Medicare in Mississippi

The nationally operated health insurance program, Medicare, is available for seniors aged 65 and above as well as people with certain disabilities. Mississippi has a population of almost three million, of which approximately 16.4% are seniors. In 2020, more than 472,000 individuals enrolled in Original Medicare and 136,000-plus people enrolled in Medicare Advantage in Mississippi. This means around 20.6% of the state’s population receives Medicare. Approximately 99% of Mississippi’s physicians accept Medicare. Mississippi spent roughly $11,000 on each Medicare beneficiary in 2019, with a total state spend of more than $5.2 billion.

Original Medicare has two parts: Part A and Part B. Part A includes inpatient hospital treatment, residential nursing home care expenses,hospice care, and some home health care. There’s no coverage cost for people, or their spouses, who paid Medicare taxes for a qualifying period. Those who don’t meet the tax requirements can pay for coverage. Part B covers outpatient services like medically necessary services and supplies, along with preventative health checks. Monthly premiums for Medicare Part B operate on a sliding scale, with a standard premium of $170.10 in 2022.

Individuals can also arrange personalized coverage through a private health insurance policy. Known as Medicare Advantage plans, or Part C, such plans provide the same basic coverage as Parts A and B (except for hospice care). Part C plans often include drug coverage (Part D) and may offer additional coverage, such as dental or vision care. 

Part D Medicare, of which Mississippi has more than 450,000 enrollees, allows individuals to add prescription medication coverage to Original Medicare and some other Medicare plans. Private insurance companies also offer supplemental plans, called Medigap, to help Original Medicare beneficiaries reduce their health care costs.

This guide provides information about Medicare in Mississippi, including plans available across the state. It also has resources to help people understand their Medicare and health insurance options.

Options for Medicare Coverage in Mississippi

The basic coverage under Original Medicare is adequate for many older adults. However, sometimes seniors need extra health care coverage. Fortunately, Mississippi’s aging population has several options regarding health insurance to ensure policies meet individual needs. Alongside the standard federal program, private insurance companies offer alternative plans or additional options for older adults.

Original Medicare (Parts A & B)

Original Medicare is administered by the Centers for Medicare & Medicaid Services (CMS) and is open to seniors aged 65 and over, along with those under 65 years old, but with certain disabilities or end-stage kidney disease. It includes two parts. Part A covers inpatient hospital care, nursing home and skilled nursing care, hospice and home health care. Part B, or medical coverage, pays for medically necessary goods and services such as durable medical equipment, mental health services and emergency medical transportation. 

Unlike most private Medicare plans, Original Medicare’s provider network isn’t limited to the beneficiary’s geographic region, making it easier to obtain services while traveling within the country. In most cases, Medicare doesn’t pay for health services the individual receives outside the United States. 

Under this program, seniors pay for services as they receive them. They must pay an annual deductible, which is $1,556 for Part A and $233 for Part B in 2022. After they’ve paid this amount, Medicare covers all eligible services at 80%. Beneficiaries pay the remaining 20% out of pocket.

Who Should Consider Original Medicare

Original Medicare may be a good option for those who:

• Travel frequently within the United States
• Don’t need extra benefits such as home-delivered meals and coverage for over-the-counter medication
• Want to choose their own prescription drug coverage

Medicare Advantage (Part C)

Provided by private insurance firms, Medicare Advantage plans, also known as Part C, offer tailored options for health insurance. Plans cover the same benefits as Original Medicare, except for hospice care, which Part A provides. Policies typically offer additional benefits, such as prescription drug coverage (Part D), telehealth services, transportation to medical appointments, hearing and sight checks, nonprescription medications and dental care. Additionally, plans might offer decreased premiums, deductibles and copay amounts. Many Part C plans have yearly limits on out-of-pocket costs, which may help seniors with their financial planning. Mississippi has more than 136,000 Medicare Advantage enrollees.

There are four main Medicare Advantage plans: Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Private Fee-for-Service Plans (PFFs) and Special Needs Plans (SNPs). Other plan types include Medicare Medical Savings Account Plans (MSAs) and HMO Point of Service Plans (HMOPOs). Costs and eligibility requirements vary between providers.

Who Should Consider Medicare Advantage

Part C Medicare plans may be appropriate for seniors who:

• Can’t meet their health needs through Original Medicare
• Are generally healthy and would benefit from decreased premiums
• Want greater predictability concerning personal medical expenses
• Are comfortable receiving managed care

The Top 10 Medicare Advantage Plans in Mississippi 

The following table details the top Medicare Advantage plans in Mississippi, showing the total number of enrollees and general costs each month per provider as of April 2022. The table also shows the types of plans available. There’s more information about Medicare Part C on the Medicare Advantage Plans in Mississippi page.

Medicare Prescription Drug Coverage (Part D)

Original Medicare doesn’t pay for most prescription drugs through Part A or B coverage. Instead, seniors purchase separate prescription drug policies, also called Part D coverage. Medicare contracts with private health insurance companies to provide this coverage. There are multiple plans to choose from with varying monthly premiums, which beneficiaries pay in addition to their Original Medicare premiums. While seniors don’t have to purchase prescription drug coverage when they’re first eligible for Medicare, not obtaining this coverage at this time may result in late enrollment penalties they pay for as long as they have Medicare if they enroll later.

Each prescription drug plan has its own formulary, or list of covered drugs. Formularies are typically split up into tiers. The tier a medication is in determines how much the insurance company pays and how much the beneficiary pays for it. Lower-level tiers are usually made up of generic and low-cost brand name drugs, while higher tiers are composed of more expensive brand name and specialty drugs. In most cases, the lower the tier, the lower the policyholder’s cost-sharing responsibility.

Who Should Consider Medicare Prescription Drug Coverage

Seniors who may benefit from prescription drug coverage include those who:

• Currently take prescription medication or expect to in the future
• Want to avoid late enrollment penalties
• Want to reduce out-of-pocket prescription drug expenses

Medicare Supplement Insurance (Medigap)

While Original Medicare provides coverage for many medical costs, seniors may still have significant out-of-pocket expenses. These may include copays, coinsurance and deductibles. Seniors may be able to reduce their cost-sharing obligations by purchasing a Medigap plan. These plans can only be used with Original Medicare. It’s illegal for private insurance companies to sell Medigap plans to those with Medicare Advantage plans.

For more information on Medigap plans, seniors can refer to the Best Medicare Supplement Companies of 2022 page.

Who Should Consider Medicare Supplement Insurance

Good candidates for Medigap may be those who:

• Have ongoing health issues and expenses
• Travel overseas often
• Want to access an expanded network of health care providers
• Expect to need health services not covered by Original Medicare

Medicare Resources in Mississippi

While understanding the many Medicare and health insurance options can feel overwhelming, Mississippi’s seniors can get help from several sources. Trained advisors offer one-on-one counseling, helping seniors understand various plans, benefits and costs to ensure they enroll in the best policy for their needs. As well as providing information about available plans, including Medicare Advantage and Medigap, advisors can perform eligibility checks and help individuals enroll for coverage.