Medicare in Missouri: Plans and Coverage (2026)

Medicare in Missouri runs on federal rules, but Missourians also get free MO SHIP counseling and the state's 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 1.3 Medicare costs change every year, and the current figures are posted at medicare.gov. To reach a person, call 1-800-MEDICARE (1-800-633-4227), staffed 24 hours a day, 7 days a week except some federal holidays; TTY users call 1-877-486-2048.7 For free one-on-one help in Missouri, call MO SHIP at 1-800-390-3330.6

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 after 60 days in a row with no inpatient hospital or skilled nursing care. 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. Original Medicare doesn't cover routine dental, vision, or hearing.3,8

• 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 qualifying for a Special Enrollment Period or a Medicare Savings Program 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. Creditable drug coverage does not protect you here; that is the Part D test, not the Part B one.9

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.8

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. CMS also notes that some plans may help pay all or part of your Part B premium itself.3,8
• 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.8
• 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 of its own, and CMS names supplemental coverage as what bounds that spending: Medigap, Medicaid, employer, retiree, or union coverage.8

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 with the results, MO SHIP offers free assistance to help you choose a plan that best meets your needs.1

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).10
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 $34.50 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 with Original Medicare, and a Medigap policy can't pay a Medicare Advantage plan's copays, coinsurance, deductibles, or premiums.8

Missouri offers the federally standardized plans, labeled A-D, F, G, and K-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, 2020.11 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.12,3

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.12 Outside it, Missouri insurers may use medical underwriting and can review your health, charge more, or decline you. But Missouri regulation adds a protection on top of the federal guaranteed-issue situations: under the state's Medigap anniversary rule, a current Medigap policyholder can switch to the same plan letter with any insurer, with no underwriting, in the window that opens 30 days before their policy's annual anniversary date and closes 30 days after it. You have to already hold a Medigap policy to use this right, and the anniversary is your policy's own start date, not your birthday.5

For people who qualified for Medicare before age 65 through disability, federal law does not require companies to sell Medigap policies at all, so under-65 access turns on state rules.13 Ask the Missouri Department of Commerce and Insurance what a given insurer will actually write for you; MO SHIP's trained counselors can also answer questions about Medigap and supplemental insurance.1 If you're approaching 65, the federal six-month open enrollment window will be your guaranteed entry point.12

Medigap or Medicare Advantage?

You can't run both at once: a Medigap policy can't pay your Medicare Advantage copays, coinsurance, deductibles, or premiums, and while you're in an Advantage plan it's illegal for anyone to sell you one unless you're switching back to Original Medicare. 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. The choice isn't permanent, though. If this is your first Medicare Advantage plan and it doesn't suit you, federal law gives you a trial right to buy a Medigap policy and a separate drug plan as long as you return to Original Medicare within 12 months of joining; if you dropped a Medigap policy to join, you may be able to get that same policy back if the company still sells it, or another policy sold by a Missouri insurer if it doesn't. Wait past that window and in most cases you can't get the old policy back, and you may not be able to get any Medigap policy at all.8 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 MO HealthNet and uses its own state labels. QMB is the same as the federal program name and covers income under 100% of the Federal Poverty Level. SLMB1 is Missouri's label for the federal SLMB program, income under 120% FPL, and SLMB2, also called QI-1, is Missouri's label for the federal QI program, income under 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 federal resource standard is $9,950 for one person and $14,910 for a couple, and it binds counted resources, not everything your household has.2 That is not an absolute cutoff: states can disregard certain income and resources, so apply rather than rule yourself out if you are somewhat over. SLMB2, Missouri's label for QI, also has to be reapplied for every year.2 Watch which chart you are reading, because two sets of numbers circulate. MO HealthNet's own Appendix K prints the poverty-level figures themselves, $1,330 for one person and $1,804 for a couple at QMB, while the figures above are Social Security's, which add the $20 monthly general income exclusion to each. That $20 is already built into them, and Social Security tells its own staff to encourage people to apply even when income or resources look somewhat higher than the state limits.2 Enrolling in QMB, SLMB1, or SLMB2 automatically qualifies you for Extra Help with Part D.2 QDWI, the fourth Medicare Savings Program, is the exception: it pays the Part A premium for certain working people with disabilities who lost premium-free Part A, and it does not confer Extra Help, so a QDWI enrollee who wants Extra Help has to apply through Social Security.2,14

One Missouri-specific catch: SLMB1 enrollment happens automatically for eligible MO HealthNet participants, who may choose to close it, and there is a documented reason someone would. Once you become eligible for SLMB1, the Medicare premium is no longer an allowable deduction, and Missouri's manual warns this may cause an increase in spend down, or give a participant who had no spend down one. SLMB2, by contrast, is optional and can't be held alongside MO HealthNet coverage of any kind. SLMB2 pays your Part B premium; it is not a back door into Missouri Medicaid.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.14 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 couple, in the 48 contiguous states and DC (Alaska and Hawaii limits run higher)14
• Resource limits: $16,590 for an individual, $33,100 for a married couple; those limits rise to $18,090 and $36,100 if you tell Social Security you expect to use some of your resources for burial expenses14
• If you qualify for QMB, SLMB1, or SLMB2, you're enrolled in Extra Help automatically2

Apply through Social Security at ssa.gov or call 1-800-772-1213.14

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.15

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.15 If you're still working past 65 with group health coverage based on that current employment, you can delay Part B without penalty and use an eight-month Special Enrollment Period to sign up, counted from the month that job or coverage ends, whichever comes first; miss it and you wait for the General Enrollment Period (January 1 to March 31) and may owe a late penalty. COBRA and retiree coverage do not count as coverage based on current employment, and if you're self-employed or your plan isn't available to everyone at the company, ask your insurer whether it qualifies before you delay; if it doesn't, sign up at 65. This Special Enrollment Period does not apply if you're eligible for Medicare based on End-Stage Renal Disease (ESRD).16

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's State Health Insurance Assistance Program is Missouri SHIP, or MO SHIP. It has been Missouri's official SHIP since 1993 and is a nonprofit organization, not an insurance agency; its services are free, unbiased, and confidential, and it does not sell anything.1 Its counselors receive extensive training to become certified; some are paid staff at their agency and others are community volunteers.1

MO SHIP's trained counselors can answer questions about Medicare, Medicaid (MO HealthNet), Medicare Advantage, Part D drug plans, and Medigap, and can also help you:1

• Enroll in Medicare, or find out whether you qualify
• See if you qualify for programs that save money on Medicare-related expenses, including a low-income subsidy or the Medicare Savings Programs
• Sign up for a Part D drug plan, and check it for changes during Open Enrollment every year
• Understand and organize your healthcare bills and statements, and submit claims1

Call 1-800-390-3330 or visit missouriship.org: Contact Center staff take your name and question, and a counselor calls you back within days.6 If you come across the name Missouri CLAIM, that is the program's former name: it operated as Missouri CLAIM from 1993 to 2023, and the Missouri Department of Commerce and Insurance announced the rebrand to Missouri SHIP in July 2023.1

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.