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Mississippi uses the federally run health insurance exchange, so residents who buy their own health insurance enroll through Healthcare.gov.
Five insurers are offering plans in Mississippi’s marketplace for 2023 — four already offered coverage in 2022, and UnitedHealthcare (which previously offered plans in 2016) has rejoined the Mississippi exchange for 2023. Coverage areas vary, but residents in all areas of the state can select from at least three insurers’ plans.
Mississippi has the nation’s highest percentage of enrollees qualifying for both premium subsidies and cost-sharing reductions. But Mississippi is also one of only two states in the country where the cost of cost-sharing reductions (CSR) is still required to be spread across all plans, instead of only being added to silver plan rates. This means subsidies (which are based on silver plan rates) are not as large as they would be if Mississippi switched to the approach that most other states use, which is to add the cost of CSR only to silver plan rates.
Mississippi uses the federally run exchange for individual market plans, so residents who buy their own health insurance enroll through HealthCare.gov.
The state initially ran its own SHOP exchange for small businesses, dubbed One Mississippi, but had switched to the federally-run SHOP exchange by 2018 (and the federally-run SHOP exchange had switched to a direct-to-carrier enrollment model by that point).
Almost all of Mississippi’s exchange enrollees — 96% — were receiving premium subsidies as of early 2022, versus about 89% nationwide. This is unsurprising, since subsidy eligibility is based on income, and Mississippi has the lowest average household income in the US.
Five insurers offer exchange plans in Mississippi, including one that rejoined the exchange for 2023:
All Mississippi residents have access to plans from at least three insurers for 2023.
In 2011 and 2012 — back when Mississippi was considering creating its own State-run exchange — Blue Cross Blue Shield of Mississippi (which had more than 80 percent of the market share in Mississippi) had told Insurance Commissioner Mike Chaney that they would participate in the exchange. But due to conflicts among the state’s leadership, HHS rejected Mississippi’s exchange application (more details below), and at that point, BCBS of Mississippi pulled out.
That left Humana and Magnolia Health Plan as the only two carriers for 2014. But leading up to the federally-run exchange’s fall 2013 debut, Mississippi had a problem. The two carriers had selected the counties in which they wanted to operate, and 36 of the state’s 82 counties had no participating carriers at all. Humana ultimately decided to go ahead and offer coverage state-wide in 2014, but only five of the state’s counties had plans available from both carriers in 2014.
In 2014 and 2015, plans were available in Mississippi’s exchange from Humana and Magnolia Health Plan (Ambetter/Centene).
For 2016, UnitedHealthcare joined them, bringing the total number of insurers on the individual exchange to three. United was the only carrier in the Mississippi exchange that offered coverage in all 82 counties in the state in 2016. Residents in every county in the state had at least two carriers from which to choose that year, and 32 counties had plans available from all three carriers.
But for 2017, United left the state (as was the case in most states where United had been offering exchange plans), and Mississippi’s exchange was back to just Humana and Magnolia
(Mississippi Insurance Commissioner Mike Chaney had reported in August 2016 that a third health insurer had proposed joining the exchange state-wide, but had been rejected by HHS due to “lack of an adequate network and specialists in each county.”)
Although Humana exited the exchanges in several states at the end of 2016, they stayed in Mississippi for 2017. There were 32 counties where both insurers offered plans that year, and 50 counties where the only carrier offering plans in the exchange was Magnolia (Magnolia had expanded to offer coverage statewide as of 2017).
Humana’s decision to remain in the exchange was short-lived, however, as they announced in February 2017 that they would no longer offer individual market plans in any state after 2017. But Centene (Magnolia/Ambetter in Mississippi) continued to offer coverage. In April 2017, Centene announced that they were planning to remain in the exchanges in 2018 in the states where they were already participating, which was in contrast to quite a few other insurers’ decisions to exit the exchanges in various states at the end of 2017. According to Centene Chairman and CEO, Michael Neidorff, “Centene’s exchange experience continues to be favorable, and we are achieving margins at the higher end of our targeted range.”
So as of 2018, Magnolia/Ambetter was the only insurer offering plans in Mississippi’s exchange, and that continued to be the case in 2019.
For 2020, however, Molina joined the exchange in 19 counties. And for 2021, Molina expanded their coverage area to include the whole state, giving all Mississippi residents a choice of two marketplace insurers.
Both insurers continued to offer plans in the exchange for 2022, and they were joined by two more insurers: Cigna and Vantage Health Plan of Mississippi, bringing the total number of participating insurers to four.
For 2023, those four insurers are continuing to offer coverage, and UnitedHealthcare has rejoined the exchange. Blue Cross Blue Shield of Mississippi continues to only offer plans outside the exchange.
The open enrollment period for individual/family health coverage runs from November 1 to January 15 in Mississippi. Outside of open enrollment, a qualifying event is necessary to enroll or make changes to your coverage.
UnitedHealthcare has rejoined Mississippi’s exchange for 2023, bringing the total number of participating insurers to five. According to ratereview.healthcare.gov, insurers filed the following average rate changes for 2023:
When we talk about average rate changes, it’s important to keep in mind that this only applies to full-price plans, and most people do not pay full price. Especially in Mississippi, nearly all exchange enrollees qualify for premium subsidies. For subsidized enrollees, the after-subsidy rate changes from one year to the next will depend on how the subsidy amount changes (and that can be affected by new insurers joining the marketplace, depending on how their plans are priced).
Average rate changes also don’t account for the fact that premiums increase with age. A person’s rates will increase each year even if their health plan’s overall average rate change is 0% (for enrollees who receive subsidies, the subsidies grow to keep pace with age-related rate increases).
Blue Cross Blue Shield of Mississippi, which only offers plans outside the exchange, filed an average rate increase of 5.5% for 2023.
Mississippi continues to be one of just two states (the other is Indiana) where the cost of cost-sharing reductions is spread across plans at all metal levels (broad loading), instead of being added only to silver plan rates (silver loading). West Virginia also took that approach through 2021, but has transitioned to a silver loading approach for 2022. Mississippi’s Insurance Department confirmed that the broad load approach is still being used for 2023.
Silver loading makes coverage more affordable in many cases, because it increases the price of Silver-level plans, and subsidy amounts are based on the cost of the second-lowest-cost Silver plan. But Mississippi regulators have not yet taken advantage of this approach, even though it’s being used in nearly every other state.
For perspective, here’s a look at how premiums have changed in prior years:
Once all of the plan selections for 2016 had been finalized, 90 percent of Mississippi exchange enrollees qualified for premium subsidies. Their average pre-subsidy premium was $388 per month (a little lower than the $396/month average across all states that use Healthcare.gov), and their average after-subsidy premium was $91/month (the average after-subsidy premium across all Healthcare.gov states was $106/month that year).
Mississippi exchange enrollment grew from 2014 through 2016, then dropped sharply in 2017. It dropped again in 2018, but has increased since then, reaching record highs in 2021 and again in 2022, with more than 143,000 people enrolling during the open enrollment period that ended in January 2022.
Here’s a summary of how enrollment has changed over the years in Mississippi’s exchange:
In June 2015, the Supreme Court ruled that subsidies are legal in every state, regardless of whether the exchange is run by the state or the federal government. That was great news for Mississippi residents, insurers, and healthcare providers; 98 percent of the people enrolled in private plans through the Mississippi exchange in 2019 were receiving premium subsidies.
The Mississippi Business Journal reported that Insurance Commissioner Mike Chaney had a contingency plan to protect subsidies for state residents if the Supreme Court had eliminated them. Rather than creating a state-run exchange, “it would entail funneling federal money through the existing Mississippi Comprehensive Health Insurance Risk Pool Association to private insurers.” But the Journal noted that the plan would have been contingent upon approval from the Governor, Lt. Governor, and the Speaker of the House (Chaney had worked to establish a state-run exchange back in 2011 – 2012, but was foiled by the Governor and the legislature).
Politico also reported that the state had a back-up plan, but they explained that Chaney wanted “Mississippi to use existing private health insurance exchanges to enroll people, qualifying for subsidies while avoiding the federal government’s technology.“
The Mississippi Comprehensive Health Insurance Risk Pool is the state-run high-risk pool that predates the ACA. Private health insurance exchanges are not run by the government — rather, they’re set up by health insurance carriers, brokers and benefits managers to provide a platform for people to shop for coverage. Mississippi’s Insurance Department did not return phone calls to clear up the discrepancy, but it did appear that in early 2015, the state was working on a back-up plan that could have been put in place if the Supreme Court had eliminated subsidies. In many states, there were no such contingency plans, and enrollees would have had few options but to terminate their coverage if subsidies had been eliminated.
The University of Mississippi Medical Center got the majority of the Navigator grants that were awarded by the federal government in August 2013 to fund enrollment efforts in Mississippi for 2014. Of $1.1 million that Mississippi received, $832,000 went to UMMC. Oak Hill Baptist Church got the remaining Navigator funding that year, but by 2015, Oak Hill had become the primary Navigator grant recipient in Mississippi, receiving $547,867 to assist with enrollment efforts for 2016 (another $415,224 was awarded to the University of Southern Mississippi in September 2015).
Navigator funding was drastically reduced under the Trump administration, however. In 2018, total Navigator grants in Mississippi came to less than $188,000. My Brother’s Keeper received $100,000 and Oak Hill got about $88,000. But navigator funding increased in Mississippi in 2019: My Brother’s Keeper got another $100,000, but Oak Hill got nearly $200,000.
And the Biden administration has dramatically increased Navigator funding. In 2022, nearly $1.9 million was awarded in Mississippi, going to Oak Hill Regional Community Development Corporation.
State Commissioner of Insurance Mike Chaney clashed with two governors as to what form a health insurance exchange should take in Mississippi. Chaney, former Gov. Phil Bryant, and former Gov. Haley Barbour are all Republicans and on record as opposing the Affordable Care Act. However, Chaney consistently maintained that the state would be better off running its own exchange.
Chaney pushed hard for a state-run exchange. In 2011, he announced that the Mississippi Comprehensive Health Insurance Risk Pool Association would operate an exchange. The Risk Pool Association developed a plan in which the exchange would be developed in four phases, with work outsourced.
Early exchange planning was carried out by the board of directors of the Risk Pool Association and an advisory board appointed by Chaney. The Risk Pool Association, the advisory board, and the insurance department continued working throughout 2012, and in November, Chaney notified the U.S. Department of Health and Human Services (HHS) that Mississippi intended to implement a state-run exchange. However, Bryant told HHS in December 2012 that Chaney had overstepped his authority.
It was also in 2012 that anti-ACA influences from outside Mississippi (including the Koch Brothers and the Cato Institute) began pressuring Cheney to give up his push for a state-run exchange. But One Mississippi, the state-run exchange that Cheney created, opened in October 2012, a year before the ACA-sanctioned exchanges nationwide. One Mississippi didn’t have any premium subsidies (those wouldn’t be available until the first ACA open enrollment period began in October 2013), but it did have coverage for sale. The task at that point switched to obtaining federal approval to have One Mississippi be the state’s official ACA exchange.
But ultimately, Governor Bryant’s opposition to the exchange was its downfall. In February 2013, HHS rejected Mississippi’s exchange blueprint, telling Chaney that it simply wouldn’t work without the Governor’s support. The exchange would have needed to work with the Mississippi Medicaid program — overseen by a Bryant appointee — and there were too many concerns that Bryant would be able to derail the exchange via funding or hiring decisions. The federal government said at the time that they “didn’t feel that [they] should get involved in a battle between two elected state officials.”
Mississippi was the only state whose exchange blueprint was rejected by the federal government, and in February 2013, One Mississippi shut down. The federal government ran the individual exchange in Mississippi from the start, but One Mississippi opened back up as the state-run SHOP exchange in the spring of 2014, offering health insurance options for small businesses. By 2018, however, Mississippi had opted to return to the federally-run exchange for small businesses. And even the federally-run small business exchange had switched to a direct-to-carrier enrollment model (instead of an enrollment portal on HealthCare.gov) by that point, as small business enrollment in the exchange had been quite low throughout most of the country.
Several factors constrain marketplace enrollment in the Magnolia State. Political opposition to the Affordable Care Act is very strong, many residents are distrustful of government assistance, and outreach efforts are limited. In a state with a 22 percent poverty rate, many people find premiums too expensive — even with subsidies factored in. And the Medicaid coverage gap is significant in Mississippi: Kaiser Family Foundation estimates that 100,000 Mississippi residents are in the coverage gap — ineligible for Medicaid (because the state has refused federal funding to expand Medicaid) and ineligible for subsidies in the exchange because their income is under the poverty level.
State Exchange Profile: Mississippi
The Henry J. Kaiser Family Foundation overview of Mississippi’s progress toward creating a state health insurance exchange.
Health Help Mississippi
Assists people insured by private health plans, Medicaid, or other plans in resolving problems pertaining to their health coverage; assists uninsured residents with access to care.
(877) 314-3843 / [email protected]
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.
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