A non-government entity
Healthy Mississippi (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Healthy Mississippi (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Healthy Mississippi (HMO) in 2025, please refer to our full plan details page.
Healthy Mississippi (HMO) is a HMO plan offered by Singh Holdings LLC available for enrollment in 2025 to people living in State of Mississippi. The overall rating for this plan is not yet available for 2025.
It's important to know that Healthy Mississippi (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Healthy Mississippi (HMO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Healthy Mississippi (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $50.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3850.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Healthy Mississippi (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay different copays depending on the drug tier and pharmacy you use. For example, preferred generic drugs have no copay, while standard generic drugs have a $10 copay at a standard pharmacy. After your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you will pay nothing for your covered drugs. If you qualify for the low-income subsidy, you will pay $0 for Part D drugs.
Additional Benefits
The Healthy Mississippi (HMO) plan offers a comprehensive range of benefits, including no copay for inpatient hospital stays and routine hearing exams. You can also expect coverage for a variety of outpatient services, preventive services, and vision and dental services, with varying copays and coinsurance depending on the service. This plan also provides coverage for emergency services, ambulance services, and home health services, with some services requiring prior authorization. The plan offers additional coverage for medical equipment, diagnostic and radiological services, and home infusion services, with specific copays and coinsurance amounts for each.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric, are covered with no copay. Additional days for inpatient hospital and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services and Observation Services with a copay between $0 and $225, and a coinsurance between 0% and 35%, as well as Ambulatory Surgical Center (ASC) Services with no copay and a coinsurance between 0% and 35%. Outpatient Substance Abuse Services have a copay between $0 and $45 for individual and group sessions. Outpatient Blood Services are covered with a coinsurance between 0% and 35%.
Partial Hospitalization See details
Partial Hospitalization is covered by the Healthy Mississippi (HMO) plan, but requires prior authorization and a doctor's referral. The copay for this benefit is between $55 and $70.
Ambulance and Transportation Services See details
The Healthy Mississippi (HMO) plan covers ambulance services with a $295 copay for both ground and air ambulance services, with no coinsurance. Transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Healthy Mississippi (HMO) plan. Emergency Services has a $110 copay, while Urgently Needed Services has a copay between $0 and $45. Worldwide Emergency Coverage has a $110 copay, Worldwide Urgent Coverage has a $45 copay, and Worldwide Emergency Transportation has a $295 copay, with a maximum plan benefit coverage of $10,000.
Primary Care See details
The Healthy Mississippi (HMO) plan covers primary care physician services with a copay of $0-$20, chiropractic services with a $15 copay, occupational therapy services with a copay of $0-$30, and physician specialist services with a copay of $0-$35. Mental health specialty services, including individual and group sessions, have a copay of $0-$45. Additionally, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services are covered with varying copays.
Preventive Services See details
The Healthy Mississippi (HMO) plan covers preventive services, including Medicare-covered services with no copay, and annual physical exams with 0-35% coinsurance. Additional preventive services, health education, re-admission prevention, weight management programs, home and bathroom safety devices and modifications (up to $250 per year), additional sessions of smoking and tobacco cessation counseling (56 visits), enhanced disease management, telemonitoring services, and counseling services (6 sessions) are also covered. Other services such as In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Wigs for Hair Loss Related to Chemotherapy, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, Support for Caregivers of Enrollees, Fitness Benefit, Remote Access Technologies, In-Home Support Services, and counseling services are not covered.
Hearing Services See details
Hearing Services include routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a maximum benefit of $500 every year; however, prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services are covered, including eye exams, eyewear, and upgrades. Eye exams have a copay of $0-$35, while eyewear has a combined maximum plan benefit of $250 per year.
Dental Services See details
Dental services are covered, with a maximum plan benefit of $2,200 per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, and oral and maxillofacial surgery have no copay. Medicare dental services have a coinsurance between 0% and 20%, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Healthy Mississippi (HMO), with a $35 copay for Medicare Part B Insulin Drugs. Other Medicare Part B drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Healthy Mississippi (HMO) plan, but require prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment which includes Diabetic Supplies with 0-20% coinsurance and Diabetic Therapeutic Shoes/Inserts with 20% coinsurance; Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by Healthy Mississippi (HMO), including Diagnostic Procedures/Tests with a copay between $0 and $95, and Lab Services with no copay. Diagnostic Radiological Services have a coinsurance up to 35% and a copay up to $225, Therapeutic Radiological Services have a coinsurance up to 20% and a copay up to $50, and Outpatient X-Ray Services have no copay and a coinsurance up to 20%.
Home Health Services See details
Home Health Services are covered by Healthy Mississippi (HMO) with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization and a doctor's referral are required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization and a doctor's referral are required, and details on copays for Tier 1 services can be obtained from the plan.
Other Services See details
The Healthy Mississippi (HMO) plan does not cover acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, or Self-Directed Personal Assistance Services. Over-the-Counter (OTC) Items and Meal Benefits are covered.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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