Mississippi seniors who qualify for Medicare can enroll in a Medicare Advantage plan, also known as Medicare Part C. These alternative health insurance plans are approved by Medicare, and administered through private insurance companies. Because numerous health insurance companies offer these plans, their benefits, costs and rules can vary significantly. While all Medicare Advantage plans include hospital and medical coverage equal to Medicare Parts A and B, they also often include additional benefits such as vision, hearing and dental care. Some plans include prescription drug coverage, while others do not but give participants the option of enrolling in a separate Medicare Part D plan. Unlike Original Medicare coverage that’s the same for all beneficiaries, seniors can shop for a Medicare Advantage plan suited to their specific needs.
According to the Kaiser Family Foundation, Medicare Advantage plan participants comprise approximately 39% of Medicare enrollees. In Mississippi, however, only 22% of Medicare participants are enrolled in Medicare Advantage. This is lower than any other state in the southeast, with the neighboring states of Alabama and Louisiana participating at 45% and 41%, respectively. Throughout the United States, 10 states and territories have lower enrollment levels than in Mississippi, and overall, rates range from 1% in Alaska to 79% in Puerto Rico.
Below, we’ve compiled information about the different types of Medicare Advantage plans available in Mississippi, tips on how to enroll and potential perks and drawbacks of each plan type. While most Medicare Advantage plans available to seniors in Mississippi are Health Maintenance Organizations (HMOs), a small percentage of Mississippi residents may enroll through a Preferred Provider Organization (PPO), Private-Fee-For-Service (PFFS) or Special Needs Plan (SNP). With so many options, we know that understanding, shopping for and enrolling in a Medicare Advantage plan can be a confusing and daunting process. To help you access support to find the best Medicare Advantage plan for your needs, we also include a list of state and local resources offering additional information, counseling and guidance.
About Medicare Advantage Plans in Mississippi
Types of Medicare Advantage Plans
In Mississippi, seniors can choose between five distinct Medicare Advantage plan types. These include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-For-Service (PFFS), Special Needs Plans (SNPs) and Medical Savings Accounts (MSAs).
Health Maintenance Organization (HMO)
Health Maintenance Organization plans, or HMOs, consist of a network of preferred providers. Participants must typically stay within this network when receiving services, or risk paying up to the full cost of services if they use an out-of-network provider. Exceptions to this rule typically include emergency and urgent out-of-area care. These plans typically have an out-of-pocket maximum, meaning that if a senior were to incur costs up to that amount within a year, they would not be charged for services received for the remainder of the year. HMO plans usually require participants to select a primary care physician (PCP) whom they see for wellness checks and undiagnosed conditions. Participants generally also must receive a referral from their PCP before seeing a specialist.
Preferred Provider Organization (PPO)
Unlike HMOs, Preferred Provider Organization plans, or PPOs, often do not require participants to select a primary care doctor or receive a referral before visiting a specialist. Like HMOs, PPOs have a list of preferred providers, but PPO participants may choose to visit a preferred in-network provider at the lowest cost, or visit an out-of-network provider and pay more for services. PPO plans typically cost more than comparable HMO plans, but offer greater flexibility.
Private Fee-for-Service (PFFS)
Private Fee-For-Service (PFFS) plans may offer seniors even more flexibility in the health care providers and facilities they use. PFFS plans form agreements directly with providers regarding cost of services and how much enrollees pay. Many PFFSs have networks of providers that have agreed to the plan’s terms, but plan participants can visit any provider, even outside the network, that accepts the plan’s payment terms. Typically, these plans do not require a participant to designate a primary care provider or obtain a referral to see a specialist.
Special Needs Plans (SNPs)
Special Needs Plans (SNPs) are Medicare Advantage plans reserved for seniors who meet certain requirements. Specific plans may only be available to seniors with certain chronic conditions or illnesses, those who live in a nursing home or seniors receiving both Medicare and Medicaid. Each plan is available only to one designated group. Typically, seniors must visit providers included in the plan’s network to receive full coverage, choose a primary care physician and receive a referral to visit a specialist. Additionally, all SNPs are required to include prescription drug coverage.
Medical Savings Accounts (MSAs)
Medical Savings Account (MSA) plans consist of two parts: a high-deductible Medicare Advantage health insurance plan and a medical savings account. The plan deposits funds into the MSA that senior participants can use to pay for the full cost of services they receive up to the plan’s yearly deductible. Once they reach the deductible, the plan begins to cover the cost of services. MSA plans do not include prescription drug coverage, so participants who choose this option must enroll in a stand-alone Medicare Part D prescription drug plan.
Enrollment and Eligibility for Medicare Advantage in Mississippi
Prior to enrolling in Medicare Advantage, seniors must first be enrolled in Original Medicare. Anyone who is eligible for Medicare Parts A and B is also eligible to enroll in Medicare Advantage. However, certain Medicare Advantage plans, such as SNPs, may have additional eligibility requirements.
Medicare Advantage has specific enrollment periods. One can only join a Medicare Advantage plan during the following periods:
- Initial Coverage Election Period: This is the 7-month period during which everyone is eligible to enroll in a Medicare Advantage plan. The period spans from 3 months before the month of one’s 65th birthday to 3 months after one’s birthday month.
- Annual Election Period (AEP): Also referred to as the Open Enrollment Period, the AEP runs from October 15-December 7 each year. During this period, anyone can enroll in Medicare Advantage for the first time or change to a new plan.
- Medicare Advantage Open Enrollment Period: From January 1-March 31 each year, anyone who is already enrolled in Medicare Advantage can switch to a different plan, or disenroll and switch back to Original Medicare. This period is not open to anyone who is not currently enrolled in Medicare Advantage.
- General Enrollment Period: In some circumstances, one can join Medicare Advantage between April 1-June 30. This enrollment period only applies to those who enrolled in Medicare Part B for the first time during Medicare’s Open Enrollment Period (January 1-March 31).
Additionally, Medicare Advantage plan participants can change their plan outside of these enrollment periods under certain qualifying circumstances, such as moving to a new state.
Prescription Drug Coverage
Mississippi seniors can receive prescription drug coverage in a couple of ways, depending on the Medicare Advantage plan they choose. If enrolling in an HMO, PPO or PFFS plan, they can receive prescription drug coverage by choosing a bundled plan that combines health care services and prescription drug coverage. With these plans, a single monthly premium covers both coverage types. If seniors choose an HMO or PPO plan without prescription drug coverage, they cannot sign up for a separate Medicare Part D plan. To obtain prescription coverage, they must wait until the next enrollment period when they can switch to a bundled plan. Seniors enrolled in a PFFS or MSA plan may enroll in a separate Medicare Part D plan to receive prescription drug coverage and pay premiums for both plans. Those enrolled in an SNP automatically receive coverage for prescription drugs.
