8 Factors to Consider for Your Medicare Coverage in Missouri

Medicare is the federally funded health insurance program for Americans 65 years old and over and those with specific disabilities. Part A and Part B. Part A covers inpatient hospital services, while Part B covers medical expenses such as doctor visits and outpatient care.

As of 2023, patients should consider some important factors when shopping for a Medicare plan in Missouri. From enrollment periods to provider networks, understanding the options available can help patients make informed decisions about their healthcare coverage options in St. Louis and the surrounding areas.

Keep reading for some helpful tips, and if you’re still unsure what your best options are, then give STL Medicare Benefits a call – (314) 804-0931.

Enrollment Periods for Medicare Plans in Missouri:

One of the first factors to consider is when to enroll in Medicare. The initial enrollment period (IEP) is a seven-month window, beginning three months before the individual turns 65, including the birth month, and ending three months after the birth month. Individuals who fail to enroll during the initial enrollment period may face late penalties.

However, if a person decides not to enroll during their initial enrollment period, other enrollment periods exist. The general enrollment period (GEP) runs from January 1 to March 31 every year, and coverage begins on July 1 of the same year. Late enrollment penalties may apply to those who enroll during the GEP.

Suppose a person misses both the initial enrollment period and the general enrollment period. In that case, they can enroll during the annual enrollment period (AEP), which runs from October 15 to December 7 every year. Coverage begins on January 1 of the following year.

Medicare Advantage vs. Original Medicare:

One of the most significant decisions a person must make when enrolling in Medicare is choosing Original Medicare or Medicare Advantage. Original Medicare is the traditional fee-for-service program, while Medicare Advantage is an alternative to Original Medicare, offered by private insurance companies that contract with Medicare.

Original Medicare covers hospital services (Part A) and medical expenses (Part B). Individuals with Original Medicare also have the option to purchase additional coverage through Medicare Supplement plans (Medigap) to cover things like deductibles and coinsurance.

Medicare Advantage (Part C) combines Part A and Part B services and often includes additional benefits like prescription drug coverage, and vision, hearing, dental, and wellness programs. As a result, Medicare Advantage plans usually have lower out-of-pocket costs than Original Medicare, and may also include prescription drug coverage (Part D).

When choosing between Original Medicare and Medicare Advantage, it is essential to consider which one better meets an individual’s healthcare needs and budget.

Coverage and Costs:

Another crucial factor when shopping for Medicare plans is coverage and costs. Medicare Part A is usually free, but most people pay a monthly premium for Part B based on income. Out-of-pocket expenses such as copayments and deductibles can vary between Medicare plans.

Medicare Advantage plans often have lower monthly premiums but may have higher costs for specific services. Some services may require a copayment, while others may have an annual deductible.

It is also essential to consider whether providers accept the Medicare plan a patient is feeling. Original Medicare does not have a provider network, so individuals can see any provider participating in Medicare. On the other hand, Medicare Advantage plans often have a provider network, and individuals may have to see an in-network provider to receive coverage.

Prescription Drug Coverage:

Prescription drug coverage is another essential factor when shopping for Medicare plans. Original Medicare does not include prescription drug coverage, but individuals can enroll in a Part D prescription drug plan.

Medicare Advantage plans often include prescription drug coverage, but it is essential to check the plan’s drug formulary to ensure that it covers the medications a person needs.

Extra Benefits:

Medicare Advantage plans often offer extra benefits not included in Original Medicare. These can have dental, vision, hearing, and wellness programs. Therefore, it is essential to review a plan’s list of extra benefits and determine whether they are worth the additional cost.

Provider Networks:

As mentioned earlier, Medicare Advantage plans often have a provider network, and individuals may have to see an in-network provider to receive coverage. Therefore, it is important to ensure that the plan’s network includes healthcare providers a person wants to see. If a healthcare provider is not in the plan’s network, the individual may have to pay higher out-of-pocket costs or find another provider.

Plan Ratings:

When shopping for a Medicare plan, individuals should consider the plan’s rating from the Centers for Medicare and Medicaid Services (CMS). CMS rates Medicare Advantage, and Part D plans on a five-star scale. The star rating is based on member satisfaction, customer service, and quality of care. Considering a plan’s star rating is important, as higher-rated programs may provide better coverage, more extra benefits, and better customer service.

Seek Assistance:

Navigating the complex world of Medicare can be overwhelming. However, individuals can seek assistance from various sources, such as the State Health Insurance Assistance Program (SHIP), a non-profit organization that provides free, unbiased information and counseling on Medicare. Medicare.gov also offers resources, including a comparison tool to help individuals compare Medicare plans based on their specific needs.

In conclusion, when shopping for a Medicare plan in 2023, it is crucial to consider various factors such as enrollment periods, coverage and costs, prescription drug coverage, extra benefits, provider networks, plan ratings, and seeking assistance. If you’re in the greater St. Louis area or Missouri, you have some great resources to ensure you’re signing up for the right plan. Contact STL Medicare Benefits to have all your Medicare questions answered. It is essential to evaluate Medicare plans to ensure they meet an individual’s healthcare needs and budget. Understanding the various Medicare options available can help individuals make informed decisions about their healthcare coverage.