About the Health Plan

American Health Advantage of Missouri is a Health Maintenance Organization (HMO) contracted with Medicare. American Health Advantage of Missouri offers an Institutional Special Needs Plan specially designed for eligible Medicare beneficiaries living in one of our participating long-term care nursing homes. As a Member of American Health Advantage of Missouri, you receive not only the standard benefits offered by original Medicare, but the added attention and care that are so important to your health and well-being.

American Health Advantage of Missouri focuses on Members who meet institutional level of care criteria and live in a American Health Advantage of Missouri participating nursing home located in the following Missouri counties:

American Health Advantage of Missouri covers all medically-necessary and preventive services covered under Medicare Part A and Part B, and prescription drug coverage under Part D.

Plus, American Health Advantage of Missouri includes extra benefits including vision, routine foot care, preventive care, and In-Home/Out-of-Home Support Services. You pay nothing for these extra benefits! This is a brief list of benefits we cover and what you pay. It does not list every medical service or item covered or every limitation or exclusion. For a complete list of covered medical services or items, you may call American Health Advantage of Missouri Member Services at 1-844-228-7934, TTY 1-833-312-0046 and request the Evidence of Coverage.

• • Part D prescription drug coverage.
  • Vision, hearing, routine foot care, and preventive services and screenings.
  • Coordinated care and more personal attention.
  • Dedicated nurse practitioner as your trusted partner to manage your care and collaborate with your doctors, your family, and the nursing home staff.
  • Regular visits from your nurse practitioner to your residing nursing home to help avoid unnecessary and often unwanted trips to the hospital.
  • Your nurse practitioner can complete tests and treatments in the nursing home that are normally done in the hospital.
  • One point of contact for communication with you, your family, your doctors and nursing home staff.

How much is the monthly premium?

• • $36.30 American Health Advantage of Missouri [H4490-001] monthly plan premium.
  • $45 American Health Advantage of Missouri Premier [H4490-002] monthly plan premium.
  • $36.30 American Health Advantage of Missouri Choice [H4490-003] monthly plan premium.
  • Note: You must continue to pay your Medicare Part B premium (unless your Medicare Part B premium is paid for you by State Medicaid or another third party).

How much is the Parts A and B deductible?

• • $226 American Health Advantage of Missouri [H4490-001] deductible per year for covered Parts A and B medical services and items you receive from in-network providers.
  • No American Health Advantage of Missouri Premier [H4490-002] deductible per year for covered Parts A and B medical services and items you receive from in-network providers.
  • $226 American Health Advantage of Missouri Choice [H4490-003] deductible per year for covered Parts A and B medical services and items you receive from in-network providers.

How much is the Part D deductible?

• • $505 American Health Advantage of Missouri [H4490-001] deductible per year for Part D prescription drugs.
  • No American Health Advantage of Missouri Premier [H4490-002] deductible per year for Part D prescription drugs.
  • $505 American Health Advantage of Missouri Choice [H4490-003] deductible per year for Part D prescription drugs.

Is there any limit on how much I will pay for my covered services?

• • Yes. American Health Advantage of Missouri protects you by having yearly limits on your out-of-pocket costs for medical and hospital care.

Your yearly out-of-pocket limit(s):

• • $8,300 American Health Advantage of Missouri [H4490-001] limit on annual out-of-pocket costs for covered Parts A & B medical services and items you receive from in-network providers.
  • $3,650 American Health Advantage of Missouri Premier [H4490-002] limit on annual out-of-pocket costs for covered Parts A & B medical services and items you receive from in-network providers.
  • $8,300 American Health Advantage of Missouri Choice [H4490-003] limit on annual out-of-pocket costs for covered Parts A & B medical services and items you receive from in-network providers.
  • If you reach the limit on out-of-pocket costs, you keep getting covered Parts A & B medical services and items and we will pay the full cost for the rest of the year.
  • Please note that you will still need to pay your monthly Medicare Part B premium (unless your Medicare Part B premium is paid for you by State Medicaid or another third party), your monthly American Health Advantage of Missouri (HMO I-SNP) premium, Part D prescription drug deductibles and Part D prescription drug cost-sharing.

Is there a limit on how much the plan will pay?

• • Our plan has a coverage limit every year for certain in-network benefits. Contact us for the services that apply.