Healthy Mississippi Institutional (PPO I-SNP)
Available to residents of Smith County, MS for 2027. Contract H1823, plan 003, segment 0.
- ✉ Email a copy of the plan benefit details
- Plan health benefits
- Benefits in plain text
- Rx cost-sharing for all pharmacies and tiers
- Other plans in Smith County
- Plan website
- Browse the Healthy Mississippi Institutional (PPO I-SNP) formulary
2027 drug-by-drug coverage is not published by CMS yet. The drug lookup covers 2026, whose formulary is live.
New for 2027. This plan has no 2026 predecessor in the CMS crosswalk. Every MS plan’s 2026–2027 changes →
Plan details
| Monthly premium (Part C + D) | $6.30 |
|---|---|
| — medical (Part C) part | $0.00 |
| — drug (Part D) part | $6.30? |
| Monthly premium with full Extra Help (LIS) | $0.00? |
| Part B premium reduction (giveback) | None |
| In-network out-of-pocket maximum | $9,250.00? |
| In- and out-of-network out-of-pocket maximum | $9,250.00 |
| Drug deductible | $700.00Tier 1 and 2 exempt |
| Drug out-of-pocket threshold | $2,400.00 |
| Plan type | PPO I-SNP? |
| Special needs plan | Institutional SNP |
| Contract / plan | H1823-003-0 |
| Offered by | Healthy Mississippi, Inc. |
| Parent organization | Singh Holdings LLC |
| Formulary tiers | 5 |
| Formulary exception tier | 4? |
| Pharmacy search | www.healthy-ms.com |
| Member services | (833)201-6413TTY (800)582-2233 |
CMS star ratings
- Overall
- —
- Health plan (Part C)
- —
- Drug plan (Part D)
- —
Published per contract — every plan under contract H1823 shares this rating.
Plan health benefits
| Service | In-network | Out-of-network? |
|---|---|---|
| Doctor visits | ||
| Primary care doctor | $0 copay | 30% coinsurance |
| Specialist | 0%–20% coinsurance | 30% coinsurance |
| Other health care professional | 0%–20% coinsurance | 30% coinsurance |
| Additional telehealth services | 0%–20% coinsurance | — |
| Preventive care | ||
| Medicare-covered preventive services | $0 copay | $0 copay |
| Annual physical exam | 0% coinsurance | 30% coinsurance |
| Kidney disease education | 20% coinsurance | 30% coinsurance |
| Glaucoma screening | 20% coinsurance | 30% coinsurance |
| Diabetes self-management training | 20% coinsurance | 30% coinsurance |
| Diagnostic tests, labs and imaging | ||
| Diagnostic tests and procedures | 20% coinsurance(authorization required) | 30% coinsurance |
| Lab services | $0 copay(authorization required) | $0 copay |
| Diagnostic radiology (e.g. MRI, CT) | 20% coinsurance(authorization required) | 30% coinsurance |
| Therapeutic radiology | 20% coinsurance(authorization required) | 30% coinsurance |
| Outpatient x-rays | 20% coinsurance(authorization required) | 30% coinsurance |
| Emergency and urgent care | ||
| Emergency room | 20% coinsurance | — |
| Urgent care | 20% coinsurance | — |
| Worldwide emergency coverage | Not covered | — |
| Worldwide urgent care | Not covered | — |
| Worldwide emergency transportation | Not covered | — |
| Hospital care | ||
| Inpatient hospital stay | Original Medicare cost-sharing(authorization required) | Original Medicare cost-sharing |
| Outpatient hospital services | 0%–20% coinsurance(authorization required) | 30% coinsurance |
| Outpatient observation | 20% coinsurance(authorization required) | 30% coinsurance |
| Ambulatory surgical center | 0%–20% coinsurance(authorization required) | 30% coinsurance |
| Outpatient blood services | $0 copay | $0 copay |
| Skilled nursing and home health | ||
| Skilled nursing facility | $0 per day for days 1–100(authorization required) | 30% coinsurance per stay |
| Home health care | $0 copay(authorization required) | $0 copay |
| Kidney dialysis | 20% coinsurance | 30% coinsurance |
| Rehabilitation | ||
| Occupational therapy | 0%–20% coinsurance(authorization required) | 30% coinsurance |
| Physical therapy and speech-language therapy | 0%–20% coinsurance(authorization required) | 30% coinsurance |
| Cardiac rehabilitation | 20% coinsurance | 30% coinsurance |
| Pulmonary rehabilitation | 20% coinsurance | 30% coinsurance |
| Mental health and substance use | ||
| Inpatient psychiatric hospital stay | Original Medicare cost-sharing(authorization required) | Original Medicare cost-sharing |
| Outpatient mental health, individual session | 0%–20% coinsurance | 30% coinsurance |
| Outpatient mental health, group session | 0%–20% coinsurance | 30% coinsurance |
| Psychiatrist, individual session | 0%–20% coinsurance | 30% coinsurance |
| Psychiatrist, group session | 0%–20% coinsurance | 30% coinsurance |
| Partial hospitalization | $0 copay(authorization required) | 30% coinsurance |
| Intensive outpatient program | $0 copay(authorization required) | 30% coinsurance |
| Outpatient substance use, individual session | 0%–20% coinsurance | 30% coinsurance |
| Outpatient substance use, group session | 0%–20% coinsurance | 30% coinsurance |
| Opioid treatment program | $0 copay | $0 copay |
| Ambulance and transportation | ||
| Ground ambulance | 20% coinsurance(authorization required) | 20% coinsurance |
| Air ambulance | 20% coinsurance(authorization required) | 20% coinsurance |
| Transportation to plan-approved locations | Not covered | — |
| Medical equipment and supplies | ||
| Durable medical equipment (e.g. wheelchairs, oxygen) | 20% coinsurance(authorization required) | 30% coinsurance |
| Prosthetics (e.g. braces, artificial limbs) | 20% coinsurance(authorization required) | 30% coinsurance |
| Medical supplies | 20% coinsurance(authorization required) | 30% coinsurance |
| Diabetes supplies | 0% coinsurance(authorization required) | 30% coinsurance |
| Diabetic therapeutic shoes or inserts | 0% coinsurance(authorization required) | 30% coinsurance |
| Chiropractic, acupuncture and foot care | ||
| Chiropractic (Medicare-covered) | 0%–20% coinsurance | 30% coinsurance |
| Routine chiropractic care | Not covered | — |
| Acupuncture | Not covered | — |
| Foot exams and treatment (Medicare-covered) | 0%–20% coinsurance | 30% coinsurance |
| Routine foot care | Not covered | — |
| Dental? | ||
| Medicare-covered dental services | 20% coinsurance | 30% coinsurance |
| Preventive dental plan limit | $3,000 plan limit every year | — |
| Oral exams | $0 copay(limits apply) | 50% coinsurance |
| Cleanings | $0 copay(limits apply) | 50% coinsurance |
| Fluoride treatment | $0 copay(limits apply) | 50% coinsurance |
| Dental x-rays | $0 copay(limits apply) | 50% coinsurance |
| Other diagnostic dental services | $0 copay | 50% coinsurance |
| Other preventive dental services | $0 copay | 50% coinsurance |
| Restorative services (fillings, crowns) | $0 copay | 50% coinsurance |
| Endodontics (root canals) | $0 copay | 50% coinsurance |
| Periodontics (gum disease) | $0 copay | 50% coinsurance |
| Dentures and other removable prosthodontics | $0 copay | 50% coinsurance |
| Maxillofacial prosthetics | $0 copay | 50% coinsurance |
| Implants | Not covered | — |
| Bridges and other fixed prosthodontics | $0 copay | 50% coinsurance |
| Oral and maxillofacial surgery | $0 copay | 50% coinsurance |
| Orthodontics | Not covered | — |
| Adjunctive general services | $0 copay | 50% coinsurance |
| Vision? | ||
| Eye exam (Medicare-covered) | 20% coinsurance | 30% coinsurance |
| Routine eye exam | $0 copay(limits apply) | 50% coinsurance |
| Eyewear after cataract surgery (Medicare-covered) | $0 copay(limits apply) | 30% coinsurance |
| Eyewear plan limit | $325 plan limit every year | — |
| Contact lenses | $0 copay(limits apply) | 50% coinsurance |
| Eyeglasses (frames and lenses) | $0 copay(limits apply) | 50% coinsurance |
| Eyeglass lenses | $0 copay(limits apply) | 50% coinsurance |
| Eyeglass frames | $0 copay(limits apply) | 50% coinsurance |
| Eyewear upgrades | $0 copay(limits apply) | 50% coinsurance |
| Hearing? | ||
| Hearing exam (Medicare-covered) | $0 copay | 30% coinsurance |
| Routine hearing exam | $0 copay(limits apply) | 50% coinsurance |
| Hearing aid fitting and evaluation | $0 copay(limits apply) | 50% coinsurance |
| Hearing aid plan limit | $1,950 plan limit every year | — |
| Hearing aids (all types) | $0 copay(limits apply) | 50% coinsurance |
| Hearing aids, inner ear | Not covered | — |
| Hearing aids, outer ear | Not covered | — |
| Hearing aids, over the ear | Not covered | — |
| Medicare Part B drugs | ||
| Part B insulin | 0%–20% coinsurance(authorization required, step therapy may apply) | 30% coinsurance |
| Chemotherapy and radiation drugs | 0%–20% coinsurance(authorization required, step therapy may apply) | 30% coinsurance |
| Other Part B drugs | 0%–20% coinsurance(authorization required, step therapy may apply) | 30% coinsurance |
| Other extra benefits? | ||
| Over-the-counter (OTC) allowance | $300 allowance every three months | — |
| Meals after a hospital stay or for a chronic condition | $0 copay | 50% coinsurance |
| Fitness benefit | $0 copay(limits apply) | 50% coinsurance |
| Health education | Not covered | — |
| Nutritional / dietary benefit | Not covered | — |
| Extra smoking and tobacco cessation counseling | Not covered | — |
| Enhanced disease management | Not covered | — |
| Telemonitoring | Not covered | — |
| Remote access technologies (web/phone, nurse line) | Not covered | — |
| Home and bathroom safety devices | $0 copay(limits apply) | 50% coinsurance |
| Counseling services | Not covered | — |
| In-home safety assessment | Not covered | — |
| Personal emergency response system (PERS) | Not covered | — |
| Medical nutrition therapy | Not covered | — |
| Post-discharge in-home medication reconciliation | Not covered | — |
| Re-admission prevention | Not covered | — |
| Wigs for hair loss from chemotherapy | Not covered | — |
| Weight management programs | Not covered | — |
| Alternative therapies | Not covered | — |
| Therapeutic massage | Not covered | — |
| Adult day health services | Not covered | — |
| Home-based palliative care | Not covered | — |
| In-home support services | Not covered | — |
| Support for caregivers | Not covered | — |
In-network cost-sharing as the plan filed it with CMS (CMS plan benefit package (PBP) files, CY2027). A range means the cost depends on the service or setting. Rows the filing does not state are left out rather than guessed; an out-of-network dash means the plan files no separate out-of-network cost for that service. Contact the plan for the full Evidence of Coverage.
Drug tiers — preferred pharmacy, initial coverage
| Tier | Cost-sharing |
|---|---|
| Tier 1 · Preferred Generic | $0.00 |
| Tier 2 · Generic | $0.00 |
| Tier 3 · Preferred Brand | 25% |
| Tier 4 · Non-Preferred Drug | 25% |
| Tier 5 · Specialty Tier | 25% |
Rx cost-sharing by coverage phase
| Tier | 30-day supply | 90-day supply | ||||
|---|---|---|---|---|---|---|
| Preferred | Standard | Mail Order | Preferred | Standard | Mail Order | |
| Initial coverage phase | ||||||
| Tier 1: Preferred Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 2: Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 3: Preferred Brand | 25% | 25% | 25% | 25% | 25% | 25% |
| Tier 4: Non-Preferred Drug | 25% | 25% | 25% | 25% | 25% | 25% |
| Tier 5: Specialty Tier | 25% | 25% | 25% | n/a | n/a | n/a |
These are the initial coverage phase amounts, as the plan filed them in its benefit package. The deductible and post-threshold phases are not stated per tier in that filing, so they are not shown here rather than being inferred; the plan's annual out-of-pocket threshold is $2,400.00.
Also available in 80 other MS counties
- Adams
- Alcorn
- Amite
- Attala
- Benton
- Bolivar
- Calhoun
- Carroll
- Chickasaw
- Choctaw
- Claiborne
- Clarke
- Clay
- Coahoma
- Copiah
- Covington
- DeSoto
- Forrest
- Franklin
- George
- Greene
- Grenada
- Hancock
- Harrison
- Hinds
- Holmes
- Humphreys
- Issaquena
- Itawamba
- Jackson
- Jasper
- Jefferson
- Jefferson Davis
- Jones
- Kemper
- Lafayette
- Lamar
- Lauderdale
- Lawrence
- Leake
- Leflore
- Lincoln
- Lowndes
- Madison
- Marion
- Marshall
- Monroe
- Montgomery
- Neshoba
- Newton
- Noxubee
- Oktibbeha
- Panola
- Pearl River
- Perry
- Pike
- Pontotoc
- Prentiss
- Quitman
- Rankin
Benefits in plain text
Healthy Mississippi Institutional (PPO I-SNP) (H1823-003-0) is a 2027 PPO I-SNP Medicare Advantage plan offered by Healthy Mississippi, Inc., available to residents of Smith County, MS.
The monthly premium is $6.30.
With full Extra Help (the Low-Income Subsidy), the total monthly premium is $0.00.
Its in-network out-of-pocket maximum is $9,250.00.
The combined in- and out-of-network out-of-pocket maximum is $9,250.00.
The drug deductible is $700.00. Tier 1 and 2 exempt.
It is a special needs plan (Institutional SNP).
At a preferred pharmacy in the initial coverage phase, a 30-day supply costs tier 1 (Preferred Generic): $0.00; tier 2 (Generic): $0.00; tier 3 (Preferred Brand): 25%; tier 4 (Non-Preferred Drug): 25%; tier 5 (Specialty Tier): 25%.
Email a copy of the plan benefit details
Plan facts come from the CMS plan Landscape file and the CMS plan benefit package (PBP) files.