Medicare in Missouri: Plans and Coverage (2026)

Medicare in Missouri runs on federal rules, but the state adds free MO SHIP counseling and its own SLMB1/SLMB2 labels for cost-saving programs.1,2

This guide covers Medicare in Missouri for 2026: what each part costs, which plan types are available, and how to get help paying. Plan selection also varies widely between the Kansas City and St. Louis metros and rural parts of the state.

In This Guide

• Key Takeaways
• Original Medicare: Parts A and B
• Medicare Advantage in Missouri (Part C)
• Medicare Part D: Prescription Drugs
• Medigap in Missouri
• Help Paying for Medicare in Missouri
• Medicare Enrollment Periods
• Free Medicare Help: MO SHIP
• Frequently Asked Questions

About these numbers: The premiums and deductibles below come from CMS for calendar year 2026, effective January 1. Medicare costs change every year. For the most current figures, contact Medicare at 1-800-633-4227 (1-800-MEDICARE) or MO SHIP at 1-800-390-3330.

Original Medicare in Missouri: Parts A and B

Original Medicare is run directly by the federal government and comes in two parts. The mechanics and costs are the same in Missouri as in every other state.

Part A (Hospital Insurance)

Part A covers inpatient hospital stays, limited skilled nursing facility care, hospice, and some home health care.3

The hospital deductible rose $60 from 2025, to $1,736 per benefit period.3 A benefit period starts the day you're admitted and ends 60 days after you leave. Get readmitted after that gap, and the deductible applies again.

Part B (Medical Insurance)

Part B covers doctor visits, outpatient care, preventive services, durable medical equipment, and mental health care. It doesn't cover routine dental, vision, or hearing.3

• Monthly premium: $202.90 (higher if your 2024 income was above $109,000 single or $218,000 married, under the income-related adjustment)3
• Annual deductible: $2833
• After the deductible: you pay 20% of the Medicare-approved amount for most services3

Part B is technically optional, but nearly everyone signs up. Miss your enrollment window without other creditable coverage and you'll owe a late penalty of 10% for every 12 months you could have had it, for as long as you keep Part B.6

Medicare Advantage in Missouri (Part C)

Medicare Advantage plans are an alternative to Original Medicare, sold by private insurers. They cover everything Parts A and B do, except hospice, which Original Medicare keeps covering. Most bundle in Part D drug coverage along with extras like dental, vision, and hearing.7

In Missouri, plan availability varies significantly by location. The Kansas City and St. Louis metro areas have wider selection across more insurers, while residents in rural parts of the state typically see fewer options. Plan networks and pricing differ by county, so compare what's actually available at your address before you decide.

How These Plans Work

• You keep paying your Part B premium ($202.90) on top of any plan premium. CMS estimates the average Medicare Advantage premium at about $14 a month in 2026, and many plans charge $0 extra.3,7
• Plans run on networks (HMO or PPO). Confirm your doctors and hospitals are in-network before you enroll.
• Plans usually require prior authorization for certain services, which Original Medicare generally does not.7
• Every plan caps your annual in-network out-of-pocket spending (federally limited to $9,250 in 2026; many plans set it lower). Original Medicare has no such cap.7

Use the Medicare Plan Finder at medicare.gov to compare plans by ZIP code. Enter your doctors and prescriptions and it shows which plans cover them and your estimated cost. If you want help reading the results, a MO SHIP counselor will go through them with you at no charge.

Medicare Part D: Prescription Drugs

Part D covers outpatient prescription drugs. You can get it as a standalone plan paired with Original Medicare, or built into a Medicare Advantage plan.

The Inflation Reduction Act eliminated the coverage gap, the donut hole, so that higher-cost middle stage is gone.4 Part D now moves through three phases:

1. Deductible: you pay full price until you meet your plan's deductible (up to $615 in 2026).8
2. Initial coverage: you pay copays or coinsurance while your plan and drug makers cover the rest.
3. Catastrophic: once your out-of-pocket spending reaches $2,100, you pay $0 for covered drugs the rest of the year.4

That $2,100 cap is the number that matters most in Part D. It was $2,000 in 2025 and rises with drug-spending growth. The average standalone Part D premium for 2026 is about $40 to $50 a month, though actual plan premiums vary widely.3 Every plan must also offer the Medicare Prescription Payment Plan, which lets you spread your out-of-pocket drug costs into capped monthly payments across the year instead of paying in full at the pharmacy.4 People who qualify for Extra Help often pay much less, sometimes nothing.

For a deeper look at how Part D works, see our guide to Medicare Part D drug coverage.

Medigap in Missouri

Medigap policies are sold by private insurers to fill the gaps in Original Medicare: the deductibles, coinsurance, and copays. They work only with Original Medicare, never with Medicare Advantage.

Missouri offers the federally standardized plans, labeled A through N, including high-deductible Plan F and Plan G. Plans C and F are closed to anyone who first became Medicare-eligible on or after January 1, 2020.9 Plan G is the popular choice for people newly eligible: it covers the Part A deductible, Part A and Part B coinsurance, and skilled nursing coinsurance, leaving only the $283 Part B deductible on you.9,3

Your first window is the federal Medigap Open Enrollment Period, the six months that begin when you're 65 and enrolled in Part B. During that window an insurer must sell you any plan at the standard rate regardless of your health.9 Outside it, Missouri insurers may use medical underwriting and can review your health, charge more, or decline you. But Missouri adds one protection no other state has: under the state's Medigap anniversary rule, a current Medigap policyholder can switch to the same plan letter with any insurer, with no underwriting, within 30 days of their policy's annual anniversary date.5

For people who qualified for Medicare before age 65 through disability, there is no state-guaranteed access to Medigap in Missouri. Insurers may voluntarily offer coverage, but they aren't required to. If you're approaching 65, the federal six-month open enrollment window will be your guaranteed entry point.9

Medigap or Medicare Advantage?

You can't hold both. Choose Medigap and you stay on Original Medicare with the freedom to see any provider who takes Medicare nationwide, at a higher monthly premium. Choose Medicare Advantage and you trade some of that flexibility for a network and a lower upfront cost. For a side-by-side look at the trade-off, see our guide to Original Medicare vs. Medicare Advantage.

Help Paying for Medicare in Missouri

If you're on a fixed income, two programs can cut your Medicare costs sharply.

Medicare Savings Programs (QMB, SLMB1, SLMB2)

Missouri administers its Medicare Savings Programs through the Missouri Department of Social Services (myDSS) and uses its own state labels. QMB is the same as the federal program name. SLMB1 is Missouri's label for the federal SLMB program (100-120% FPL), and SLMB2 is Missouri's label for the federal QI program (120-135% FPL).2

QMB is the most generous, covering your Part B premium plus your deductibles and coinsurance. Federal law bars providers from billing a QMB enrollee for that cost-sharing.2 For all three programs the 2026 resource limit is $9,950 for one person and $14,910 for a couple.2 Income figures are tied to the Federal Poverty Level and update each April. You apply through mydss.mo.gov, and enrolling in any of these programs automatically qualifies you for Extra Help with Part D.2

Extra Help for Part D

Extra Help, also called the Low-Income Subsidy, pays Part D premiums, deductibles, and copays for people with limited income and resources.10 Since 2024 the partial-subsidy tier is gone, so everyone who qualifies now gets the full subsidy.

• Income limit (2026): up to about $1,995 a month for an individual, $2,705 for a couple10
• Resource limits: $16,590 for an individual, $33,100 for a married couple10
• If you qualify for QMB, SLMB1, or SLMB2, you're enrolled in Extra Help automatically

Apply through Social Security at ssa.gov or call 1-800-772-1213.10

Medicare Enrollment Periods in Missouri

Miss a deadline and you can face coverage gaps or permanent penalties. These dates are federal and the same in Missouri as everywhere else.11

Changes you make during Annual Open Enrollment take effect the following January 1. If you're already getting Social Security before 65, you're enrolled in Parts A and B automatically; if not, you sign up yourself through the Social Security Administration.11 If you're still working past 65 with coverage from a current employer, you can delay Part B without penalty and use an eight-month Special Enrollment Period to sign up after that job or coverage ends; miss it and you wait for the General Enrollment Period (January 1 to March 31) and may owe a late penalty.12

For a full breakdown of how each period works and the late-enrollment penalties to avoid, see our Medicare enrollment periods guide.

Free Medicare Help: MO SHIP

You don't have to sort through this alone, and you don't have to pay a broker. Missouri runs the State Health Insurance Assistance Program under the name MO SHIP. Counselors are trained volunteers who give free, unbiased help and don't sell insurance.1

A MO SHIP counselor can help you:

• Understand your Medicare options and what each part covers
• Compare Medicare Advantage, Part D, and Medigap plans side by side
• Apply for the QMB, SLMB1, and SLMB2 Medicare Savings Programs and Extra Help
• Sort out claims, coverage questions, and appeals

Call the statewide line at 1-800-390-3330 or visit missouriship.org to find local help.1

Key Missouri Medicare Contacts

Learn More

Find personalized help comparing your Medicare plan options in Missouri at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.