What are Medicare Advantage Plans and Can I Get One in Missouri?
The advantages of Medicare Advantage (MA) plans are found in what they can cover that Original Medicare cannot. Specifically, the MA plans available in Missouri can include minor healthcare benefits such as prescriptions, vision, hearing, dental, fitness, telehealth, and more. In contrast, Original Medicare only covers major medical healthcare services.
Many people love the extra benefits they get with their MA plan. However, before you jump in with both feet, take the time to fully understand the trade-offs. The extra benefits and perks are nice, but they come at a cost. Specifically, when you join a Medicare Advantage plan in Missouri you are agreeing to accept the plan's managed care health system. As an MA plan member, you agree to let the plan be a gatekeeper and fully control your access to doctors and other healthcare providers.
Original Medicare vs. Medicare Advantage
One way to better understand how different Original Medicare is from Medicare Advantage is to have a look at the pros and cons of each type of health insurance. So, let's do that.
Pros and Cons: Medicare vs. Missouri Medicare Advantage Plans
- When you have Original Medicare you are free to use any Medicare-approved doctor you choose. When you join a Medicare Advantage plan, your choices are limited to the plan's network of Missouri providers.
- If you travel frequently or you are a snowbird and winter or summer in another state, your Original Medicare coverage remains the same. It goes where you go. This is not true with Missouri Medicare Advantage plans, which are only required to cover you if you have a medical emergency.
- With OriginalMedicare there are no limits on your out-of-pocket costs. However, all Missouri Medicare Advantage plans have an annual maximum out-of-pocket (MOOP) limit. If you reach the MOOP spending limit on your copays and coinsurance, the plan picks up the tab for the remainder of the year.
- If you want prescription coverage and have Original Medicare you must purchase a Medicare Part D plan. However, most Medicare Advantage plans include a Missouri Medicare Part D plan. Just be aware that a stand-alone Part D plan gives you the best opportunity to get your most expensive prescriptions at the lowest cost.
- In the Medicare Advantage program, the government allows plans to set their own copays and coinsurance for each healthcare service offered. This makes comparing plans difficult, at best. However, in the Original Medicare system deductibles and coinsurance are fixed, making them predictable. Plus, you can get a Medigap plan to help pay these costs.
Medicare Advantage vs. Medigap
Most Missouri seniors just getting their Medicare benefits want to know which type of plan is better. We commonly see these three questions:
- Why are Medicare Advantage plans bad?
- What are the disadvantages of Medicare Advantage plans?
- Is it better to have Medicare Advantage or Medigap?
Let's take a minute or two to compare and contrast, shall we?
Why Missouri Medicare Advantage Plans are Bad
This is a myth. There's nothing wrong with Medicare Advantage plans. In fact, over 20 percent of all Medicare beneficiaries in Missouri choose Medicare Advantage.
What you really need to know is that these plans are not for everyone. Some people are better served with traditional Medicare and a Medicare supplement. The question is, which option is best for you?
MedicareWire advises people who have one or more serious chronic conditions to keep their Original Medicare, particularly if you have specialists treating you and you want to stay with them. Our opinion is that Medicare Advantage is an excellent option for those who qualify for both Medicare and Medicaid (dual eligible) and for extremely healthy, active seniors.
Similarly, traditional Medicare, plus Medicare supplement insurance, work best for people with chronic health conditions, as well as those who can afford a higher monthly premium. Most experts agree that this is the best health insurance seniors can get in Missouri.
Are There Disadvantages to Joining a Medicare Advantage Plan in Missouri?
As you have already read, both Medicare Advantage and traditional Medicare have their benefits. But the two types of coverage are like apples and oranges. However, if you remove the issue of doctor choice from the equation, the primary difference is when and how you pay.
With most Medicare Advantage plans you pay a little each month (the monthly premium) and a copay when you use medical services. With most Medigap plans you pay most of your costs upfront with your monthly premium. As a result, your costs are more predictable than they might be if you have Medicare Advantage and use a lot of healthcare services
Is it better to have Medicare Advantage in Missouri or Medigap?
- If you can afford Medigap Plan F or G, then keep your Original Medicare and add one of these supplements.
- If you are a healthy senior and have good health in your family heritage, Medigap Plan N will let you save money by sharing some costs when you see your doctor.
- If you are a healthy senior but you cannot afford a Medigap Plan F, G, or N, Medicare Advantage is a good choice.
- If you are turning age 65, have one or more chronic health conditions that require frequent doctor visits, and you do not qualify for both Medicare and Medicaid (dual eligible), the most Medigap coverage you can afford is the best option.
- If you qualify for both Medicare and Medicaid, regardless of your health condition, Medicare Advantage is your best option.
- If you have special needs (i.e., a full-time nursing home resident, diabetes, etc.) and an appropriate Medicare Advantage Special Needs Plan (SNP) is available, this is your best option.
Frequently Asked Questions About Missouri Medicare Advantage Plans
Medicare Advantage plans vary from County to County in Missouri. This is due to the local nature of healthcare provider networks. If you enter your zipcode into this tool it will show you all of your plan options and 5-star ratings.
More than 90% of all Medicare Advantage plans in Missouri include a Part D plan for prescriptions, but not all. However, coverage is different with each plan. It is very important to verify that a plan covers your most important medications before you join. You can do so using this tool.
While not for everyone, Medicare Advantage plans have their benefits. The best way to understand these plans is to evaluate your health and financial situation. Here is an article that will help you make the right choice.