Medicare plays a key role in providing health and financial security to beneficiaries residing in Missouri. With more than 1.2 million Missouri beneficiaries enrolled in Medicare, we’ll cover some very important information below about Medicare in Missouri. We want to help you better understand your options and make the decision-process as seamless as possible once you’re ready to enroll in Medicare or discover different coverage options.

Who Qualifies for Medicare in Missouri?

Medicare covers most Missouri residents who are 65 or older, and it also covers disabled Missouri residents. In general, Medicare enrollment in Missouri works the same way as it does in the rest of the country. If you qualify for Original Medicare, also known as Part A and Part B, it will help cover 80% of your health care costs.

When you’re first eligible for Medicare, you have a 7-month Initial Enrollment Period to sign up for Part A and/or Part B. If you’re eligible for Medicare when you turn 65, you can sign up during the 7-month period that:

  • Begins 3 months before the month you turn 65
  • Includes the month you turn 65
  • Ends 3 months after the month you turn 65

In most cases, if you don’t sign up for Part B when you’re first eligible, you’ll have to pay a late enrollment penalty. You’ll be responsible for paying this penalty for as long as you have Part B, and you could have a gap in your health coverage.

Once you reach Medicare eligibility, you can begin choosing additional coverage options to help pay for the remaining 20% of your medical expenses through Medicare Advantage (Part C), Medigap, and/or a Medicare Prescription Drug (Part D) plan.

Who Qualifies for Medicare

Missouri Medicare Enrollments

744,363

Original Medicare Plans
(Part A and B)

496,475

Medicare Advantage & Other Health Plans

521,501

Stand-alone Medicare
Part D (Drug plans)

1,240,838

Total Medicare Beneficiaries
in Missouri

Missouri Medicare Advantage Plans (Part C)

More than 37% of Missouri Medicare beneficiaries select Medicare Advantage plans.

Medicare Advantage plans are private, Medicare-approved insurance companies. They provide all of your Original Medicare benefits and often include extra benefits such as drug, dental, and vision coverage.

The Medicare Advantage Open Enrollment Period runs from January 1 to March 31. During this period, Medicare beneficiaries in Missouri who already enrolled in a Medicare Advantage plan can switch to a different Medicare Advantage plan or drop their Medicare Advantage plan and enroll in Original Medicare.

As of 2020, 98 Medicare Advantage plans are available in Missouri. The average monthly Medicare Advantage premium changed from $12.28 in 2019 to $10.35 in 2020. $0 is the lowest monthly premium for a Medicare Advantage plan in Missouri. Availability for Medicare Advantage plans in Missouri ranges from nine to 40 plans, depending on the county.

According to the Centers for Medicare and Medicaid Services (CMS), as of May 2020, there are 496,475 beneficiaries enrolled in Medicare Advantage and other plans in Missouri. More than 37% of Missouri Medicare beneficiaries were enrolled in a private Medicare Advantage plan in 2019. 100% of people with Medicare have access to a Medicare Advantage plan.

Missouri Medicare Supplement (Medigap) Insurance Plans

Missouri law gives Medigap enrollees the opportunity to switch to a different plan (at the same coverage level) during their anniversary window.

Medigap plans are used to supplement Original Medicare, covering some or all of the out-of-pocket costs (for coinsurance and deductibles) that beneficiaries would otherwise incur if they only had Original Medicare on its own. Typically, Medigap plans are popular for those who want little to no copay when they access healthcare services.

Many states don’t give beneficiaries the chance to switch to a new Medigap plan on a guaranteed-issue basis after their initial enrollment window ends. However, Missouri’s “anniversary rule” allows enrollees an annual opportunity to switch from one Medigap insurer to another. Enrollees are able to do so during a guaranteed-issue basis during a window that starts 30 days before the plan anniversary date and continues for 30 days after it. In a nutshell, there’s a two-month period each year when people with Medigap coverage can switch to a different Medigap plan (with the same coverage level as their current plan). Missouri also has rules to ensure at least some access to Medigap plans for enrollees under the age of 65.

Missour Medicare Prescription Drug Coverage (Part D)

Original Medicare doesn’t cover outpatient prescription drugs. However, Medicare beneficiaries can get prescription coverage via a Medicare Advantage plan, an employer-sponsored plan (offered by a current or former employer), or a stand-alone Part D plan. Medigap plans don’t cover prescription drugs unless they’re covered under Part B.

As of 2020, There are 521,501 Medicare beneficiaries in Missouri enrolled in stand-alone Part D prescription drug plans and 440,744 enrolled in Medicare Advantage Prescription Drug plans. For 2020 coverage, there are 28 stand-alone Part D plans available in Missouri, with premiums ranging from about $13 to $89 per month. About 24% of people with a stand-alone Medicare prescription drug plan get Extra Help (also called the low-income subsidy, or LIS).

When deciding on a Part D plan, it’s important to evaluate several factors such as each plan’s premium, formulary, and copays since every plan is different. Learn how you can save money on your out-of-pocket costs with a Medicare Advantage, Part D, or Medigap plan, fill out this form or give us a call.

Local Medicare Health Plan Resources in Missouri

  • Community Leaders Assisting the Insured of Missouri, or CLAIM, is Missouri’s State Health Insurance Assistance Program (SHIP). CLAIM services are free, unbiased, and confidential. CLAIM averages around 300 volunteer counselors and 180 community partners throughout Missouri who provide local Medicare counseling in their communities. Volunteers receive extensive training to become a certified Medicare counselor and continue to receive updates and training on a regular basis.
    Contact: Call 800-390-3330, visit the CLAIM website to fill out an online form, or visit the office at 4215 Philips Farm Road, Suite 101-A in Columbia.

  • Missouri SMP, or Senior Medicare Patrol program helps Medicare and Medicaid beneficiaries prevent, detect, and report health care fraud. In doing so, they help protect older persons and promote integrity in the Medicare program. Because this work often requires face-to-face contact to be most effective, SMPs have recruited nearly 6,000 volunteers nationwide to support this effort. SMP volunteers serve in many ways, including outreach, education, and one-on-one counseling. Most are Medicare beneficiaries themselves and are thus well-positioned to assist their peers.
    Contact: Call 888-515-6565 or 660-747-5447, email [email protected], or mail an inquiry to 106 W. Young, P.O. Box 1078, Warrensburg, MO 64093.

  • The Missouri Department of Insurance is a state agency dedicated to helping residents understand their insurance options, consumer rights, and the laws regulating insurance.
    Contact: Call 573-751-4126, visit the office in person at 301 W. High St., Room 530 in Jefferson City, or mail questions and inquiries to P.O. Box 690, Jefferson City, MO 65102-0690.

  • VOYCE is an advocacy and resource nonprofit serving 21 counties in and around St. Louis. VOYCE offers advocacy services to the 22,000 individuals who reside in more than 350 skilled nursing, assisted living and residential care communities in Greater St. Louis and northeast Missouri. More than 50% of these individuals have no one to advocate on their behalf. VOYCE also delivers options to those making long-term care decisions. As the demand for long-term care continues to grow, an estimated 70% of those 65 and older will need long-term care, and 43% will spend some time in a long-term care community.
    Contact: Call 314-919-2403 or 866-918-8222, email VOYCE through its online inquiry form, or visit the office Monday through Friday at 680 Craig Road, Suite 245 in St. Louis.

The licensed agents that are partnered with Timefor65 can help you compare the availability, benefits, and costs of Medicare plans in your specific region of Missouri. Our process makes it easier for you to access your Medicare eligibility in Missouri so that you receive personalized, affordable, and easy-to-use coverage options and solutions. Fill out the form or give us a call at (866) 327‑0148 anytime to get a free quote or to ask any questions.

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