Missouri had almost one million Medicare beneficiaries in 2010.
Medicare Advantage plans, sometimes called Part C Medicare, are offered through private insurance companies but must provide all the same benefits as original Medicare Parts A and B, except for hospice. By using a Medicare Advantage plan, you choose to follow the rules set by the company rather than the federal government regarding benefits, payments and deductibles, but you also generally receive more services than through original Medicare. MA plans change depending on the company and where you live. Most insurance companies in Missouri offer Medicare Advantage plans in three different ways.
Health Maintenance Organization Plans
Many of Missouri's MA plans are offered through a health maintenance organization. HMO policies require members to choose a primary care physician and then receive all health care and health care referrals through her. You cannot go outside of the network with the vast majority of HMO plans. If your regular doctor is not part of the network, you must choose another doctor. HMOs generally have lower out-of-pocket costs and co-payments than other plans. Since there are rules regarding how far a network can be from its customers, HMOs in Missouri are offered according to county. Medicare Advantage HMO plans available as of 2011 in Missouri include the Advantra Advantage, the Gold Advantage Option 1, the Ozark Health Plan, the Humana Gold Plus and AARP's MedicareComplete Plus.
Preferred Provider Organization Plans
Preferred provider organization (PPO) plans offer more choice than HMOs but may also cost more. PPOs also have a network of providers, but you may be allowed to go outside the network if you pay higher co-payments. Most PPOs also let you choose your own providers from the network without needing a referral from your primary care physician. The Care Improvement Plus Medicare Advantage plan is a PPO offered all across Missouri. Others include the Humana Choice, the Mercy Medicare Advantage Silver and the Advantra Freedom plan.
Private Fee-For-Service Plans
Private fee-for-service plans allow you to go to any doctor, hospital or health care provider who agrees to accept the payment terms of the plan. The benefits for PFFS plans can oftentimes be much more than other kinds of MA plans and include prescription drug coverage, diagnostic testing and health and wellness programs. PFFS plans do require co-payments, however. Medicare Advantage PFFS plans in Missouri are offered by United Healthcare, Humana and Anthem Blue Cross and Blue Shield.
Enrollment
You can only enroll in Medicare and Medicare Advantage during the annual open enrollment periods. The first comes at the end of the year, from Nov. 15 through Dec. 31. You are also allowed to change your coverage once during Jan. 1 through March 31. There is no need to enroll in more than one Medicare Advantage plan. You also can't use any of the standardized Medicare supplements, also called Medigap, with a Medicare Advantage plan. In Missouri, you can't enroll in Medicare Advantage if you use the state Medicaid program, MO Health Net. MO Health Net will not cooperate with Medicare Advantage unless you are also eligible to receive QMB or QMB Plus assistance.
