you can enjoy benefits, including copayments, coinsurance, and deductibles.
This health plan comes in handy when you need coverage for prolonged prescription treatment. It covers the cost of medications prescribed by your healthcare provider. That being said, the list of drugs in this plan may vary depending on your service area. As a beneficiary, you’ll have to enrol yourself for a standalone Medicare Part D plan that’s compatible with your Original Medicare health plan. Another option is to use this plan as an extension of your Medicare Advantage Plan.
The best way to find out which health plan in Missouri is ideal for you is by determining your medical needs. Our professionals are here to offer you expert guidance throughout the process to ensure that you make a cost-effective decision.
Like most Medicare Health Plans, the Missouri plans are available for every U.S. citizen. So, if you’re a native or have a permanent legal residency for at least five continuous years, you can apply for an Original Medicare Plan.
Additionally, you must meet the following requirements:
Once you’ve enrolled yourself for the Original Medicare Health Plans, you can apply for part C and D. Just make sure that the health plan and desired services are available in your zip code if you want to receive the benefits on your healthcare plan. That being said, you should understand that Medicare disability refers to both permanent physical and mental impairment that warrants continuous treatment.
Offered by private insurance firms in collaboration with Medicare, Medicare Advantage Plans include standard healthcare benefits along with supplemental perks.
The two common Medicare Advantage plans include:
Health Maintenance Organization (HMO) refers to a network of healthcare providers that offers reduced rates for its members. This means that if you consult with a specialist out of the network, your insurance company won’t cover your medical care cost and you’ll have to pay the bills yourself.
As a beneficiary with HMO, you enjoy increased flexibility in emergency cases since you won’t have to wait for a healthcare provider’s appointment. HMO members need a reference from their Primary Care Provider before they can refer to a specialist.
Preferred Provider Organization (PPO) allows you to choose your own healthcare specialist and doctors, which means more flexibility. Getting a reference from a primary care provider is optional. If you do so, you can enjoy lower rates. As with HMOs, PPOs also have a network of healthcare providers and so, consulting with a specialist outside of the network will incur out-of-pocket expenses.
Missouri residents who have both Medicaid and Medicare health plans may qualify for a Special Needs Plan (SNP). These plans have networks similar to an HMO or PPO.
Enrolling for a Medicare Health Plan in Missouri is pretty easy.
If you’ve already signed up for Social Security, you’ll automatically be enrolled in Medicare. Those who haven’t are required to call Social Security or enroll through the website.
Please note that you can still qualify for part A if your employer offers healthcare benefits.
There are three enrollment periods you must know about:
Please note that eligible residents who don’t sign up for Part B in their initial enrollment period may face a late penalty of 10% for every year they wait. This penalty lasts for the entire Medicare duration.
At O’Neal Insurance Group, our professionals are fully equipped with the necessary knowledge and resources regarding Original Medicare Health Plans in Missouri. We’ll help you determine the best option that aligns with your specific medical needs and particular circumstances.