MSLegalServices.orgMississippi

Medicare Choice Plan

Authored By: North Mississippi Rural Legal Services LSC Funded

Information

Medicare Choice Plan

  1. Do Medicare + Choice Plans provide the same coverage as traditional Medicare?
  2. Where can a person find up-to-date information on Medicare plans available in Mississippi?
  3. When and how are services provided under a Medicare + Choice Plan?
  4. Who can enroll in Medicare Plus Choice Plan?
  5. Which Medicare plan choice plans are available in Mississippi?

Do Medicare + Choice Plans provide the same coverage as traditional Medicare?

With the exception of MSAs, Medicare + Choice Plans must provide the same benefits under Parts A and B of traditional Medicare. Beneficiaries who enroll in these plans may experience higher co-insurance amounts than they would if they were in traditional Medicare. Plans may offer supplemental benefits for which they charge a separate premium, though the premiums may be combined with the premium representing the charge for Medicare co-payments and deductibles. Beneficiaries may not have the option to decline the supplemental benefits.

Plans, other than MSA plans, will be required to pass on to beneficiaries in the form of additional benefits, any "saving" they achieve because their costs are less than the Medicare payment.

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Where can a person find up-to-date information on Medicare plans available in Mississippi?

CMS is required to provide beneficiaries with information about their plans in order to help Medicare beneficiaries make an informed choice. The information is available on the Medicare website at Select Medicare Health Plan Compare or call 1-800-633-4227, TTY/TDD: 1-877-486-2048 for the hearing and speech impaired.

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When and how are services provided under a Medicare + Choice Plan?

Benefits must be made available and accessible within the plan service area "with reasonable promptness" and in a manner that assures continuity of care. Medically necessary services must be made available and accessible to beneficiaries twenty-four hours a day, seven days a week. Urgently needed and emergency services received outside the plan must be covered. Congress adopted the prudent layperson standard to define emergency medical care, and included severe pain as a symptom indicative of an emergency situation. Plans also must provide beneficiaries with information about their benefits and premiums and about any potential beneficiary liability.

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Who can enroll in Medicare Plus Choice Plan?

A beneficiary must have both Part A and B of Medicare in order to enroll in a Medicare + Choice plan. Individuals with end stage renal disease are ineligible. Generally, beneficiaries are only eligible to enroll in a Medicare + Choice plan that serves the area in which they live. Beneficiaries who are covered by federal employee health benefits plans, or plans through the Veterans Administration or the Department of Defense may not enroll in MSAs until the government determines whether MSA enrollment will increase government expenditures and issues policies providing for such enrollment. Similarly, people eligible for cost-sharing under a Medicaid State Plan, including QMBs and SLMBs cannot enroll in a MSA plan. A Medicare + Choice Plan may not deny enrollment to an eligible individual based on health status or other factors described by the Health Insurance Portability and Protection Act of 1996.

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Which Medicare Choice Plans are available in Mississippi?

One Medicare + Choice option is available in Mississippi as of April 15, 2002. Family Health Care Plus - a Medicare HMO - is available only in Harrison County. See, http://www.medicare.gov and click on Medicare compare to view plan options.

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Last Review and Update: Nov 20, 2002