Page Reviewed / Updated - May 22, 2020
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 34% of Medicare enrollees. In Mississippi, however, only 18% 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 39% and 36%, 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 71% 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.
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.
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:
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.
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.
The Mississippi State Health Insurance Program, or SHIP, is a statewide network of volunteers trained specifically to help seniors and their loved ones understand, enroll in and manage their health insurance options. SHIP volunteers are available to answer questions about Medicare eligibility, discuss Medicare Advantage plans and benefits, file appeals and more. Seniors can also contact SHIP for guidance on how to keep track of their medical bills, to discuss their eligibility for Medicaid and learn about options for long-term care.
To speak with a SHIP volunteer to learn more or request assistance, seniors can contact their local Area Agency on Aging.
The Mississippi Insurance Department is a state agency providing residents with access to a wealth of information and resources related to all types of insurance. Seniors can call the department to receive Medicare and Medicare Advantage plan counseling services. On the department website, seniors can access links to educational materials on topics including tips for avoiding Medicare fraud, Medicare prescription drug coverage, the state's Medicare Supplement Shoppers Guide and the official federal Medicare & You handbook. The Mississippi Insurance Department also helps seniors file complaints, learn about their long-term care insurance options and obtain resources regarding other types of insurance.
Seniors can contact the Mississippi Insurance Department by calling its statewide, toll-free consumers line at 800-562-2957, emailing a representative listed in its email directory or by visiting the department's office located on the 10th Floor of the Woolfolk State Office Building at 501 North West Street in Jackson.
The Mississippi Division of Medicaid helps eligible, low-income individuals and families obtain health care coverage through the state Medicaid program. Its three Medicare cost-sharing programs can assist Medicare-enrolled seniors in paying their out-of-pocket health care costs, such as premiums and coinsurance. These include the Qualified Medicare Beneficiaries (QMB), Specified Low-Income Medicare Beneficiary (SLMB) and Qualifying Individual (QI) programs. To participate in QMB, seniors must be eligible for Medicare Part A, and seniors must already have Medicare Part A to qualify for SLMB and QI. Additionally, applicants' monthly income may not be more than 100% of the federal poverty level to qualify for the QMB program, 120% for the SLMB and 135% for the QI program.
To learn more or apply for these programs, Mississippi seniors can call their Medicaid regional office. A list of regional office locations and phone numbers is provided on the Mississippi Division of Medicaid website. They can also apply online, or call the division's main switchboard at 601-359-6050.
Mississippi Senior Medicare Patrol protects seniors enrolled in Medicare plans within the state against scams and fraudulent practices. To do this, trained volunteers counsel and educate seniors on how to read their Medicare bills, statements and other documents, protect their identities and report errors and suspicious or fraudulent behaviors. They can also help seniors recognize deceptive or illegal marketing practices when shopping for Medicare Advantage plans. Because many volunteers are Medicare beneficiaries themselves, they serve as trustworthy, informed and unbiased supporters. Services are provided through one-on-one counseling, group presentations and via a telephone helpline.
To contact the Mississippi Senior Medicare Patrol, seniors can call 877-272-8720, email [email protected] or visit the regional headquarters located at 8440 Jefferson Highway, Suite 101, in Baton Rouge, LA.
Mississippi's Area Agencies on Aging are located throughout the state to provide seniors with information, assistance, referral programs and access to SHIP volunteers and other Medicare and health-related counseling services. To qualify for services, seniors must be aged 60 and older or disabled. Assessments are done to evaluate an individual's eligibility for certain services.
A list of Mississippi's Area Agencies on Aging, the counties each one serves and their contact information can be found on the Mississippi Department of Human Services website here.
Mississippi Access to Care Centers (MAC) are places seniors can visit to learn about and apply for Medicare benefits, shop for Medicare Advantage plans and receive referrals, counseling and information about long-term care. Seniors can receive this assistance by phone, in person at a center or through a home visit. The MAC website also includes information on a wide range of other programs and services for seniors. Assistance through MAC is not limited based on a senior's financial situation.
Seniors can call MAC at 844-822-4622. A list of MAC centers throughout Mississippi, including their locations and contact details, is available on the program's website.