Medicare Advantage Plans in Louisiana
Fact checked Contributing expert: Roseann Birch; Reviewed by: Leron Moore - Published: April 12, 2021
Medicare Advantage offers Louisiana seniors the same coverage as Original Medicare Parts A and B and may provide a number of additional benefits. On top of hospital and general medical costs, Medicare Advantage plans in Louisiana usually cover the cost of prescription drugs, dental, vision, and hearing services. Unlike Original Medicare plans that are administered by the federal government, Medicare Part C is managed by private insurance companies that have been approved by Medicare.
Key Point Module
- 1 In 2019, there were 51 Medicare Advantage plans available in Louisiana.
- 2 34% of the total Medicare population in Louisiana is enrolled in Medicare Advantage plans as of 2018.
- 3 In 2018, Original Medicare spent an average of $11,932 per beneficiary in Louisiana, which is 18% higher than the national average.
- 4 Available Medicare Advantage plans range from 17 to 36 across Louisiana’s 64 counties.
Medicare Advantage plans in Louisiana differ in coverage and costs. This means seniors should carefully consider each plan to find the right level of coverage to suit their specific needs. The Medicare Advantage plans’ availability depends on the enrollee’s geographic location and the individual health insurance provider. All these plans must adhere to Medicare’s coverage rules and provide the same rights, benefits, and protections as Original Medicare.
Medicare Advantage Plans in Louisiana
Types of Medicare Advantage Plans
Louisiana’s Medicare Advantage program offers a range of plans to seniors looking for quality health insurance. The availability of these plans vary across the state and may include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-For-Service (PFFS) plans, and Special Needs Plans (SPNs). Each type of Medicare Advantage plan has its own eligibility and network rules.
Health Maintenance Organization (HMOs)
When enrolled in an HMO plan, participants must receive all medical care from a specific network of healthcare providers. The only exception to this rule is if emergency treatment is necessary. If general medical treatment is received from providers outside of the network, the participant will be liable to pay all costs. Plan members are also required to choose a primary care physician responsible for all decisions relating to treatment and any specialist referrals that need to be made. HMOs are the most restrictive type of plan, but they are the most affordable of all Medicare Advantage plans and typically come with low or no deductibles.
Planned Provider Organizations (PPOs)
PPO plans are generally more expensive than HMOs and always come with deductibles, but these plans give enrollees more freedom when choosing a healthcare provider. PPOs still have a preferred network of providers, but they have a more extensive selection than other plans. These providers offer reduced rates to PPO participants, so they pay the lowest co-pay and coinsurance rates by staying in-network. However, PPOs usually pay participants at least a fraction of the cost of any medical treatment received outside of the network. With a PPO plan, participants aren’t required to select a primary care provider or need a referral to visit a specialist.
Private Fee-For-Service Plans (PFFS)
PFFS plans offer the most freedom and flexibility for participants choosing a healthcare provider. These plans may offer a partial or full network of providers and sometimes have no network at all. Enrollees have the freedom to choose out-of-network hospitals, doctors, and other providers who accept the terms and conditions of the plan. However, costs are typically lower if treatment is received from in-network providers. When part of a PFFS network, providers receive payments on a fee-for-service basis, and the insurer decides how much participants pay for services and how much the plan pays providers. Because of the flexibility that PFFSs offer, these plans usually have higher premiums.
Special Needs Plans (SNP)
SNPs have stricter enrollment criteria than other Medicare Advantage plans and are only available to applicants with certain conditions and in certain circumstances. As a result of their rules and the coverage they offer, the premiums for an SNP plan may be higher compared to other plans. However, these higher costs are offset by the carefully tailored benefits that an SNP offers. For example, seniors who suffer from chronic and disabling health conditions may be able to enroll in an SNP that caters to their specific circumstances. SNPs have a network of targeted healthcare providers, and participants must receive all of their medical treatment from within this network. Due to their specialized nature, SNPs can be quite limited in geographic coverage, and seniors may find it difficult to find a plan in their area.
Enrollment & Eligibility for Medicare Advantage Plans in Louisiana
Seniors can enroll in Louisiana’s Medicare Advantage program if they’re eligible for Medicare Parts A and B and meet the following criteria:
- Are at least 65 years old, or have a qualifying disability if younger
- Live in an area where Medicare Advantage plans are sold
- Aren’t enrolled in a Medigap insurance plan
- Are a U.S. citizen or permanent resident
- Not suffering from End Stage Renal Disease, although an SNP may be an option
The enrollment periods for Medicare Advantage plans run throughout the year, and each period has different criteria. Some enrollment periods are only open to existing members who wish to switch plans, while others are only available to first-time applicants.
- Initial coverage election periods are only available to first-time applicants. This enrollment period runs for seven months, including the three months before an applicant’s 65th birthday month and the three months following.
- Annual election periods start on October 15th and end on December 7th. This enrollment period is only available to Original Medicare members changing to a Medicare Advantage plan for the first time or to existing Medicare Advantage members interested in switching plans.
- Medicare Advantage open enrollment periods are for existing Medicare Advantage participants who are changing plans or reverting back to Original Medicare coverage. The period runs from January 1st to March 31st.
- Special general enrollment periods are available to Medicare Part A members who enrolled in Part B during open enrollment and wish to change to a Medicare Advantage plan. This enrollment period runs from April 1st to June 30th.
Prescription Drug Coverage
Medicare prescription drug coverage, also known as Medicare Part D, is an optional benefit to all Medicare participants. This coverage may come packaged as a Medicare Advantage Prescription Drug plan, also known as an MA-PD. Members enrolled in an HMO or PPO plan that doesn’t include drug coverage cannot obtain a stand-alone Medicare Part D plan. However, PFFS plans offer coverage for prescription drugs or allow participants to enroll in a stand-alone Medicare Part D plan. It’s a legal requirement that all SPNs include prescription drug coverage.
Medicare Advantage Resources in Louisiana
For seniors to make an informed decision about which Medicare Advantage plan is the best choice, they must be armed with all the facts. That includes a thorough understanding of each plan, eligibility criteria, and network rules. They should also be aware of potential scams and understand how costs are calculated. Fortunately, Louisiana is home to a number of free and unbiased resources that can help seniors get the information they need to make the right decision.
Senior Health Insurance Information Program (SHIIP)
The Senior Health Insurance Information Program (SHIIP) helps Medicare beneficiaries understand their Medicare benefits and coverage options. Experienced counselors are on hand to provide free and impartial guidance over the phone or through interactive face-to-face sessions. From enrollment periods and network options to understanding how to change plans, counselors can help seniors make an informed choice about their healthcare coverage.
- Contact Information: Website | 800-259-5300
Louisiana Senior Medicare Patrol (SMP)
The Louisiana Senior Medicare Patrol program helps Medicare beneficiaries to detect, prevent, and report any instances of healthcare fraud or abuse. This free service not only protects seniors from potential scams and financial fraud but also helps preserve and protect the integrity of the Medicare program in Louisiana. Seniors can arrange a face-to-face discussion with an SMP volunteer or speak over the phone. The majority of SMP volunteers are retired and enrolled in Medicare and are, therefore, in a good position to inform their peers.
- Contact Information: Website | 877-272-8720
Capital Area Agency on Aging
The primary purpose of the Capital Area Agency on Aging is to provide systems and services designed to assist seniors with living meaningful, independent, and dignified lives in their own communities and homes for as long as possible. The agency services several counties in southeastern Louisiana, including the city of Baton Rouge. It offers free assistance obtaining low-cost prescriptions and enrolling in Medicare Part D.
- Contact Information: Website | 225 922 2525
- Featured Sources [-]
https://www.cms.gov/Medicare/Health-Plans/SpecialNeedsPlans Last accessed April 2021
https://www.medicare.gov/blog/medicare-enrollment-period-2020 Last accessed April 2021
https://www.medicare.gov/drug-coverage-part-d Last accessed April 2021
https://www.ldi.la.gov/consumers/senior-health-shiip Last accessed April 2021
https://stopmedicarefraud.org/ Last accessed April 2021
https://www.capitalaaa.org/ Last accessed April 2021
Roseann Birch, Medicare Consultant
With experience in the insurance field since 1986, Roseann Birch is a seasoned Medicare consultant who is passionate in educating and guiding seniors through their Medicare and Medicare Advantage journey.
Leron Moore, Medicare Consultant
With over 10 years of experience in the Medicare industry, Leron Moore has dedicated his career to effecting change, educating, informing, and resolving issues for Medicare patients and their families.