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Medicare in Missouri

Valuable guidance for Missouri residents seeking answers to their Medicare questions

Reviewed by: Cassandra Parker, Licensed Insurance Agent. Written by: Bryan Strickland.

Key Takeaways

  • Applying for Medicare in Missouri when you approach age 65 is easy, but understanding the coverages offered and the costs involved is important.

  • If you choose not to enroll in Medicare at age 65, make sure you have a plan for dealing with late-enrollment penalties or issues with getting certain coverages in the future.

  • Medicare AdvantageMedicare Advantage (Medicare Part C) is health insurance for Americans aged 65 and older that blends Medicare benefits with private health insurance. This typically includes a bundle of Original Medicare (Parts A and B) and Medicare Prescription Drug Plan (Part D). in Missouri could help you save money whether you sign up now or later.

 

From St. Louis on the eastern border, through the Gateway Arch, and westward to Kansas City on the far side, Missouri is known as the “Show-Me” state.

When it comes to the complicated world of Medicare, Missourians can benefit from having someone who can show them the way.

GoHealth is here to help.

Who Qualifies for Medicare in Missouri?

Any U.S. citizen age 65 or older that calls Missouri home is eligible to enroll in the federal healthcare insurance program known as Medicare. Some people under 65 also may qualify for Medicare in MO.

How do I apply for Medicare in Missouri?

  • You can enroll online with the Social Security Administration. [1]
  • You can enroll via phone by calling 1-800-772-1213 (TTY: 1-800-325-0778).
  • You can enroll by visiting a local Social Security office. [2]

You have the option of enrolling in Part A of Original Medicare (which covers a portion of your hospital-related expenses), Part B (which covers an amount of your other medical expenses) or both.

If you enroll in both Parts A and B, you have the option to add Part D to cover a portion of your prescription expenses. You may also choose to add Medigap, which is supplemental coverage that helps fill in the gaps in terms of out-of-pocket expenses like copays and coinsurance.

Enrolling in Parts A and B also opens the window for you to replace Original Medicare with Medicare Advantage. Medicare Advantage in Missouri bundles your coverage options while offering additional ones like dental and vision coverage.

Do I Automatically get Medicare when I turn 65?

If you start receiving Social Security benefits before your 65th birthday, you will automatically be enrolled into Original Medicare in Missouri at age 65. If not, you can enroll during the seven-month Initial Enrollment Period that includes the month of your 65th birthday as well as the three months before and the three months after your 65th birthday.

  • If you are automatically enrolled, then you will be enrolled in both Parts A and B. Most people, regardless of any other insurance they may carry, most people have Part A at age 65 because it provides hospital coverage without a monthly premium if have worked at least 10 years.
  • Some people still have employer-sponsored insurance at 65 and wait on Part B because it has a monthly premium. If you are automatically enrolled, you should receive a welcome packet leading up to your 65th birthday and fill out CMS Form 1763 or contact the Social Security Administration if you don’t want to enroll in Part B. [3]

What is the Cost of Medicare when you turn 65?

Passing on Part B at age 65 because you’re still using an insurance option at work usually creates a Special Enrollment Period that allows you to add Part B later without a penalty. But in most other situations, the cost of Medicare in Missouri will increase if you don’t enroll at age 65 because of late-enrollment penalties that last a lifetime.

You may have to pay more if you pass on Part B or Part D at age 65, and adding Medigap after your Initial Enrollment Period can be more expensive as well — not to mention potentially trickier. Generally speaking, it’s best to get your Medigap plan within the first six months after you enroll in Original Medicare. During this period, you won’t be asked medical questions that could impact your ability to secure a specific plan at a special price.

If you don’t get supplemental coverage in Medigap around age 65, Medicare Advantage in Missouri could fill your supplemental insurance needs. A GoHealth licensed agent can help you understand your options.

What are the Different Plans of Medicare?

Medicare Advantage beneficiaries can’t carry a Medigap plan, but they don’t need one because Medicare Advantage plans offer their version of supplemental coverage to fill in the gaps.

That’s an example of how Medicare Advantage plans bundle services, a fundamental difference between Medicare plans in Missouri.

  • Medicare Advantage bundles the hospital and medical coverage offered by Parts A and B of Original Medicare in MO, as well as the drug coverage and supplemental coverage that can be added to Original Medicare.
  • Medicare Advantage also offers additional coverage options not provided by Original Medicare like dental and vision coverage and a monthly stipend for purchasing over-the-counter supplies.
  • Medicare Advantage and Original Medicare have different coverage areas and various costs. While Original Medicare can be used nationwide, Medicare Advantage is usually limited to a network of providers in your area. Still, that distinction allows Medicare Advantage in Missouri to often offer more affordable options.

Who has the Best Medicare Advantage Plan?

While there’s only one Original Medicare plan, Medicare Advantage in Missouri offers multiple plan options that could fit your specific situation and improve your coverage effectiveness. A GoHealth licensed insurance agent, just a phone call away, specializes in guiding you through the strengths of various plans, helping you make an educated decision.

Medicare in Missouri by the Numbers

Thousands of older adults enroll in Medicare every day across the United States. The latest CMS data shows that 1,149,563 people are enrolled in Medicare in Missouri. The total number of beneficiaries enrolled in Medicare Advantage in Missouri is 431,055. The previous year, 398,631 enrolled in Medicare Advantage. Medicare Advantage participation in Missouri went from 35.28% to 37.50% year over year. If you’d like to dive deeper into how Medicare in Missouri breaks down across the state, we provide a glance at who is using Medicare, and how.

Outline of Missouri
1,149,563
Beneficiaries with Part A & Part B
431,055
Medicare Advantage Beneficiaries
37.50%
Medicare Advantage Participation Rate
54.82%
% Female
45.18%
% Male
1.02
Average HCC Score
$9,993.63
Actual Per Capita Costs
17.69%
% Eligible for Medicaid
33.50%
% of Beneficiaries with an Emergency Department Visit
18.64%
Hospital Readmission Rate
89.44%
% Non-Hispanic White
7.02%
% African American
1.06%
% Hispanic
2.48%
% Other/Unknown

Table reflects the latest Beneficiary Demographics data: 2018, All Beneficiaries by State, Centers of Medicare & Medicaid Services (CMS)

Average HCC Score: The Hierarchical Condition Category score gauges a population’s overall health. The score is based on a value of 1.0. Populations with an HCC score of less than 1.0 are considered relatively healthy. The score can be used to estimate health costs.

Missouri Medicare Resources & Contacts

Beneficiaries spend an average of $9,993.63 each year on Medicare in Missouri. To be certain you are not leaving anything on the table, let us help. A GoHealth licensed insurance agent can assess your coverage or explain which Missouri-based resources, like these, may be able to help:

CLAIM - Medicare Counseling

1-800-390-3330

https://www.missouriclaim.org/

What should I know about CLAIM?

The state’s official State Health Insurance Assistance Program (SHIP) provides free counseling for all things Medicare in Missouri.

Missouri Department of Insurance

1-800-726-7390
Phone lines open M-F, 8 a.m. to 5 p.m.

https://insurance.mo.gov/consumers/complaints/index.php

What should I know about the Missouri Department of Insurance?

The department’s Division of Consumer Affairs responds to insurance-related complaints.

MO Healthnet

1-855-373-4636
Phone lines open M-F, 6 a.m. to 6:30 p.m., Saturday 8 a.m. to 5 p.m.

https://mydss.mo.gov/healthcare

What should I know about the MO Healthnet?

It is the official state Medicaid program, with representatives available to answer questions and help Missourians apply.

Missouri Veterans Commission

573-751-3779

https://mvc.dps.mo.gov/index.php

What should I know about the Missouri Veterans Commission?

The commission helps veterans and their families understand and even apply for health-related benefits.

Nationwide Resources

Speak with an insurance agent that is licensed in Missouri about your Medicare questions.

1-855-792-0088 TTY: 711

Monday - Friday, 8 AM - 9 PM CT

Medicare & Medicaid

If you have general questions about Medicare in MO, or need help with current Medicare benefits.

1-800-MEDICARE (1-800-633-4227)

Social Security Administration

You can reach the SSA by phone for general questions. Not all questions can be answered over the phone.

Also, SSA.gov provides online resources for the following: Review information, apply for benefits, or manage your account online

Speak to SSA Representative, Monday - Friday, 8 AM - 7 PM ET

Medicare Learning Guides

Healthcare is personal. So is choosing insurance. If you are new to Medicare, a beneficiary researching options, or a caregiver, we have tailored Medicare Guides for you.

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