TABLE OF CONTENTS
Today, nearly 91% of Louisianans have health insurance. Multiple options are available through your employer, the Health Insurance Marketplace, direct from insurers, or government-sponsored programs like Healthy Louisiana.
This guide explains your Louisiana health insurance options in detail.
Visiting the marketplace at Healthcare.gov is the easiest way to compare Louisiana’s health insurance plans and estimated costs. The service also determines if you qualify for Medicaid or tax credits that can reduce your monthly premiums. To see available plans, enter your zip code, and provide information about your household, including:
Once you have provided this information, the site will determine if you or your dependents are eligible for premium tax credits. If you earn less than 138% of the Federal Poverty Level, you may qualify for free health insurance through Medicaid. If you meet this threshold, the marketplace will direct you to the state’s Medicaid agency to complete your application. Otherwise, you can start comparing plans. Prices will reflect any applicable tax credits, which can reduce monthly premiums to $0.
The marketplace makes it easy to compare plans at a glance by providing information about deductibles, copays or coinsurance rates, and out-of-pocket maximums. In addition, you’ll see a breakdown of costs for standard services, such as primary and specialty medical care and emergency room visits. For a complete picture, consider adding information about medications and preferred health care providers to check network coverage. Once you have confirmed your selection, you can sign up for a health insurance plan and select a start date.
The following companies offer health insurance in Louisiana on and off the exchange.
The Health Insurance Marketplace isn’t the only way to enroll in coverage. You can also work with an independent broker, go through a comparison-shopping website, or contact insurance companies online or over the phone. However, once you leave the Marketplace, you won’t have access to the tax credits it provides. In addition to ACA-compliant health insurance plans, short-term health insurance plans and programs like the Consolidated Omnibus Budget Reconciliation Act (COBRA) let you extend existing health coverage for up to 18 months after leaving a job by paying 102% of the entire cost.
Individual health insurance plans offer the most flexibility for Louisiana residents. These plans let you balance your budget and current needs depending on whether you’re seeking a basic low-cost plan or have a chronic medical condition and need lower out-of-pocket costs.
Health insurance premiums can be based on your age, county of residence, tobacco use, and coverage tier. Louisiana allows insurance companies to charge older beneficiaries up to three times as much for the same plan. Tobacco users may have to pay up to 50% more for premiums, and prices vary in Louisiana’s eight geographic rate determination zones. However, insurance companies cannot charge you more based on your medical history or gender. In addition, you cannot be denied coverage due to preexisting medical conditions.
The type of plan you choose is also an important consideration.
Point-of-Service (POS) plans combine the features of an HMO with the features of a PPO. You have to ask for a referral to see a specialist, but you can get care from out-of-network providers if you’re willing to pay a larger percentage of the cost.
Family plans cover more than one person, potentially even including exes, step-children, and domestic partners as well as dependents. Although slightly less flexible than individual plans, family plans offer a competitive value. Some insurers cap premiums after the first three children, which can provide substantial savings. Deductibles and out-of-pocket maximums are typically double for family plans regardless of the number of people insured.
Time savings is another advantage since there’s no need to spend hours shopping for the right plan for each member of your household. Claims and billing statements are also streamlined. In addition, you don’t have to wonder which family member is covered by which network since everyone has access to the same providers.
The Affordable Care Act aims to ensure that all Louisianans have access to reasonably priced, comprehensive health insurance that costs no more than 10% of your total income. According to the Centers for Medicare & Medicaid Services, more than 83,159 state residents are enrolled in Marketplace plans, and 91% qualify for premium tax credits that reduce the total cost. When shopping for insurance on the Health Insurance Marketplace, plans are divided into four metallic tiers – bronze, silver, gold, and platinum.
According to the Kaiser Family Foundation, bronze plans average around $410, increasing $43 compared to 2018. Silver plans increased by $57 from $445 to $502, and gold plans increased by $64 to reach the current cost of $614.
|Average premiums in Louisiana||2018||2019||2020||2021|
|Most affordable bronze plan||$367||$341||$376||$410|
|Most affordable silver plan||$445||$419||$467||$502|
|Most affordable gold plan||$550||$523||$571||$614|
With monthly premiums averaging around $545 per month, affordable health insurance seems out of reach for many Louisianans. If you have low income or substantial medical needs, you may qualify for Medicaid, covering parents with low income, expectant mothers, and uninsured women with breast or cervical cancer. Tax credits are available if you earn up to 400% of the Federal Poverty Limit, making marketplace plans available for as little as $50 per month. Low- and moderate-income seniors may qualify for Medicare Savings Programs and Extra Help Benefits to pay for deductibles, copays or coinsurance, and prescription drug coverage.
Medicaid covers 1.7 million adults and children in Louisiana, about 28% of the total population. Louisiana is a Medicaid expansion state, meaning no-cost coverage for needy citizens, including pregnant women, low-income parents, and childless adults who earn less than 138% of the Federal Poverty Limit based on household size. In addition, Healthy Louisiana is available if you:
Medicaid income limits in Louisiana
In Louisiana, regular Medicaid benefits are provided by insurers that operate managed care organizations. Companies offer the same medical and dental services plus a varied selection of extras. There are five MCOs in the state, including:
LaHIPP is a program to help if you qualify for Medicaid but have access to employer-sponsored health insurance.
LaMOMS provides no-cost insurance to uninsured women for the duration of their pregnancy and up to 60 days following the delivery. It covers doctor’s visits, hospital care, labs, prescriptions, and obstetric services.
LaCHIP is available to children under 19 who don’t have health insurance and are part of a household with low income. Subsidized LaCHIP Affordable Plans are available to families with higher income levels.
Medicaid Long-Term Care is available if you require a nursing home level of care and intend to remain a licensed facility for at least 30 consecutive days. To qualify for this program, you must be at least one of the following:
Income for Medicaid long-term care is limited to 300% of the Supplemental Security Income rate, which is $2,382 per month for 2021, with capped assets of $2,000 for individuals or $3,000 for married couples living in the same facility. If only one spouse requires care, the nonapplicant can retain up to $130,380 in assets. A variety of items are excluded from these calculations, such as a home and vehicle. In addition, this program offers various home- and community-based services through waivers.
You can apply for Medicaid online, phone, in-person, or on the Health Insurance Marketplace. For more information, call the Medicaid hotline at 888-342-6207 or visit Healthy.LA.gov. Applications are also processed at more than 200 Medicaid Application Centers.
Medicare is a health insurance program for older citizens and some disabled adults. Most U.S. citizens who are Louisianans aged 65 or older qualify for Medicare. You have options with Medicare choices:
It can be challenging to afford premiums, copays, deductibles, and other out-of-pocket costs, even with Medicare coverage. Medicare Supplement Insurance plans, also known as Medigap, make your Medicare coverage more affordable by covering many of these expenses.
|Eligibility and Enrollment|
|Eligibility||To enroll in Original Medicare or Medicare Advantage, you must meet certain eligibility requirements. First, you must be a U.S. citizen or permanent resident. You must also be at least 65 years old or have a disability that causes you to receive SSDI benefits for at least 24 months. You may also qualify for Medicare at a younger age if you have end-stage renal disease.|
|Enrollment||Three months before you turn 65, you’ll become eligible for an initial enrollment period. During the IEP, you’ll have an opportunity to sign up for Medicare. If you started receiving Medicare before the age of 65, you could make changes to your coverage at this time.
Medicare has an open enrollment period from October 15 to December 7 each year. You can sign up for Medicare or switch your Medicare Advantage or Medicare Part D plan to meet your needs better during open enrollment.
You can learn more about available plans on Medicare.gov or by contacting the Senior Health Insurance Information Program.
Insurance companies in Louisiana offer short-term policies for one to 36 months. Coverage may be limited to six months, depending on how much information the carrier requests about preexisting conditions. Coverage terms vary significantly depending on the plan. Deductibles range from $2,500 to $15,000 with 50% to 80% coinsurance.
Short-term plans provide peace of mind and financial protection if you face a coverage gap, such as retiring before you qualify for Medicare, when you’re between jobs, losing a parent’s coverage, or dealing with other life changes that affect your insurance coverage.
You can enroll in short-term coverage at any time, and coverage can begin as soon as the next day, which is helpful if you need insurance before the next open enrollment cycle.
Since the Affordable Care Act does not regulate short-term health insurance, you may be asked about your health status, weight, tobacco use, and whether you received treatment for any chronic health conditions in the past one to five years. Contact a qualified insurance agent for more information about these plans or consult the Louisiana Department of Insurance Office of Consumer Services.
No, Louisiana does not require residents purchase private health insurance. Congress repealed individual tax penalties for being uninsured in 2019. However, the ACA does require companies with more than 50 workers to provide health insurance or pay penalties.
If you want to purchase subsidized health insurance using premium tax credits, you’ll need to use the federal Health Insurance Marketplace. You can also buy ACA-compliant coverage and alternative health plans directly from insurance companies or independent insurance agents.
In addition to ACA-compliant health insurance and short-term policies, you can find cost-sharing plans offered by Health Care Sharing Ministries (HCSMs), which may pay for health care expenses at a lower cost than insurance.
Flexible Spending Accounts and Health Savings Accounts are designed to help with out-of-pocket medical expenses. FSAs are offered as part of employer-sponsored benefits plans and are funded with pretax funds. HSAs are only available if you have a high-deductible health plan.
Short-term disability coverage and health insurance provide very different benefits. However, even if you have health insurance, you may want short-term disability coverage to ensure your family has enough money to pay for essentials if you’re unable to work for three to 12 months following a disabling event.
Long-term disability insurance provides valuable financial benefits to replace your income if you cannot work for several years. These funds are for housing, utilities, food, education expenses, and medical care. Although disability insurance includes some medical services to facilitate the claims process, you still need health insurance to pay for preventive medical care or services related to the qualifying injury or illness.
Healthy Louisiana covers various medical services, including doctor’s visits, emergency medical care, home health, X-rays, prescription medications, chemotherapy, and durable medical equipment. You may also qualify for needs-based programs that pay for nursing home care, community-based waiver services, and prenatal support.