If you’re eligible for Original Medicare, or Medicare Part A (hospital care) and Medicare Part B (outpatient care), you may be wondering if you can get enough coverage with the federal program. Original Medicare won’t cover all of your medical expenses or prescription drugs. It also doesn’t limit your out-of-pocket costs.
One alternative could be a Medicare Advantage (MA) plan or Medicare Part C, formerly known as Medicare + Choice. These plans roll Medicare Part A and B services into one plan administered by private insurers. Medicare pays them to provide at least the same coverage as Original Medicare except for hospice care, which stays covered under Medicare Part A. Most MA plans include Medicare prescription drug coverage and a limit on your out-of-pocket expenses.
What You Need to Know
Medicare Advantage plans have to cover the same basic protections as Original Medicare.
Most Medicare Advantage plans in Louisiana provide prescription drug coverage.
You can join a Medicare Advantage plan during one of the enrollment periods each year.
What Types of Medicare Advantage Plans Are Available in Louisiana?
Many of Louisiana’s Medicare Advantage plans work with networks of doctors and healthcare facilities to keep the costs of services more affordable. Some plans let you use out-of-network providers, but often at a higher cost. The different types of plans in Louisiana are:1
- Health Maintenance Organization (HMO and HMO-POS): With most HMO plans, you must use in-network doctors for your care. HMO-POS plans offer more freedom. If you use out-of-network doctors, you’ll face higher out-of-pocket costs except in emergencies. You’ll have to pick a primary care physician (PCP) and get referrals to see specialists.2
- Preferred Provider Organization (PPO): With a PPO plan, you won’t have to choose a PCP, get referrals for specialists or be limited to in-network doctors. However, you’ll likely pay more if you go to an out-of-network doctor.3
- Special Needs Plans (SNP): SNPs provide carefully tailored benefits to people with specialized health needs. Medicare-approved private insurance companies offer them mainly as HMOs, and access varies by county.4 Dual-eligible SNP (D-SNP) plans are available to Louisianans eligible for Medicare and Medicaid services and either over age 65 or age 18 through 64 with a disability.5 Institutional SNP (I-SNP) plans are for those living in a nursing home or other facility. Chronic condition SNP (C-SNP) plans focus on those living with certain medical conditions such as cancer or epilepsy.6
- Private Fee-for-Service (PFFS): You won’t need a PCP, and you can visit any Medicare-approved healthcare provider that accepts your plan. Your plan determines how much it will pay for medical services and how much you’ll pay for care.7
- Medicare Medical Savings Account (MSA): MSA plans combine a high-deductible insurance plan with a medical savings account that you use to pay for your healthcare costs. These plans cover the same services as MA plans, but not prescription drugs.8
You’ll save money with most MA plans by using in-network providers.
What Are Prescription Drug Options with Medicare Advantage?
With Original Medicare in Louisiana, you’ll have to buy a separate Medicare Part D plan to get prescription drug coverage. Most Medicare Advantage plans (except for some MSA and PFFS plans) available in Louisiana include prescription drug coverage.
When selecting a Medicare Advantage plan, be sure your prescriptions are included on the plan’s list of covered drugs, known as the drug formulary. If your Medicare Advantage plan covers prescription drugs, you can lose that plan by buying a Part D plan.
How Do You Choose Medicare Advantage Plans in Louisiana?
First, check the doctors and hospitals listed on the plans you’re considering. Are yours in-network or out-of-network? Then compare the costs and benefits of different Medicare Advantage plans in Louisiana, including:
- Premiums: Your monthly cost for health insurance in addition to the Medicare Part B premium ($148.50 for most people in 2021). Zero-premium plans might be an option, but other costs under those plans (like deductibles and coinsurance) could cost more.
- Other Costs:
- Deductible: Your out-of-pocket costs for healthcare services before your plan starts paying each year.
- Coinsurance: This set percentage of the total cost is your share of the cost of a service.
- Copayment: The fixed price you pay for a specific service.
- Out-of-pocket maximum: The total amount of out-of-pocket expenses you pay each year, except for premiums.
- Plan Benefits:
- Vision: Covers frames and routine vision exams.
- Dental: Covers teeth cleaning and checkups.
- Telehealth: Covers remote or virtual visits.
- Additional Perks: Many Louisiana Medicare Advantage plans cover part or all of your gym memberships or fitness classes.
Vision and Dental
Most Medicare Advantage plans also offer vision and dental coverage.
When and How Do You Enroll in a Medicare Advantage Plan in Louisiana?
- Initial Enrollment Period (IEP): You can sign up for a Medicare Advantage plan when you enroll in Original Medicare during a seven-month window around your 65th birthday.
- Medicare’s Annual Open Enrollment Period, or Annual Election Period (AEP): You can join, switch or disenroll from a Medicare Advantage plan from October 15 to December 7 each year. New coverage is effective January 1 of the following year.
- General Enrollment Period: If you enroll in an MA plan during Open Enrollment, you can make changes to it during the first three months of the new plan year (January 1 – March 31), including switching back to Original Medicare. Coverage begins the first day of the month after the plan gets your enrollment form.
- Special Enrollment Period (SEP): Under certain circumstances, you can disenroll, join or switch to a different plan outside of regular enrollment periods.10 Reasons include:
- You moved from the plan’s service area.
- You get your healthcare coverage from an employer or union health plan.
- You’re losing your coverage, whether from a job or Medicaid.
- Your plan is being discontinued or is leaving the Medicare program.
- You qualify for an SNP plan.
After signing up, you can replace Original Medicare with a Medicare Advantage plan. To qualify, you have to live within the plan’s service area. Starting in 2021, you can join an MA plan with end-stage renal disease.
Who Has Signed Up for Medicare Advantage in Louisiana?
Around 370,000 of 960,000 Medicare-eligible seniors in the Bayou State have signed up for Medicare Advantage plans in Louisiana. That number has almost tripled since 2008 and represents a penetration rate of about 38%, which is similar to the national average of 39%.11
How Much Do Medicare Advantage Plans Cost in Louisiana?
How much Medicare Advantage coverage will cost depends on your plan type and where you live. For example, one ZIP code in New Orleans (70116) offers 29 plans with monthly premiums ranging from $0 to $179.13 A ZIP code in Shreveport (71106) has 23 available plans with premiums between $0 and $210.14 Be sure to consider costs like deductibles and copays as well when comparing different plans.
What If You Want to Change Your Medicare Advantage Plan?
You can change your Medicare Advantage plan in Louisiana during any open enrollment period each year. Just sign up for a new plan. When you sign up for a new plan, your old plan will be canceled automatically.
What Are the Alternatives to Medicare Advantage?
In Louisiana, staying with Original Medicare is the most common alternative to Medicare Advantage.
Expenses Original Medicare doesn’t pay can be covered by buying a Medicare Supplement plan, or Medigap policy, from a private insurer. You’ll still need a stand-alone prescription drug plan (Medicare Part D).
The Program of All-Inclusive Care for the Elderly (PACE) is a community-based care program that provides all needed services through the Office of Aging and Adult Services so that seniors can stay in their communities. There are centers in Baton Rouge, Greater New Orleans and Lafayette. Call (877) 456-1146 for information.15
What Medicare Resources Are Available in Louisiana?
The Senior Health Insurance Information Program (SHIIP) offers free, unbiased information about Medicare through calls and face-to-face interviews with trained counselors. It has partnered with agencies across the state to offer its services. Call (800) 259-5300.
The Louisiana Department of Insurance’s Office of Consumer Services can help policyholders with complaints and questions. Call (800) 259-5300 for consumer protection issues.
Louisiana helps eligible, low-income seniors with state-level Medicare Savings Programs by helping to pay for medical services for those who meet the requirements. These programs help you pay premiums, deductibles, coinsurance and copayments. Contact SHIIP at (800) 259-5300 or Medicaid at (888) 342-6207 for further information.
If a Medicare Advantage plan in Louisiana is the best Medicare option for you, compare the coverage and costs of the plans in your area. Be sure you know which plan you want once you’re eligible to sign up.