Medicare in Missouri

Missouri has strong consumer protections for Medigap coverage

At a glance: Medicare health insurance in Missouri

How many Missourians are enrolled in Medicare?

2020 Medicare enrollment dates1,230,528 Missouri residents were enrolled in Medicare as of October 2019. That’s a little more than than 20 percent of the state’s total population, compared with a little less than 19 percent of the United States population enrolled in Medicare.

82 percent of Missouri’s Medicare beneficiaries are eligible due to being 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.

Medicare Advantage in Missouri

32 percent of Missouri Medicare 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.

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. In some counties there are as few as nine plans available in 2020, while other counties have as many as 40 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.

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

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. 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 Part D and Medicare Advantage), 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 switch 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 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 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’s Medigap buying guide includes sample prices for each insurer, for under-65 and 65+ buyers.

New Medigap Rate Shopper Tool helps consumers compare plans

The state also created a user-friendly 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. Previously, the state had a tool that allowed enrollees to select an age closest to their own and see a listing of prices and contact information for each insurance company. The state put out a request for data from insurers in 2019, explaining how the new system would work and what information insurers would need to submit to the state.

Medicare Part D in Missouri

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.

As of late 2019, there were 533,818 Missouri Medicare beneficiaries with coverage under stand-alone Part D prescription drug plans. That’s about 43 percent of the state’s total Medicare beneficiaries, which is very much in line with the national average — about 42 percent of all Medicare beneficiaries nationwide are enrolled in stand-alone Part D plans. In Missouri, another 407,828 Medicare beneficiaries have Part D coverage integrated with their Medicare Advantage plans.

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

Medicare spending in Missouri

In 2017, Original Medicare spent an average of $9,832 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 $9,761 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 $11,542, and Hawaii had the lowest, at $6,690.

You can read more about Medicare in Missouri in our state Medicare guide. You can also contact CLAIM, the Missouri State Health Insurance Assistance Program that’s set up to help Missouri residents navigate the Medicare system.

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 Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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