Medicare Advantage Plans in Mississippi
Fact checked Contributing expert: Roseann Birch; Reviewed by: Leron Moore - Published: January 29, 2021
Medicare Advantage (Part C) is an alternative to the federal government's Original Medicare program. Offered by private insurance companies, Medicare Advantage plans must cover the same hospital and medical services as Original Medicare. However, these plans often provide additional benefits, too. Many Medicare Advantage plans include prescription drug coverage (Part D), and some offer vision, hearing, and dental coverage. In addition, these plans may include coverage for a broad range of supplemental benefits, including nonmedical transportation, therapeutic massages, and home modifications.
- 1 In 2019, there were 26 Medicare Advantage plans available in Mississippi.
- 2 17% of the total Medicare population in Mississippi is enrolled in Medicare Advantage plans as of 2018.
- 3 In 2018, Original Medicare spent an average of $11,427 per beneficiary in Mississippi, which is 13% higher than the national average.
- 4 Available Medicare Advantage plans range from four to 28 across Mississippi’s 82 counties.
The wide variety of Medicare Advantage plans in Mississippi allows seniors and other Medicare-eligible individuals to choose a plan that best meets their needs. All Medicare Advantage plans offer the same basic services as Original Medicare, while additional benefits vary from one plan to another. Companies that offer Medicare Advantage plans may set rules about how members get services, such as requiring a referral to see a specialist. Out-of-pocket costs may also vary between plans.
Medicare Advantage Plans in Mississippi
Types of Medicare Advantage Plans
Mississippi’s Medicare Advantage program features several categories of plans, including Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-For-Service plans, and Special Needs Plans. These plan types may differ in their out-of-pocket costs and access to healthcare providers and facilities, and some have specific eligibility criteria. Since private insurance companies offer these plans, not all options are available in all areas. Seniors can visit Medicare.gov to find specific plans available in their ZIP code.
Health Maintenance Organizations (HMO)
HMO plans have a network of doctors, specialists, and other healthcare providers. Usually, plan members are required to stay within this network to receive coverage. Members who get care outside of the network may need to pay the full cost themselves. There are a few exceptions, such as emergency care and out-of-area dialysis. Some HMO plans have a point-of-service option and provide limited coverage for out-of-network providers. Members of HMO plans are generally required to choose a primary care physician who will manage their treatment and provide specialist referrals.
Preferred Provider Organizations (PPO)
PPO plans also have a network of doctors, hospitals, and healthcare providers, but these networks are less restrictive than HMOs. Plan members can receive care from out-of-network providers, but they’ll pay lower prices if they receive care from the plan’s list of preferred providers. Unlike HMO plans, PPO plans don’t require members to choose a primary care physician. Referrals aren’t generally necessary to see specialists, although members pay lower prices when using in-network specialists. These plans tend to cost more than HMOs.
Private Fee-For-Service Plans (PFFS)
PFFS plans offer more flexibility than other types of Medicare Advantage plans, but they tend to have higher premiums. Members can receive care from any Medicare-approved healthcare provider who accepts the plan’s payment terms. Some plans have a network of providers who’ve agreed to accept the terms, while others have no network. Plan members don’t need to choose a primary care physician or get a referral to see a specialist.
Special Needs Plans (SNP)
SNPs differ from other types of plans in that they limit membership to people with specific diseases or circumstances. The plan’s benefits and provider network are designed to meet the needs of this specific group. Seniors may be eligible to join an SNP if they require nursing home care, are eligible for both Medicare and Medicaid, or have a disabling condition, such as dementia or end-stage renal disease. Members usually need to choose a primary care physician, and the plan may use care coordinators to help members follow their doctor’s orders.
Enrollment & Eligibility for Medicare Advantage Plans in Mississippi
In Mississippi, Original Medicare is available to people aged 65 and older, as well as younger adults with qualifying disabilities. Medicare Advantage plans have a few additional eligibility requirements. To join one of these plans, enrollees must:
- Live within the plan’s service area
- Be enrolled in both Medicare Parts A and B
- Be a citizen of the United States or a permanent resident
- Not have Medigap insurance
Eligible Mississippi residents can sign up for a Medicare Advantage plan or make changes to their existing Medicare Advantage coverage at certain times during the year:
- Initial enrollment period: This seven-month period is for people who are newly eligible for Medicare coverage. This period starts three months before the month an enrollee turns 65, includes their birthday month, and ends three months later. For those who are eligible due to a disability, the seven-month period starts three months before their 25th month of receiving Social Security disability benefits.
- Open enrollment period: Also called the annual election period, the open enrollment period occurs from October 15th to December 7th. At this time, people with Original Medicare can switch to a Medicare Advantage plan, and current Medicare Advantage members can change plans. Any changes made during this period take effect on January 1st of the following year.
- Medicare Advantage open enrollment Period: This annual period is limited to current Medicare Advantage members. Between January 1st and March 31st, they can switch to another Medicare Advantage plan or go back to Original Medicare. Their new coverage will take effect on the first of the month after the insurer receives the request.
- General enrollment period: Seniors who have Medicare Part A coverage can get Part B during the general enrollment period, which occurs from January 1st to March 31st every year. Those who enroll in Part B at this time can sign up for a Medicare Advantage plan between April 1st and June 30th. Their Medicare Advantage coverage will start on July 1st.
- Special enrollment periods: People who experience certain life events can sign up for a Medicare Advantage plan outside of the standard enrollment periods. These qualifying events include losing health coverage provided by an employer, moving back to the United States after living abroad or moving into a skilled nursing facility.
Prescription Drug Coverage
Prescription drug coverage (Medicare Part D) is an optional benefit available to all Medicare beneficiaries. Many Medicare Advantage plans include this coverage; they’re called Medicare Advantage Prescription Drug plans (MA-PD). Some Medicare Advantage plans don’t include drug coverage. Since members aren’t usually permitted to buy a stand-alone Part D plan, those who want drug coverage generally need to join an MA-PD plan.
Each Medicare Advantage plan has its own list of covered prescription drugs, but they must include at least two different drugs from each commonly prescribed category. Members who use drugs that aren’t on the plan’s list may need to pay full price.
Medicare Advantage Resources in Mississippi
Mississippi’s Medicare Advantage program is complex, and first-time enrollees may need some help understanding their options. Seniors who want to switch to a new Medicare Advantage plan may also require assistance evaluating plans. The state has many resources to help beneficiaries access Medicare plans that suit their needs, including nonprofit organizations and legal aid providers.
Central Mississippi Planning & Development District
As the Area Agency on Aging for several counties in the region, the Central Mississippi Planning & Development District provides many services for people aged 60 and older. It works with the State Health Insurance Assistance Program (SHIP), a counseling program that helps seniors navigate Medicare. SHIP volunteers are trained to help seniors understand Medicare benefits and evaluate Medicare Advantage options. The AAA also provides civil legal assistance, and cases may involve Medicare.
Contact Information: Website | (601) 981-1516
Mississippi Center for Legal Services
The Mississippi Center for Legal Services is a legal aid provider serving 43 counties throughout the state. The Center provides free civil legal help to low-income people, ranging from brief advice to full legal representation. Seniors and younger adults with disabilities can contact the firm for help with Medicare issues. It can also assist with cases related to Medicaid, Social Security Disability Insurance, and Supplemental Security Income. To apply for legal aid, seniors can call the firm’s statewide number. Seniors who don’t qualify for legal assistance can access free information and legal forms at MSLegalServices.org.
Contact Information: Website | (800) 498-1804
Mississippi Insurance Department
The Mississippi Insurance Department provides information and assistance about a wide variety of insurance matters, including health insurance. The department offers Medicare and health insurance counseling to help seniors understand their options. It also provides free Medicare information on its website, such as questions to ask when shopping for insurance and tips for avoiding Medicare Advantage scams.
Contact Information: Website | (601) 359-3569
- Sources [-]
https://www.cms.gov/Outreach-and-Education/Look-Up-Topics/Medicare/New-Medicare-Benefits.pdf Last accessed April 2021
https://www.medicare.gov/sign-up-change-plans/types-of-medicare-health-plans/special-needs-plans-snp Last accessed April 2021
https://www.medicare.gov/sign-up-change-plans/joining-a-health-or-drug-plan Last accessed April 2021
Roseann Birch, Medicare Consultant
With experience in the insurance field since 1986, Roseann Birch is a seasoned Medicare consultant who is passionate in educating and guiding seniors through their Medicare and Medicare Advantage journey.
Leron Moore, Medicare Consultant
With over 10 years of experience in the Medicare industry, Leron Moore has dedicated his career to effecting change, educating, informing, and resolving issues for Medicare patients and their families.