Medicare in Missouri

Missouri has strong consumer protections for Medigap coverage


At a glance: Medicare health insurance in Missouri

Medicare enrollment in Missouri

Medicare enrollment in Missouri was 1,245,040 as of July 2020, amounting to a little more than than 20 percent of the state’s total population.

82 percent of those filing for Medicare benefits in Missouri are eligible due to being at least 65 years old, while 18 percent are eligible due to a disability that lasts at least two years (people with ALS or end-stage renal disease do not have to wait two years for Medicare enrollment). Nationwide, 85 percent of Medicare beneficiaries are eligible due to age and 15 percent are eligible due to disability.

Medicare options

Medicare beneficiaries can chose among several options to access Medicare coverage. The first choice is between Medicare Advantage plans, where coverage is through private Medicare Advantage plans or Original Medicare, where coverage is paid for directly by the federal government. Medicare beneficiaries also have options around Medigap policies and Medicare Part D (prescription drug) coverage.

Original Medicare includes Part A (also called hospital insurance, which helps pay for inpatient stays, like at a hospital, skilled nursing facility, or hospice center) and Part B (also called medical insurance, which helps pay for outpatient care like a doctor appointment or a preventive healthcare service). Medicare Advantage plans bundle Parts A and B under a single monthly premium and often include other services like prescription drug and vision coverage. There are pros and cons to either option, and the “right” solution is different for each individual.

Medicare Advantage use in Missouri

About 32 percent of Medicare in Missouri beneficiaries were enrolled in private Medicare Advantage plans in 2018. Nationwide, the average was 34 percent. The remaining 68 percent of the state’s Medicare beneficiaries had coverage under Original Medicare. By mid-2020, however, 40 percent of Missouri’s Medicare beneficiaries were enrolled in private coverage (not counting Original Medicare beneficiaries who supplement their coverage with Medicare Part D plans and/or Medigap plans). That’s in line with the nationwide growth in Medicare Advantage enrollment: About 40 percent of all Medicare beneficiaries nationwide were enrolled in private coverage as of mid-2020.

Missouri residents who seek Medicare Advantage enrollment can choose from a variety of different health plans. Plan availability varies from one county to another (where a given insurance company offers coverage is called its “service area.”) In some counties there are as few as nine plans available in 2020, while other counties have as many as 40 different Medicare Advantage plan options available to beneficiaries.

There’s an annual open enrollment period each fall (October 15 to December 7) during which people can change from Original Medicare to Medicare Advantage, or vice versa. There is also 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.

Medigap in Missouri: Extensive consumer protections

Medigap plans are used to supplement Original Medicare, covering some or all of the out-of-pocket costs (for coinsurance and deductibles) that people would otherwise incur if they only had Original Medicare on its own.

There are 50 insurers that offer Medigap plans in Missouri. The state created a helpful Medigap Rate Shopper Tool in 2019 that allows a user to enter some basic information and see prices for the Medigap plans available in their area (the state’s previous tool could only give a rough estimate based on age ranges).

Medigap plans are standardized under federal rules, and there is a six-month window, when people turn 65 and enroll in Original Medicare, during which coverage is guaranteed issue for Medigap plans.

But federal rules do not allow for any sort of annual open enrollment period for Medigap (like the annual open enrollment period that applies to Medicare Part D plans and Medicare Advantage plans), nor to federal rules guarantee access to a Medigap plan if you’re under 65 and eligible for Medicare as a result of a disability.

So in most states, people do not have a chance to switch to a new Medigap plan on a guaranteed-issue basis after their initial enrollment window ends. But Missouri’s “anniversary rule” allows enrollees an annual opportunity to change from one Medigap insurer to another (as long as both plans are the same letter; for example, from one Plan G to another Plan G) on a guaranteed-issue basis during a window that starts 30 days before the plan anniversary date and continues for 30 days after it. So there’s essentially a two-month period each year during which people with Medigap coverage can switch to a different Medigap plan (with the same coverage level as their current plan). This window is different for each enrollee, since it’s based on the date they initially got their plan.

And Missouri is among the majority of the states that have adopted rules to ensure at least some access to Medigap plans for enrollees under the age of 65. Missouri residents have access to the same six-month guaranteed-issue window for Medigap, regardless of whether they’re becoming eligible for Medicare in Missouri due to age or due to disability. The premiums are higher for enrollees under age 65, but not drastically so.

In many states, premiums are two to four times more expensive for people under 65; in Missouri, most insurers’ rates for people under 65 are not more than 35 percent higher than the rates that apply to people who are 65. This is because Missouri regulates how much Medigap insurers can charge under-65 enrollees: According to the terms of Missouri’s Code of State Regulations [see 20 CSR 400-3.650(11)(E)(1)(B)], under-65 Medigap rates for each insurer must be equal to the “weighted average aged premium rate.” This document shows how that’s calculated, but it essentially means that people under the age of 65 will end up paying premiums that are higher, but not significantly higher, than the rates charged for a 65-year-old.

Medicare enrollees are given another Medigap enrollment window when they turn 65, so they can then switch to lower-cost Medigap coverage at that point.

Missouri Medicare Part D

Original Medicare does not cover outpatient prescription drugs. Avenues for Medicare beneficiaries to secure needed prescription drug coverage include Medicaid, an employer-sponsored plan (offered by a current or former employer to supplement Medicare coverage), or a Medicare Part D plan. Medicare Part D coverage can be obtained with a stand-alone prescription drug plan (PDP) or as part of a Medicare Advantage plan that includes Part D coverage, also known as a MA-PD plan. Ninety percent of Medicare Advantage plans provide integrated Part D coverage.

As of July 2020, there were 521,280 Missouri Medicare beneficiaries with coverage under stand-alone Medicare Part D plans. Another 444,837 people with Medicare in Missouri had Part D coverage integrated with their Medicare Advantage plans at that point, for a total of nearly a million Missouri Medicare beneficiaries with Part D coverage.

Total Medicare Part D enrollment has been growing in Missouri as the overall population enrolled in Medicare increases. But the number of people with stand-alone Medicare Part D plans in Missouri has been dropping, while the number of people with Part D coverage integrated with Medicare Advantage plans has been rising. That’s in line with the national trend too: Medicare Advantage enrollment has been steadily increasing since the early 2000s, resulting in a larger percentage of the Medicare population getting their Part D coverage as part of an Advantage plan.

For 2020 coverage, there are 28 stand-alone Medicare Part D plans available in Missouri, with premiums ranging from $13 to $89 per month.

The Medicare Part D enrollment window is the same as the Medicare Advantage enrollment window each fall. It runs from October 15 to December 7, with plan changes effective January 1.

Medicare spending in Missouri

In 2018, Original Medicare spent an average of $10,205 per beneficiary in Missouri (the data were standardized to eliminate differences in payment rates from one area to another, but it was only based on Original Medicare spending, so it did not include costs for Medicare Advantage enrollees). The national average that year was $10,096 per enrollee, so Medicare spending in Missouri was essentially the same as the national average. At either end of the spectrum, Louisiana had the highest average per-beneficiary Medicare costs, at $11,932, and Hawaii had the lowest, at $6,971.

How does Medicaid provide financial assistance to Medicare beneficiaries in Missouri?

Many Medicare beneficiaries receive financial assistance through Medicaid with the cost of Medicare premiums and services Medicare doesn’t cover – such as long-term care.

Our guide to financial assistance for Medicare enrollees in Missouri includes overviews of these programs, including long-term care benefits, Medicare Savings Programs, and eligibility guidelines for assistance.

Helpful resources for Missouri Medicare beneficiaries and their caregivers

Need help with your Medicare application in Missouri, or have questions about Medicare eligibility in Missouri? These resources provide free assistance and information.

  • Contact CLAIM, the Missouri State Health Insurance Assistance Program that’s set up to help Missouri residents navigate various Medicare programs. Visit the CLAIM website or call 1-800-390-3330.
  • Use the Missouri’s Medigap Rate Shopper tool, which you can access on the Missouri Department of Insurance website, shows rate information for each Medigap insurer in the state, based on the plan selection, age, gender, tobacco use, and zip code.
  • Visit the Medicare Rights Center. This website provides helpful information geared to Medicare beneficiaries, caregivers, and professionals.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

 

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