You get coverage for the same services as Original Medicare and you often receive additional benefits. Medicare Advantage plans are run by private insurance companies, but still follow rules from the federal government.
What Types of Medicare Advantage Plans Are Available?
Like most private health insurance, Medicare Advantage plans come in several types. The type that’s right for you depends on your coverage needs and budget. Plan types include:
- Health maintenance organization (HMO): An HMO plan uses a network of doctors to provide care. In general, you’ll need to visit a doctor within your plan’s network or risk paying for your care out-of-pocket. You also usually need to choose a primary care physician (PCP).
- Preferred provider organization (PPO): PPO plans use a medical provider network, but you don’t have to choose a PCP. You can go to any doctor, but choosing a medical facility that’s in-network costs less out-of-pocket.
- Special needs plans (SNP): These plans are tailored for those with specific health issues by covering providers, prescription drugs and medical services related to the condition.1
- C-SNP: Chronic condition special needs plans cover specific severe or disabling chronic health conditions, such as stroke, cancer or cardiovascular disorders.
- D-SNP: Dual-eligible special needs plans provide coverage if you have both Medicare and Medicaid.
- I-SNP: Institutional special needs plans cover you if you live in a nursing home or other institutions or require nursing care at home.2
- Private fee-for-service (PFFS): The provider of a PFFS plan determines how much the plan will pay for medical services and how much you have to pay. Some PFFS plans have a provider network, while others don’t.
- Medicare medical savings account (MSA): Medical savings accounts use a high-deductible health care plan and a medical savings account (MSA). You’ll need to pay out-of-pocket for medical care until you reach your deductible. You can use money from your MSA to pay for costs before you hit your deductible.3
What You Need to Know
Medicare Advantage plans cover the same services as Medicare Part A and B.
Many Medicare Advantage plans include prescription drug coverage and additional benefits like dental or vision services.
Medicare Advantage plans have out-of-pocket maximums, meaning you won’t pay any more out-of-pocket after reaching this limit.
What Are Prescription Drug Options with Medicare Advantage?
Most Medicare Advantage plans include Medicare Part D coverage for prescription drug benefits. Be sure to look at the drug formulary — the plan’s list of covered prescriptions — to see if the medication you need is covered.
A Word of Advice
Check your plan’s formulary to make sure your medications are covered.
How Do You Choose Medicare Advantage Plans?
You’ll need to consider several factors when comparing Medicare Advantage plans. Once you have a list of the plans available in your area, you can look at features such as:
- Premiums: Premiums are the monthly cost to be a part of your plan.
- Zero-premium plans: These plans have no monthly premiums. You still have to pay for deductibles and coinsurance or copays, and those costs might be higher under a zero-premium plan.
- Other plans: Medicare Advantage plans with monthly premiums can range in price.
- Other Costs: Your premium is the price you pay to be enrolled in a plan. Other costs include:
- Coinsurance: This is the percentage you pay for medical services, treatments or visits after meeting your deductible.
- Copays: A copay is a fixed out-of-pocket amount you pay for specific medical services.
- Deductibles: Your deductible is the amount you have to pay out-of-pocket for medical expenses before your health plan starts to pay.
- Out-of-pocket maximum: Medicare Advantage plans limit the total amount you will have to pay out-of-pocket. Maximums vary between plans.
- Plan Benefits: Many Medicare Advantage plans offer additional benefits not usually covered by Original Medicare.
When and How to Enroll in Medicare Advantage?
You can join a Medicare Advantage plan after enrolling in Medicare Part A and B. You must live within a plan’s service area in Mississippi to enroll.
To join a plan, you’ll need to contact the plan provider and fill out an application. You can join a plan at several different times:
- Initial Enrollment Period: You can join a Medicare Advantage plan when you become eligible for Medicare.
- Medicare Open Enrollment Period: Each year from October 15 to December 7 you can join, switch, or drop a plan. New coverage begins on January 1 the following year.
- Medicare Advantage Open Enrollment Period: If you already have a Medicare Advantage plan, you can switch plans or return to Original Medicare from January 1 to March 31.
- Special Enrollment Period: Some circumstances allow you to change your Medicare coverage outside of Open Enrollment Periods.
- Moving outside of your plan’s service area.
- Loss of coverage, including losing your Medicaid eligibility.
- Gained coverage through an employer or union.
- Changes to the plan, such as the plan being terminated.
- Special circumstances like being diagnosed with a chronic condition that’s better served by a C-SNP.
Did You Know?
You can join or switch a Medicare Advantage plan at several different points during the year.
How Much Do Medicare Advantage Plans Cost in Mississippi?
Costs vary for Medicare Advantage plans in Mississippi. Monthly premiums range from $0/month to $110/month in Jackson. Annual out-of-pocket maximums could be up to $7,550 for in-network care.4
Remember to consider more than just the cost of the monthly premium. Your deductible and coinsurance or copays affect how much you’ll pay out-of-pocket for medical care. You should also consider the benefits a plan offers, not just the price.
What If You Want to Change Your Medicare Advantage Plan?
You can change your plan during enrollment periods. Simply join a new plan during an enrollment period and you will be automatically disenrolled from your old plan once your new coverage begins.
What Are Medicare Resources in Mississippi?
- SHIP: State Health Insurance Assistance Program5
- Mississippi Insurance Department: (800) 562-2957
- Mississippi Medicaid Medicare Cost-Sharing Program6
Learn more about enrolling in Medicare so you can start comparing Medicare Advantage plans in Mississippi.
1. U.S. Government Website for Medicare. “Special Needs Plans (SNP).” medicare.gov (accessed October 23, 2020).
2. U.S. Government Website for Medicare. “How Medicare Special Needs Plans (SNPs) work.” medicare.gov (accessed October 23, 2020).
3. U.S. Government Website for Medicare. “Medicare Medical Savings Account (MSA) Plans.” medicare.gov (accessed October 23, 2020).
4. U.S. Government Website for Medicare. “Find a 2021 Medicare Plan.” medicare.gov (accessed October 29, 2020).
5. Mississippi Department of Human Services. “State Health Insurance Assistance Program.” mdhs.ms.gov (accessed October 23, 2020).
6. Mississippi Division of Medicaid. “Medicare Cost-Sharing.” medicaid.ms.gov (accessed October 23, 2020).