Resources for Missouri beneficiaries
State Health Insurance Assistance Programs (SHIPs) provide free, in-depth, one-on-one insurance counseling and assistance to Medicare beneficiaries, their families, friends, and caregivers. SHIPs operate in all 50 states.
In Missouri you can reach SHIP at 1-800-390-3330; or 573-817-8320 or online here.
Snapshot of Medicare in Missouri
- Total Medicare enrollment in Missouri
- Medicare spending per beneficiary
- Medigap in Missouri — including strong consumer protections
- Medicare Advantage in Missouri
- Stand-alone Part D prescription drug coverage in Missouri
- Health insurance coverage if you not eligible for Medicare in Missouri
Total Medicare enrollment in Missouri
1,205,759 Missouri residents were enrolled in Medicare as of November 2018. That’s a little less than 20 percent of the state’s total population, compared with a little more than 18 percent of the United States population enrolled in Medicare.
82 percent of Missouri’s Medicare beneficiaries are eligible for coverage because theyre at least 65 years old, while 18 percent are eligible due to a disability. Nationwide, 84 percent of Medicare beneficiaries are eligible due to age and 16 percent are eligible due to disability.
Individuals who qualify by virtue of their age alone make up 79 percent of Missouri Medicare recipients. The balance — 21 percent — are on Medicare as the result of a disability. Kentucky, Alabama, Mississippi, and Puerto Rico have the highest percentage of Medicare beneficiaries who are eligible due to a disability, at 23 percent. Hawaii and the Virgin Islands have the smallest percentage at 9 percent.
Medicare spending per recipient
According to 2016 data that were standardized to eliminate variation in payment rates from one area to another, Original Medicare spent an average of $9,521 per beneficiary in Missouri (that does not include Medicare Advantage spending). Average Medicare spending in Missouri was roughly the same as the national average in 2016, which was $9,533 per enrollee. At either end of the spectrum, Louisiana had the highest average per-beneficiary Medicare costs, at $11,399, and Hawaii had the lowest, at $6,441.
Medigap in Missouri
Medigap is the only form of private coverage for Medicare beneficiaries that has no federally-mandated annual open enrollment period. Medigap coverage is guaranteed issue for six months when you turn 65 and are enrolled in Original Medicare. During that window, enrollees can select any Medigap plan available in their area, with no medical underwriting.
But after that six month period is over, enrollees often find themselves locked into the plan they initially purchased — regardless of how the premium changes —because in most states, switching to another plan can be impossible or unaffordable due to medical underwriting (per federal guidelines, there are seven limited circumstances when you can get a new Medigap plan without medical underwriting).
In response to the lack of a nationwide annual open enrollment period for Medigap, some states have implemented legislation that makes it easier for seniors to switch from one Medigap plan to another. Missouri offers an Anniversary Guaranteed Issue Period; seniors who already have Medigap coverage have a 60 day window around their plan anniversary each year during which they can switch to the same plan from any other carrier, guaranteed issue (ie, if you already have Plan F, you can switch to any other carrier’s Plan F during that window).
Missouri also provides a guaranteed issue six-month enrollment window during which disabled, under-65 Medicare beneficiaries can enroll in a Medigap plan when they first enroll in Original Medicare. Premiums are higher for disabled younger enrollees, but they are then allowed another enrollment period when they turn 65, during which they can enroll in a plan at the lower rates that apply to people who are gaining eligibility for Medicare due to age, rather than disability.
Medicare Advantage in Missouri
Medicare Advantage allows Medicare beneficiaries to obtain health benefits through private plans instead of through Original — or traditional — Medicare (the federal government’s fee-for-service program). Enrollees can decide whether they’d rather have private Medicare Advantage coverage or Original Medicare (which generally needs to be supplemented with private Part D coverage and Medigap) — there are pros and cons either way.
31 percent of Missouri Medicare beneficiaries were enrolled in private Medicare Advantage plans in 2017. Nationwide, the average was 33 percent. The remaining 69 percent of the state’s Medicare beneficiaries had coverage under Original Medicare. Minnesota is the only state where more than half (56 percent) of Medicare eligibles enrolled in a Medicare Advantage plan. Alaska, with one percent of Medicare beneficiaries enrolled in Advantage plans, has the lowest Medicare Advantage enrollment in the country.
Missouri residents who wish to enroll in Medicare Advantage can choose from a variety of different plans, although plan availability varies from one county to another. Some counties have as few as six plans available in 2019, while other counties have as many as 33 different Medicare Advantage plans available for purchase. As of 2019, there’s a Medicare Advantage open enrollment period (January 1 to March 31) during which people who are already enrolled in Medicare Advantage plans can switch to a different Medicare Advantage plan or drop their Medicare Advantage plan and enroll in Original Medicare instead.
Stand-alone Medicare Prescription Drug plans
Original Medicare does not cover outpatient prescription drugs. But Medicare beneficiaries can get prescription coverage via a Medicare Advantage plan, an employer-sponsored plan (offered by a current or former employer to supplement Medicare coverage), or a stand-alone Part D plan.
For 2019 coverage, there are 26 stand-alone Part D plans available in Missouri, with premiums ranging from $13 to $102 per month.
As of November 2018, there were 540,250 Missouri Medicare beneficiaries with coverage under stand-alone Part D prescription drug plans. That’s about 45 percent of the state’s total Medicare beneficiaries, which is very much in line with the national average — about 43 percent of all Medicare beneficiaries nationwide are enrolled in stand-alone Part D plans. Another 373,132 Missouri Medicare beneficiaries have Part D coverage integrated with their Medicare Advantage plans.
Medicare prescription drug coverage — called Medicare Part D — was the result of legislation passed in 2003 and signed into law by President George W. Bush in 2006.
Need health insurance in Missouri and not eligible for Medicare?