Mississippi health insurance marketplace guide 2023

Louise Norris | May 24, 2023

Key takeaways

Read frequently asked questions about marketplace enrollment, rates and carriers in Mississippi
King v. Burwell: Chaney had a plan in case SCOTUS ruling had been different.
Navigator funding was drastically reduced under the Trump administration, but grew to a record high under the Biden administration.
State Commissioner of Insurance Mike Chaney clashed with two governors as to what form a health insurance exchange should take in Mississippi.
See links to resources for the Mississippi health insurance marketplace.

Mississippi exchange overview

Mississippi uses the federally run health insurance exchange, so residents who buy their own health insurance enroll through Healthcare.gov.

Five insurers offer plans in Mississippi’s marketplace for 2023 — four already offered coverage in 2022, and UnitedHealthcare (which previously offered plans in 2016) 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.

Frequently asked questions about Mississippi's ACA marketplace

What type of health insurance marketplace does Mississippi utilize?

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 — 97% — were receiving premium subsidies as of early 2023, versus about 90% natio nwide. This is unsurprising, since subsidy eligibility is based on income, and Mississippi has the lowest average household income in the US.

Which health insurance carriers offer coverage in the Mississippi marketplace?

Five insurers offer exchange plans in Mississippi, including one that rejoined the exchange for 2023:

Molina
Ambetter/Magnolia
Cigna
Vantage Health Plan of Mississippi
UnitedHealthcare (new for 2023, after previously leaving the market at the end of 2016)

All Mississippi residents have access to plans from at least three insurers for 2023.

Which health insurance carriers have offered coverage in the Mississippi marketplace in the past?

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.

When can I enroll in health insurance in Mississippi?

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.

If you have questions about open enrollment, you can learn more in our comprehensive guide to open enrollment. We also have a comprehensive guide to special enrollment periods.

How did Mississippi exchange premiums change for 2023?

UnitedHealthcare rejoined Mississippi’s exchange for 2023, bringing the total number of participating insurers to five. According to ratereview.healthcare.gov, insurers implemented the following average rate changes for 2023:

Ambetter/Magnolia: 3% increase
Molina: 8.1% increase
Cigna: 6.9% increase
Vantage Health Plan of Mississippi: 2.8% increase
UnitedHealthcare: New for 2023, so no applicable rate change

(Blue Cross Blue Shield of Mississippi raised average premiums by 5.5% for 2023, but their individual/family plans are not available through the marketplace in Mississippi, and can only be purchased off-exchange, without any subsidies.)

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).

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 transitioned to a silver loading approach as of 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.

How have premiums changed in Mississippi's exchange in previous years?

For perspective, here’s a look at how premiums have changed in prior years:

How many people are enrolled through Mississippi's health insurance exchange?

183,478 people enrolled in private plans through Mississippi’s exchange during the open enrollment period for 2023, setting a new record high.

Here’s a summary of how enrollment has changed over the years in Mississippi’s exchange:

2014: 61,494 people enrolled (most enrolled in a plan from Humana, which was the only insurer in all but four counties)
2015: 104,538 people enrolled
2016: 108,672 people enrolled (effectuated enrollment stood at 77,747 by March 31, 2016 — that’s an attrition rate of 28%, which was more than double the national average rate of attrition during the first quarter).
2017: 88,483 people enrolled. President Trump took office less than two weeks before the end of open enrollment that year, and immediately eliminated an advertising campaign that had been designed to direct people to HealthCare.gov to enroll in coverage. Across all states that use HealthCare.gov, enrollment dropped by about 5% in 2017, but in Mississippi, it dropped by almost 19%.
2018: 83,649 people enrolled
2019: 88,542 people enrolled. In most states that use HealthCare.gov, enrollment continued to decline in 2019, but that was not the case in Mississippi. Among the 39 states that use HealthCare.gov, only six saw their enrollment grow in 2019, and only Oklahoma had a higher percentage increase in enrollment than Mississippi.
2020: 98,892 people enrolled. This was nearly a 12 percent increase over 2019’s enrollment, which was the largest percentage increase in the country. That could be partially due to the fact that enrollment had dropped so precipitously in 2017 (more so than the rest of the country), and also partially due to a new insurer joining the exchange in some areas of the state.
2021: 110,966 people enrolled, reaching a record high for the state’s marketplace.
2022: 143,014 people enrolled, again setting a record high.
2023: 183,478 people enrolled, setting another record high.

Would ACA subsidies lower your health insurance premiums?

Use our 2023 subsidy calculator to see if you’re eligible for ACA premium subsidies – and your potential savings if you qualify.

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* This tool provides ACA premium subsidy estimates based on your household income. healthinsurance.org does not collect or store any personal information from individuals using our subsidy calculator.

King v. Burwell: Commissioner Chaney had a plan in case SCOTUS ruling had been different

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.

Federal funding for enrollment assistance

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.

Exchange creation battle in Mississippi

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.

Mississippi health insurance exchange links

HealthCare.gov
800-318-2596

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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