Mississippi, like all the stats, is faced with bringing its state insurance regulations in line with the provisions of the 2010 Patient Protection and Affordable Care Act by 2014. Some changes have already taken effect nationally. For instance, insurers may no longer deny coverage to children based on pre-existing conditions, and must allow children to remain on their parents’ health policies until age 26. This extension applies even if the child is no longer a student or has married.
Additionally, the states have worked with federal authorities to establish high risk pools and to explore their options for creating the required health insurance exchanges that will become active on January 1, 2014, replacing the temporary pools.
General Insurance Regulations
All insurance companies in Mississippi are required to clearly disclose what services are covered by the policy and for which benefits will be paid. The policy language must also include explanations of all exceptions, reductions or limitations and the length of time they will be in effect. Renewal, cancellation, and termination policies must be spelled out as well.
Currently, pre-existing conditions may be excluded from a policy for a period of up to 12 months. During this time insurers will not pay for any treatments or care related to the specific condition. If the insurance company decides to issue a policy in spite of a health condition, coverage restrictions may be applied. There is a five-year look-back period to determine if a pre-existing condition has been diagnosed or treated. Insurance cannot be canceled due to age or medical condition, however, so as long as the premiums are being paid.
Creation of Health Care Exchanges
In October 2011 the state’s Commissioner of Insurance, Mike Chaney, announced that Mississippi will create a health insurance exchange to be run by the Mississippi Comprehensive Health Insurance Risk Pool Association and regulated by the Insurance Department. Final plans for the operation of the exchange are still being worked out.
Pre-Existing Condition Insurance
Residents of Mississippi who are eligible for coverage can apply for the Pre-Existing Condition Insurance Plan program, which is administered by the U.S. Department of Health and Human Services. Covered benefits include both primary and specialty care, as well as prescription medications and hospital stays. Depending on age and option applicable, monthly premiums run from $146 to $628 with deductible of $1000 to $3000 and the potential for a separate prescription deductible. Maximum out-of-pocket expenses are capped at $7000.
Medicaid
In all states Medicaid benefits are figured as a factor of income according to a percentage of the Federal Poverty Level. Infants in Mississippi who are under one year of age qualify for Medicaid at 185% FPL, children 1-5 at 133%, and those age 6-19 at 100%. Pregnant women may draw assistance at 185% FPL, parents at 27%, and non-elderly Social Security disability recipients at 74%.
Medicare
Approximately 16 percent of residents in Mississippi draw Medicare benefits, with 480,000 accessing prescription drug coverage.
Some Medicare recipients may be eligible for the Mississippi Medicare program. This is a state funded program that helps Medicare recipients with additional medical expenses.
Mississippi’s Department of Human Services, Aging and Adult Services Division offers the SHIAP program or the Mississippi State Health Insurance Assistance Program that counsels Medicare recipients on the various Medicare options available to them and can also help them choose the plan that best fits their medical needs.