Medicare Plans
Medicare Advantage (Part C) in St. Louis, MO
With a Medicare Advantage plan, a private company approved by Medicare pays your claims in place of Original Medicare. You're still on Medicare. The plan just runs your hospital, doctor and usually your drug coverage under a single card.
You get a lower premium in exchange for copays and a network. In St. Louis, the network is the whole question. The metro has BJC, Mercy, SSM Health and St. Luke's, and a plan that works for a Mercy patient in Creve Coeur may not work for someone who sees doctors at Barnes-Jewish.
- Lower or $0 monthly plan premium
- Yearly cap on your out-of-pocket costs
- Drug coverage usually built in
- Extras like dental, vision and hearing
Check the network first, then the premium
Send us the doctors and hospital you want to keep. A licensed insurance agent checks them against the Advantage plans we represent in your St. Louis ZIP code and calls you back during business hours, including with the plans that won't work for you.
What to expect
Free review- A licensed agent calls you back during business hours, Mon-Fri, 8:30am-5:30pm CT
- Your doctors and prescriptions get checked before any plan is suggested
- No fee for our help, and your premium is the same either way
- No obligation to enroll, and no pressure if you'd rather stay put
Reviewed by the licensed insurance agents at St. Louis Senior Insurance. Last reviewed: October 2026. Office hours: Mon-Fri, 8:30am-5:30pm CT.
Thanks, we have your request.
A licensed agent will call you during business hours, Mon-Fri, 8:30am-5:30pm CT. If you'd rather not wait, call 314-463-5815 now.
Plan types
HMO or PPO: you feel the difference when you need a specialist
| HMO | PPO | |
|---|---|---|
| Monthly premium | Usually lowest, often $0 | A bit higher |
| Out-of-network care | Emergencies only | Covered, but you pay more |
| Referrals | Usually needed for specialists | Usually not needed |
| Good fit for | People who get all their care in one St. Louis system | People who use more than one system or travel |
Look at the network before the premium
Not every plan contracts with every St. Louis hospital system, and contracts can change at renewal. We check your doctors, your hospital and your pharmacy against this year's directory before you sign anything.
Costs
What you pay with a Part C plan
Your Part B premium still goes to Medicare. For most people that's $202.90 a month in 2026. The Advantage plan may add its own premium, from $0 to a modest amount, and then you pay copays as you use care: a set amount to see your family doctor, a higher one for a specialist, and more for outpatient surgery or a hospital stay.
The safety net is the yearly out-of-pocket maximum. Once you reach it, the plan pays for covered in-network care for the rest of the year. Original Medicare by itself has no cap like that, which is why people who don't buy a Medigap plan often go with Advantage. To weigh the two, read Advantage vs. Medigap in St. Louis.
- Your monthly Part B premium doesn't go away
- Flat copays take the place of most coinsurance
- The out-of-pocket maximum caps a rough year
- Networks, benefits and drug lists can change every January 1
Extras
Sizing up the extra benefits
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Dental, vision and hearing
These allowances differ a lot. A large dollar figure in an ad may only apply to certain services, so ask what a cleaning and a crown are each worth. -
Drug coverage included
Most Advantage plans include Part D. Run your exact prescriptions through the plan's drug list, since the tier a drug lands on matters more than the premium. See Part D drug plans. -
Fitness, rides and OTC cards
Gym memberships, over-the-counter allowances and rides to appointments are common. They help if you'll really use them.
Timing
When you can join or switch
Most people sign up during their Initial Enrollment Period when they're turning 65, or during the Annual Open Enrollment Period from October 15 to December 7. If you're already in an Advantage plan, the Medicare Advantage Open Enrollment Period from January 1 to March 31 gives you one more change.
A move, the end of employer coverage or qualifying for Extra Help can open a Special Enrollment Period at other times of year. Already in a plan you don't like? Start with switching your plan.
Prior authorization
The approval step you don't have with Original Medicare
Many Advantage plans want to approve higher-cost care before they pay for it. That often includes MRI and CT scans, outpatient surgery, a skilled nursing stay after the hospital, home health, medical equipment and some specialist visits. Your doctor sends the request, the plan says yes or no, and the care waits for that answer.
Most requests get approved. Timelines differ by plan, though, and you can appeal a denial, first to the plan and then to an outside reviewer. If you get a denial, we can help you work through the appeal.
Original Medicare with a Medigap plan has very little prior authorization. If that matters more to you than a low premium, tell us at the start. It changes what we'd suggest.
Our process
How we check a St. Louis provider network
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1
You give us your list
Your family doctor, each specialist, the hospital you'd want and your pharmacy. Names and office locations are plenty.
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2
We look at this year's directory
We check every Advantage plan we represent against your list for the coming plan year, not last year's.
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3
We call the office if it's unclear
Plan directories get things wrong. Sometimes a quick call to the front desk is the only way to know for sure.
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4
You get a plain answer
Which of our plans keep all of your providers, which keep some, and what the gaps would cost.
We do not offer every plan available in your area
Our check covers the companies we represent. For details on every plan sold in the St. Louis area, contact Medicare.gov, 1-800-MEDICARE, or Missouri SHIP at 800-390-3330.
Local networks
Advantage networks around St. Louis
St. Louis Advantage networks are built around four hospital groups. BJC has Barnes-Jewish Hospital in the Central West End, Missouri Baptist Medical Center in Town and Country, Christian Hospital in North County and Barnes-Jewish St. Peters in St. Charles County. Mercy has Mercy Hospital St. Louis in Creve Coeur and Mercy Hospital South. SSM Health has Saint Louis University Hospital, DePaul in Bridgeton, St. Clare in Fenton and St. Joseph in St. Charles. St. Luke's Hospital in Chesterfield is independent. Veterans may also use the John Cochran or Jefferson Barracks VA medical centers.
The plans on sale also aren't the same everywhere. A plan offered in St. Louis County may not be sold in St. Charles County, or the reverse, so we always start with your ZIP code. See all the places we help on our service areas page, or go back to the St. Louis Medicare overview.
Fit
When Advantage works well, and when it doesn't
It usually fits if you
- Already get your care inside one St. Louis hospital system
- Want a low or $0 plan premium
- Like having a firm cap on a bad year
- Will use the dental, vision, hearing or fitness extras
- Don't mind copays and the occasional referral
It usually doesn't fit if you
- See doctors at more than one system, like BJC and Mercy
- Have several specialists and want steady, flat bills
- Are in the middle of treatment and can't risk a network change
- Don't want approvals holding up your care
- Spend months each year out of state
Before you sign
What to ask about any Advantage plan
Will all of my doctors be in network next year?
What is the yearly out-of-pocket maximum, in dollars?
What do I pay for a specialist, an outpatient surgery and a hospital stay?
Do any of my drugs need prior authorization or step therapy?
How far will the dental allowance go for the work I need?
How do I get out of this plan if it doesn't work?
Want your doctors checked against our plans?
Send us your doctors and prescriptions. We'll tell you which of the Advantage plans we represent keep them, at no cost to you.