Today I will share some insight about Medicare Advantage plans available in St. Louis, Missouri. Before we dive in, there a few definitions / details you should know that will be referenced through out this article. If you’re new to Medicare, please do not skip this first section. 🙂
Medicare Beneficiary – This is you.
Private Insurance Companies – These are the actual insurance companies offering the Medicare Advantage plans because these health insurance plans are administered by private companies approved by Medicare, not the actual Medicare system.
Original Medicare – This is Medicare Part A and Medicare Part B only and covers 80%, leaving you with 20% financial exposure that can be covered by either a Medicare Supplement or a Medicare Advantage Plan, those are you two choices for Medicare coverage plan options. Original Medicare is required in order to get an advantage plan or supplement, so this is the first thing you need to take care of.
Medicare Advantage Plans – Also known as Medicare Part c, these usually do not charge a monthly premium, but you will have copayments and coinsurance up to a maximum out of pocket cost which is detailed below. I like to think of these plans as “pay as you go” because it’s little to no cost unless you actually have to use your plan. If you have an advantage plan, you can’t have a supplement.
Medicare Supplement Plans – These plans always charge a monthly premium and based on the type of plan you choose (there are only 10) and the most common plans (N, F, and G) have minimal copays. I like to think of these plans as “pre pay” because you pay a fixed monthly premium regardless if you use the plan or not. If you have a supplement, you can’t have an advantage plan.
Medicare Part D (Prescription Drug Plan)– This is Part D of Medicare which covers your prescription drugs. Most advantage plans have part D included, but if you have a supplement, you’ll need to purchase a stand alone part D plan. All part D plans are listed in the back of your Medicare and You handbook that you receive in the mail every year.
Star Ratings – Each plan is issued a star rating of 1-5. There are 3 plans in Missouri that have the highest star rating. The three 5 star Medicare plans in Missouri are Essence, UnitedHealthCare, and Missouri Healthcare Advisors (institutional plan only).
Medicare Advantage Plans in St. Louis, Missouri
According to Medicare’s website, there are 58 available Medicare advantage plans in St. Louis from 14 different insurance companies. I’ve listed those below. You should also understand that not every insurance broker can offer all of these plans, these are simply the plans listed in the publicly available database from the federal Medicare program for all of St. Louis county.
Also, there are eligibility requirements for the different types of plans, so not everyone is eligible for the same type of plan.
Below are very two common areas we get questions about with all the plans.
- Copayments – Every plan has a different set of copayments and coinsurance for various items.
- Deductibles – All advantage plans cover the Part A and Part B deductible and some may charge a drug deductible.
Some include prescription drug plans and it’s important to remember that prescription drug coverage is a requirement to avoid a late penalty. Every drug plan includes a formulary which is a list of prescription drugs covered by that plan.
Is Medicare Advantage Available in Missouri?
Yes, these plans are available through out Missouri and are available by county. Every county can have completely different plans, so it’s important to review the details.
Below are the plans available in St. Louis county.
- Aetna Medicare
- American Health Advantage of Missouri (5-Star Plan in 2022)
- Anthem Blue Cross and Blue Shield
- Anthem HealthKeepers
- Essence Healthcare (5-Star Plan in 2022)
- Lasso Healthcare
- NHC Advantage
- Provider Partners Health Plans
- UnitedHealthcare (5-Star Plan in 2022)
- WellCare by Allwell
- WellFirst Health
Of these 58 plans, 3 are 5-Star plans, 17 are special needs plans, also knowns as SNP plans which are designed for individuals who meet special circumstances such as low income subsidy or chronic conditions such as diabetes and heart disease, or confined to a nursing home.
What are the two types of Medicare Advantage Plans?
The main two plans most people are used to hearing about are HMO and PPO, but there are actually additional types of plans available in some areas.
St. Louis has 6 types of plans that make up the 58 available.
- Health Maintenance Organization (HMO) – 29
- Health Maintenance Organization (HMO-POS) – 6
- Preferred Provider Organization (PPO) – 19
- Medicare Savings Account (MSA) – 2
- Private Fee-for-service (PFFS) – 2
- Regional PPO – 6
Important things to remember about the various plan types.
- HMO’s require a referral from your primary care doctor if you would like to see a specialist.
- HMO service areas are usually smaller.
- Out of pocket costs are usually less.
- PPOs do not require referrals.
- Service area is larger than HMO and include an out of network fee schedule.
- Out of pocket maximums are usually higher than HMOs.
Which company has the best Medicare Advantage plan?
There isn’t a best until you have had a chance to review the plans from perspective of how you will use them for your healthcare experience. This includes your current coverage needs, prescription coverage, health care providers such as primary care and any specialist, out of network providers, etc.
Once you have properly reviewed the details of the plans and compared based on what you need, you and your agent can determine what’s best for you.
What is the out of pocket maximum for Medicare Advantage plans for 2022?
Every plan has a different out of pocket maximum.
Below is the percentage of plans within the following range of out of pocket maximums.
- $0 – $1999 – 6%
- $2,000 – $2999 – 22%
- $3,000 – $3,999 – 25%
- $4,000 – $4,999 – 13.5%
- $5,000 – $5,999 – 6.7%
- $6,000 – $6,999 – 20%
- $7,000 – $7,999 – 6%
The rule of thumb to remember is the lower the maximum out of pocket, the more likely the plan is an HMO and will require referrals which is very important to some people. As you’ll notice 2/3 of all plans have out of pocket maximum of less than $5,000.
How can I apply for Medicare Advantage?
State law requires a licensed agent to complete an application for insurance. You have a few options.
- Talk to an independent insurance agent that is approved to sell Medicare Advantage plans.
- Talk to an insurance agent that works directly for a specific insurance company.
- Contact Medicare directly and work with an insurance agent employed by CMS.
Either of these options work, our suggestion is to work with an independent agent or directly with Medicare so the agent can compare all the available plans for you vs. only focusing on one specific plan.
How do I pick a Medicare Supplement Plan?
Here are the steps I suggest.
- Start with Plan G and Plan N. These are the two most common plans available for someone turning 65. Every single one of the 65 plans listed above offer a Plan N and a Plan G available in San Diego. And, every doctor that accepts Medicare will also accept these plans.
- Remember that every “like” plan is the same. This means that a Plan G from Mutual of Omaha offers identical benefits to a Cigna plan G, the only difference is the price. Yes, you read that correctly, every plan of the same type offers the exact same benefits, except the price you pay. You can easily pay much more for one plan G than another if you don’t take the time to shop. You really should take the time to shop the plans so you don’t over pay.
- Compare plans and enroll. I always suggest meeting with a licensed insurance agent. There are three ways you can do this and the only way to enroll is by working with someone licensed by the California department of insurance.
- Work with an independent broker that offers most of the available plans. I say most because brokers cannot offer all plans because some Medicare supplement plans are only available directly from insurance companies and brokers cannot distribute. Call our team today to schedule a time with a broker who represents many of the plans available in San Diego.
- Work with a fee only Medicare advisor that will walk you through all the plans and then connect you directly with someone who can enroll. There is a cost associated with this, but you are guaranteed to get unbiased advice as the fee only Medicare advisor doesn’t earn a commission for any specific plan. Go here to learn more about a fee only Medicare advisor.
- Contact the insurance company directly. You can always call an insurance company directly and if they have an internal licensed sales team they will transfer you there, or they will connect you with a licensed broker of their product.
Seven Things you need to know about Medigap plans.
According to CMS, there are 7 things you should know about Medigap plans.
- A Medigap policy is different from a Medicare Advantage Plan, and policies don’t cover prescription drugs. Medicare Advantage Plans bundle your Hospital (Part A), Medical (Part B), and usually drug coverage (Part D) into one plan. Most Medicare Advantage Plans also offer extra benefits that Medicare doesn’t cover, like vision, hearing, dental, and more.A Medigap policy helps lower your share of costs for approved Part A and Part B services when you have Original Medicare. If you want drug coverage, you can join a Drug Plan (Part D) in addition to buying a Medigap policy.
- Medigap only works with Original Medicare. Medicare pays its share of the approved service, and then your Medigap policy helps pay your share. You can’t get a Medigap policy if you have a Medicare Advantage Plan, unless you switch back to Original Medicare.
- You need both Medicare Part A and Part B to buy and keep a policy. This is the same as Medicare advantage.
- The best time to get a policy is during your Medigap Open Enrollment Period. It’s the six month period that starts the month you turn 65 and you first have both Medicare Part A and Part B. During this time, you can buy any Medigap policy sold in your state, even if you have health problems.If you’re under 65, you may not be able to buy a Medigap policy, or you may have to pay more.
- After your Medigap Open Enrollment Period ends, you may not be able to buy a policy. If you’re able to buy one or want to switch policies later, it may cost more.You may have Medigap protections, called guaranteed issue rights, in certain situations when insurance companies must offer you certain Medigap policies.
- There are 10 standardized plans. Each plan offers different levels for how much of your costs they’ll pay for. They’re named by letter, like Plan A, and Plan B. Not all plans are offered in every state.
- You’ll keep your policy, even if you have health problems, as long as you pay your Medigap policy and Part B premiums.