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Posted 04/26/2023 in Medicare Advantage

Medicare in St. Louis, MO


Medicare in St. Louis, MO

This article was reviewed for accuracy by Dave Adams from  https://SimplySeniorSolutions.com.


Medicare in St. Louis, MO

It's no secret that Medicare in St. Louis, MO, can be tricky. But with our help, you'll be able to navigate the system like a pro! 


What is Medicare?

Medicare is a federal health insurance program founded in 1965. The Federal Government designed the plan to provide medical coverage for people 65 years or older, certain younger people with disabilities, and those with End-Stage Renal Disease (ESRD). 


Medicare has four parts: 

1. Part A covers inpatient hospital stays; 

2. Part B covers doctor visits and other outpatient care; 

3. Part C is private health insurance that covers everything in Parts A and B plus extras like prescription drugs, and 

4. Part D is stand-alone prescription drug coverage. You can get Parts A and B, sometimes called original Medicare. Or you can choose to get A, B, and D through a private company that contracts with CMS (Center for Medicare and Medicaid Services), known as a "Medicare Advantage" plan.


If you have Original Medicare, you can add a supplemental insurance policy to help pay for deductibles, coinsurance, and copayments of Original Medicare. If you want prescription drug coverage, you'll need to join a stand-alone Prescription Drug Plan (PDP) or get it through a Medicare Advantage Plan that offers drug coverage.


"Medicare Advantage Plans" come in 4 different types: Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for-Service Plans (PFFSs), and Special Needs Plans (SNPs). 


What are the benefits of Medicare?

There are many benefits of Medicare, a health insurance program for people 65 and older or those under 65 with specific disabilities. Medicare provides coverage for hospitalization, doctor visits, prescription drugs, and other health care needs. Medicare Advantage plans, which are private health insurance plans that contract with Medicare to provide coverage to beneficiaries, may offer additional benefits such as dental and vision coverage.


How do I enroll in Medicare?

There are numerous ways to enroll in Medicare. One way is to sign up online at https://www.ssa.gov/benefits/medicare.

Another is to call Social Security at 800-772-1213.

Or you can go to your local Social Security office (you might want to make an appointment, though!)


If you have any questions about enrolling in Medicare, your state insurance department may be able to help. You can find your state's insurance department contact information at https://content.naic.org/state-insurance-departments.


Anniversary Rules for Medicare Supplement Plans in Missouri:

In Missouri, you have the right to change insurance companies every year for 30 days before or after the anniversary of your policy (the date your policy first began). 


Suppose you switch to the plan with the same letter, from Plan F with company XYZ to Plan F with insurance company ABC. In this case, the new insurer cannot deny you insurance coverage or impose a waiting period depending on existing conditions.


 If you switch to a plan with fewer benefits, such as from Plan F to Plan C, you may or may not qualify for coverage if the insurance company takes your health into account. Not all insurers allow you to switch to a rate with fewer benefits. 


If you opt for a more comprehensive plan (with more benefits), you will likely be subject to underwriting, and you could be denied coverage. Or the insurance company could set a waiting period for your new plan's new benefits due to a pre-existing medical condition. 


Once you have received the new policy and are sure that it meets your needs, you should cancel the old one. 


By taking advantage of this anniversary rule, you can compare the premiums of Supplement plans annually.


Source: https://insurance.mo.gov/seniors/documents/2019MedigapBook.pdf (Page: 8)


What are the costs of Medicare?

Original Medicare has two parts: 

Part A (hospital insurance) and Part B (medical insurance). You'll generally get Part A for free if you qualify for Social Security. 

The standard Part B premium in 2023 is $164.90, which you must pay monthly. Most people who get Social Security pay the standard premium amount, but if you are high-income, you may pay more.


How do I use my Medicare coverage?

There are a few ways that you can use your Medicare coverage in St. Louis, Missouri. You can use it to see a doctor (Part B), get a prescription (Part D), or go to the hospital (Part A). You can also use it for preventive care, like vaccines or screenings.

Medicare plans can be pretty confusing to understand. If you live in St. Louis, Mo, and are ready to sign up for Medicare, use the Certified Medicare Agents Directory. to find a qualified agent or broker who can help! 


Our licensed Medicare agent Members will help you make your insurance plan decision as easy as possible.


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