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
In 2009 there were 1,040,491 Medicare beneficiaries in Missouri, which is 17.3 percent of its total population. That compares with 16 percent of the United States population enrolled in Medicare.
The states with the highest percentage of beneficiaries are West Virginia and Maine with about 21 percent each. Those with the lowest percentage are Alaska (9.5 percent) and Utah (10 percent). In raw numbers, Alaska has the least recipients at 69,301 and California (which has about an eighth of the country’s population within its borders) has the most at a little over 5 million (13 percent of its population).
Breakdown of the aged vs. disabled
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 has the highest percent of Medicare recipients listed as disabled (28 percent), followed by Alabama, Mississippi, West Virginia and Arkansas. Hawaii has the smallest percentage at 12 percent, followed by North and South Dakota at 14 percent each.
Medicare spending per recipient
Medicare pays about $9,724 annually per enrollee in Missouri. Growth in per-enrollee spending in Missouri from 1991 to 2009 has been about 6.4 percent.
In terms of spending per recipient, about 20 states spend $10,000 or more per recipient. (Medicare spends the most per beneficiary — $11,903 — in New Jersey and the least per enrollee — $9,576 — in Montana. South Carolina and Nebraska lead in per-enrollee spending growth at 7.4 percent, and Pennsylvania‘s growth per enrollee has been the least at just over 5 percent.
Medicare spending overall
In total spending on Medicare, Missouri ranks #16 with $9.6 billion per year. With the largest and smallest numbers of recipients, itʼs no surprise that California accounts for $50.6 billion of overall Medicare spending while Alaska spends only $553 million. Total Medicare spending for all states and the District of Columbia was $471 billion in 2009 (latest available data).
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).
Maine 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. Carriers are not allowed to charge disabled younger enrollees higher premiums than they would charge a 65-year-old enrollee.
Medicare Advantage in Missouri
Medicare Advantage offers Americans health benefits through private plans instead of through Original — or traditional — Medicare (the federal government’s fee-for-service program). These plans are one option for consumers who desire additional benefits beyond what Original Medicare offers, but are not considered a wise option by some consumers who are concerned that government spends more per enrollee on the private plans than it does on its own program.
In 2014 in Missouri, 26 percent of all Medicare recipients chose a Medicare Advantage plan. Missouri ranks #24 among all states for insureds choosing an Advantage plan. Nationwide, 30 percent of Medicare beneficiaries enrolled in a Medicare Advantage program. A full 32 percent of urban dwellers choose them, compared to only 20 percent of rural dwellers, likely due to less access to plans.
Minnesota is the only state where more than half (51 percent) of Medicare eligibles enrolled in a Medicare Advantage plan. Alaska, with only 22 Advantage enrollees, is the only state to have zero percent enrolled in Medicare Advantage. Five more states have Medicare Advantage enrollment (by percentage of the state’s Medicare enrollees) in the single digits: Wyoming with 3 percent, New Hampshire with 6 percent, Vermont and Delaware (both with 7 percent) and Maryland squeaking in with 9 percent.
Stand-alone Medicare Prescription Drug plans
Missouri has 521,570 in stand-alone prescription drug plans. The state has 33 plans with premiums ranging from $13 to $138 per month. That amounts to 48 percent of all enrollees in Missouri having a stand-alone Rx plan compared to an average of 47 percent nationally. (Florida is highest with 52 percent.)
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. It is a bit of a controversial program because it was an unfunded liability — meaning that the vast majority of costs fell on taxpayers — and the law also barred Medicare from negotiating lower drug prices with drug makers.
For those under 65 in Missouri