Medicare in Mississippi

In most areas of the country, including all of Mississippi, Medicare beneficiaries have the option to get their healthcare coverage through Original Medicare (directly from the federal government) or from a private Medicare Advantage plan.

Plans include all the covered benefits of Original Medicare (hospital services and outpatient/physician services), although the out-of-pocket costs can be quite different, as Medicare Advantage plans set their own copays, deductibles, and coinsurance, within parameters established by CMS (the maximum out-of-pocket limit for in-network care under Advantage plans in 2023 is $8,300, but most Advantage plans set their out-of-pocket caps below the upper allowable limit).

Most Medicare Advantage plans also include Part D coverage for prescription drugs, although the aforementioned maximum out-of-pocket does not include the cost of prescription drugs. And most also include extra benefits such as dental and vision coverage. But Advantage plans tend to have limited localized provider networks, as opposed to Original Medicare’s nationwide network of providers. There are pros and cons to either option.

As of 2018, only 17% of Medicare beneficiaries in Mississippi had selected Medicare Advantage plans, compared with an average of 34% nationwide. The large majority of Mississippi Medicare beneficiaries had opted for Original Medicare instead.

By 2023, however, 38% of Mississippi Medicare beneficiaries were enrolled in Medicare Advantage plans, mirroring the nationwide trend towards increasing Medicare Advantage enrollment (nationwide, Advantage enrollment had grown to about 48% of all Medicare beneficiaries by 2023).

There are Medicare Advantage plans for sale in all 82 counties in Mississippi for 2023, although the number of available plans varies widely across the state: There are only nine plans available in Lowndes County, but residents in some counties can select from up as many as 53 different Medicare Advantage plans.

During the Medicare annual election period (October 15 to December 7), people with Medicare in Mississippi can switch between Medicare Advantage plans and Original Medicare (and can add or drop a Medicare Part D prescription plan), with their coverage changes effective January 1. People who are enrolled in Medicare Advantage plans also have the option to make coverage changes during the Medicare Advantage open enrollment period (January 1 to March 31). During this window, they can switch to a new Medicare Advantage plan or drop their Medicare Advantage plan and enroll in Original Medicare instead.

More than half of Original Medicare beneficiaries have employer-sponsored insurance or Medicaid to supplement their Medicare coverage. But for those who don’t, optional Medigap plans (also known as Medicare supplement plans) will cover some or all of the out-of-pocket healthcare costs for Medicare coinsurance and deductibles that the enrollee would otherwise have to pay themselves. Original Medicare does not cap out-of-pocket costs, and coinsurance and deductibles can add up quickly.

Medigap plans are sold by private insurers, but are standardized under federal rules, with ten different plan designs (differentiated by letters, A through N). The covered benefits of a particular plan (Plan A, Plan G, etc.) are the same from one insurer to another, making it fairly easy for consumers to compare plans (the plans will differ on things like price and customer service).

As of 2022, there were 65 insurers licensed to sell Medigap plans in Mississippi. And 167,211 people had Medigap coverage in Mississippi in 2020, according to an AHIP analysis.

Read the Mississippi Insurance Department’s Medicare Supplement Shopper’s Guide.

Medigap plans differ from other private Medicare coverage (Medicare Advantage and Medicare Part D plans) in that there is not an annual open enrollment window for Medigap. Instead, people are given a single six-month guaranteed-issue window that begins when they are at least age 65 and enrolled in Medicare Part B (you have to be enrolled in both Part A and Part B to buy a Medigap plan).

Federal rules do not guarantee access to Medigap plans for people who are under 65 and enrolled in Medicare due to a disability. But Mississippi is one of the majority of the states that have implemented rules to ensure at least some access to Medigap coverage for people under age 65.

As explained in the state guide to Medicare supplement plans, people who become eligible for Medicare under the age of 65 are granted the same six-month open enrollment window for Medigap as people who gain eligibility for Medicare when they turn 65. Insurers have to offer all of their Medigap plans to disabled enrollees, but the premiums can be higher — the state notes that they can be up to 50% higher than the rates that apply to people who are 65 years old. A disabled beneficiary under age 65 will have another Medigap open enrollment period upon turning 65, allowing them the option to switch plans and enroll at a lower price than they were paying before turning 65.

It’s important to understand that although pre-existing conditions are no longer an issue in most of the private health insurance market as a result of the Affordable Care Act, those regulations don’t apply to Medigap plans. When you enroll in a Medigap plan, the insurer can impose a pre-existing condition waiting period of up to six months, if you didn’t have at least six months of continuous coverage prior to your enrollment. And if you apply for a Medigap plan after your initial enrollment window closes (and assuming you aren’t eligible for one of the limited guaranteed-issue rights), the insurer can use your medical history to determine your eligibility for coverage and your premium amount.

Original Medicare does not cover outpatient prescription drugs. Many Original Medicare beneficiaries have supplemental coverage from an employer-sponsored plan, and these plans often include prescription coverage.

But Medicare beneficiaries who don’t have such coverage need to obtain prescription coverage under a Medicare Medicare Part D plan. These can be purchased as stand-alone coverage, or as part of a Medicare Advantage plan that includes Part D prescription drug coverage. Part D coverage is optional, but there’s a late enrollment penalty for people who didn’t enroll when they were first eligible and didn’t have creditable coverage.

There are 22 stand-alone Medicare Part D plans for sale in Mississippi for 2023, with monthly premiums that range from about $5 to $113/month.

479,294 Mississippi Medicare beneficiaries (more than three-quarters of the state’s total Medicare population) had Medicare Part D coverage as of mid-2023. That included more than 253,000 with stand-alone Part D plans, and more than 226,000 who had Part D coverage integrated with Medicare Advantage plans. Although overall enrollment in Part D coverage has been increasing in Mississippi in line with increasing Medicare enrollment, the number of people with stand-alone Part D coverage has been decreasing, since an increasing percentage of the Medicare population is choosing Medicare Advantage plans.

Medicare Part D enrollment follows the same schedule as Medicare Advantage enrollment. Beneficiaries can pick a plan when they’re first eligible for Medicare, and there’s also an annual window each fall (October 15 – December 7) when Medicare beneficiaries can enroll for the first time or change to a different plan.

Seven rules for shopping for Medicare Part D plans

Many Medicare beneficiaries receive financial assistance through Medicaid with the cost of Medicare premiums and services Medicare doesn’t cover – such as long-term care.

Our guide to financial assistance for Medicare enrollees in Mississippi includes overviews of these programs, including long-term care coverage, Medicare Savings Programs, and eligibility guidelines for assistance.

If you have questions about Medicare eligibility in Mississippi or Medicare enrollment in Mississippi, you can contact the Mississippi Health Insurance Assistance Program (SHIP). They can provide information and assistance with a wide range of questions related to Medicare coverage in Mississippi.

The Mississippi Insurance Department has a resource page for state residents who need help or have questions about Medicare in Mississippi, and a useful Medigap shopper’s guide. The Insurance Department regulates the insurers that offer Medigap plans in the state, as well as agents and brokers who sell any type of Medicare coverage (governance of Medicare Advantage plans and Part D plans is mostly done by CMS, although states do license the insurers and oversee them to ensure financial solvency). Their office can provide assistance with a range of insurance-related inquiries and complaints.

The Medicare Rights Center is a nationwide service that can provide information and assistance with questions related to Medicare eligibility, enrollment, and benefits.

Read more about how Medicaid supports more than one in five Medicare beneficiaries nationwide, and the specifics of how Mississippi Medicaid can assist Medicare beneficiaries with limited income and assets.