With most of the Affordable Care Act’s major provisions now in effect, the nation’s health insurance marketplace has undergone a significant transformation. Obamacare impacts individuals, families and small business owners alike. Most Americans are required to have minimum essential coverage unless they qualify for an exemption; however, the law is designed to make health insurance plans more accessible and affordable with income-based financial assistance and one-stop shopping via state-based and federally facilitated exchanges. Meanwhile, the private marketplace remains a place to shop for quality, affordable health insurance plans that meet ACA requirements.
The following guide offers a glimpse at the various types of ACA-compliant health insurance in Mississippi, including individual and family health plans, small group health plans, coverage for high-risk applicants, mini-COBRA continuation coverage, Medicaid, and CHIP.
Health and healthcare in Mississippi
Mississippi ranked last (50th) in United Health Foundation’s 2014 America’s Health Rankings.1 Its strengths include a low prevalence of binge drinking, high immunization coverage among children, and a small disparity in health status by educational attainment. Health challenges Mississippi faces include a high prevalence of physical inactivity, obesity and diabetes; low immunization coverage among adolescents; and a high infant mortality rate and high prevalence of low birthweight.
The U.S. Department of Health and Human Services reported that 61,494 individuals in Mississippi selected a marketplace plan through the exchange from Oct. 1, 2013, through April 19, 2014.2 In 2015, the number of individuals in Mississippi enrolled in a marketplace plan increased to 104,538 during the open enrollment period.3
Mississippi individual and family health insurance
Mississippi opted to participate in the federal Health Insurance Marketplace. The state’s federally facilitated Obamacare exchange provides individuals and families with access to qualified health plans. Those who buy health insurance through the exchange may be eligible for income-based subsidies, including premium tax credits that may be applied to any metal plan and cost-sharing subsidies that apply to silver plans. Mississippians who go without health insurance may face a tax penalty known as the shared responsibility payment.
The private marketplace also offers Mississippi residents with access to ACA-compliant, affordable health insurance. Consumers can find Obamacare qualified health plans through websites such as HealthCare.com. Use HealthCare.com’s tax credit subsidy calculator to see if you are eligible for an income-based premium tax credit. If you do, visit Mississippi’s Health Insurance Marketplace to shop and apply for health insurance.
|Mississippi’s health insurance exchange:||healthcare.gov|
|Mississippi department of insurance:||mid.ms.gov|
Mississippi small group health insurance plans
The federal website also provides Mississippi’s small businesses with a way to offer employees group health insurance coverage through the SHOP portal. Small business owners with 50 or fewer employees may purchase group health insurance plans through the federally facilitated Small Business Health Options Program marketplace, as well as in the private marketplace. Small businesses that use SHOP and have 25 or fewer employees may qualify for the Small Business Healthcare Tax Credit.
Self-employed individuals with no employees must apply for an individual health insurance plan on or away from Mississippi’s federally facilitated exchange.
Mississippi state COBRA variations for small groups
The Consolidated Omnibus Reconciliation Act (COBRA) allows those employed by businesses with 20 or more employees to continue their group health insurance plan for a limited time should they lose coverage due to qualifying events such as termination of employment due to reasons other than gross misconduct, a reduction in work hours, divorce or legal separation, and loss of dependency status. To learn more about the federal COBRA program, visit dol.gov/ebsa/cobra.html.
In some states, those who work for a small business and lose health insurance coverage due to a qualifying event may be eligible for health insurance continuation through mini-COBRA or a similar state continuation program. In a few states, these programs may also be extended to those who work for larger companies and exhaust their federal COBRA continuation coverage limit. Mini-COBRA generally works like the federal COBRA continuation coverage, but its terms may vary.
Mississippi’s small group COBRA continuation variations are as follows4:
|Eligible group sizes||2 to 19; those ineligible for COBRA|
|Maximum continuation period – standard||12 months|
|Maximum premium Increase||100 percent|
|State legislation reference||Miss. Code Ann. § 83-9-51 (2014)|
|Additional notes||Employees and their dependents must have been covered by the group policy for at least three months prior to the qualifying event.The continued policy must cover all dependents covered under the group policy.|
Mississippi high-risk pools
It used to be that health insurance companies could deny applicants or charge them more based on health history and preexisting conditions. When the Affordable Care Act was passed in 2010, many states created federally funded preexisting condition insurance programs or accepted federal funding to assist with similar high-risk pool programs they already operated.5
The Affordable Care Act prohibits this practice for health insurance plans considered minimum essential coverage with effective dates beginning Jan. 1, 2014, and later. As such, the PCIPs and state high-risk pools created to provide health insurance for those once considered uninsurable are being phased out.
Medicaid is a state health insurance program for low-income individuals under age 65, pregnant women, children, disabled individuals, and seniors over age 65; it is partially funded by the federal government. In 2014, states were given the option to accept additional federal funding and expand their Medicaid program eligibility to those who make up to 133 percent of the federal poverty level (effectively 138 percent due to how it is calculated, according to HealthCare.gov).6 Prior to this expansion, low-income adults under age 65 without dependents or disabilities did not typically qualify for Medicaid.
Mississippi opted not expand its Medicaid program in 2014.7 There is a resulting coverage gap that consists of individuals who do not qualify for Medicaid under the state’s current guidelines but still earn too little to qualify for premium tax credits (less than 100 percent of the federal poverty level) that reduce the cost of private health insurance plans sold through the exchange.
The information below is specific to Mississippi’s Medicaid program:
|Governing agency||Centers for Medicare & Medicaid|
|Administrator||Mississippi Division of Medicaid|
|Where to apply||healthcare.govAdditional application options: medicaid.ms.gov/medicaid-coverage/how-to-apply/|
|Phone number||601-359-6050 / 800-421-2408|
|Open-enrollment period||Year-round in all states|
|Eligibility||Eligibility dependent upon specific Mississippi Medicaid program criteria|
The Children’s Health Insurance Program is a partnership between the states and federal government. CHIP provides health insurance to uninsured children who meet certain eligibility guidelines.
The information below is specific to CHIP in Mississippi:
|Where to apply||healthcare.gov Additional application options: medicaid.ms.gov/medicaid-coverage/how-to-apply/|
|Phone number||601-359-6050 / 800-421-2408|
|Eligibility8||Uninsured children up to age 19 who are not eligible for Medicaid and meet household income criteria|
1 United Health Foundation. 2014 America’s Health Rankings Annual Edition. “Annual State Health Rankings.” http://www.americashealthrankings.org
2 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2014/.
3 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2015/.
4 Mississippi Code of 1972. Miss. Code Ann. § 83-9-51 (2014). January 2012. http://www.lexisnexis.com/hottopics/mscode/.
5 National Conference of State Legislators. Coverage of Uninsurable Pre-Existing Conditions: State and Federal High-Risk Pools. Updated April 2014. http://www.ncsl.org/research/health/high-risk-pools-for-health-coverage.aspx.
6 Centers for Medicare & Medicaid Services. “Medicaid Expansion & What It Means for You.” HealthCare.gov. N.D. https://www.healthcare.gov/what-if-my-state-is-not-expanding-medicaid/.
7 Centers for Medicare & Medicaid Services. “Mississippi.” Medicaid.gov. http://www.medicaid.gov/medicaid-chip-program-information/by-state/mississippi.html.
8 Mississippi Division of Medicaid. “Children’s Health Insurance Program (CHIP).” http://www.medicaid.ms.gov/programs/childrens-health-insurance-program-chip/.