Medicare Plan Options
While Original Medicare provides the same basic coverage for all enrollees, you may need more than the standard coverage of Parts A and B. There are several ways to customize your Medicare policy. As an alternative to Original Medicare, Louisiana’s Medicare Advantage program provides all the basic coverage included in Parts A and B and some additional benefits, such as vision and dental coverage, residential care, and gym memberships. Prescription drug coverage and Medicare Supplement Insurance plans can be added to your Medicare policy to make it a better fit for your needs.
Original Medicare is the basic health care coverage managed by the federal government. It has two parts. Part A covers inpatient care in a hospital, nursing home care, short-term care in a skilled nursing facility, hospice, and home health care. Part B covers medically necessary services and preventative care, including clinical research, ambulance services, mental health services, medical equipment such as walkers and blood sugar meters, and a handful of outpatient prescription drugs. You have the freedom to go to any health care provider who accepts Medicare, and you don’t have to choose a primary care doctor or get a referral to see a specialist.
Medicare Advantage Plans
A Medicare Advantage Plan is another way to receive your Medicare benefits. These plans are provided by private insurance companies and are similar to the insurance plans available on the federal Marketplace and through employers. There are several different types of Medicare Advantage Plans: HMOs, PPOs, PFFS, and Special Needs Plans. Regardless of the plan type, all Medicare Advantage Plans provide the same basic coverage as Original Medicare. However, they often include additional benefits such as dental, vision, and prescription drugs, making them a popular option for those who want more robust coverage. Depending on your plan, you may have to see an in-network provider, choose a primary care doctor, and get a referral to see a specialist.
Medicare Prescription Drug Coverage Plans
Original Medicare doesn’t include prescription drug coverage. If you use prescription medications now or expect to in the future, you may opt to add optional coverage to your policy. Prescription drug coverage, which is called Part D, covers a variety of drugs, including brand name and generic medications and commercially available vaccines. Part D coverage can be added to Original Medicare and Medicare Advantage PFFS plans, although it can’t be added to other Medicare Advantage Plans. Part D plans have separate premiums, annual deductibles, and copays. How much you pay for a given medication depends on whether your plan covers the drug, what tier it’s in, and whether you’ve met your out-of-pocket limit.
Medicare Supplement Insurance Plans
Medigap policies are sold by private licensed health insurance companies to supplement Original Medicare, reducing your out-of-pocket costs on deductibles and copays. These policies are standardized, meaning that they all provide the same benefits to all enrollees. With a Medigap plan, you pay a monthly premium in addition to the premium you pay for your Original Medicare policy. When you receive a medical service, Medicare pays the Medicare-approved amount, then your Medigap policy pays its share, and you’re responsible for whatever is left over.
Medicare in Louisiana by the Numbers
|People enrolled in Original Medicare||Average plan cost||Annual state spending per beneficiary||Spending per beneficiary compared to the national average|
|508,604||Plan A: $0 to $471 per month*
Plan B: $148.50 per month**
*Most people pay no premium, but this can vary depending on how long they paid Medicare taxes.
**This is the average number, but it can vary based on income.
Medicare Resources in Louisiana
Choosing the right Medicare coverage can significantly cut down on what you spend for health services. Through Louisiana’s Senior Health Insurance Information Program, you can work with an expert who can help you get the most from Medicare. You can connect with Louisiana SHIIP counselors through the state’s Department of Insurance, local Area Agencies on Aging, the statewide Aging and Disability Resource Center, and local nonprofit law firms.
Louisiana Department of Insurance
The Louisiana Department of Insurance sponsors SHIIP, a program that helps you understand your Medicare coverage options and benefits. This free program provides unbiased information regarding Original Medicare’s coverage limits and Medigap and Medicare Advantage Plans available in your area. Its counselors can help you understand and organize medical bills and dispute denied claims. Through the Department’s website, visitors can find SHIIP counselors in their community.
Contact Information: Website | 225-342-5301 or 800-259-5300
New Orleans Council on Aging
The New Orleans Council on Aging is one of the state’s 34 Area Agencies on Aging. This federally funded agency provides a range of services to older adults and those with disabilities, including information and referrals for local resources, legal assistance, and Medicare options counseling. Through the statewide SHIIP, trained volunteers help you get the most from your Medicare benefits, understand your coverage options, and determine which plan can save you the most money on medical expenses.
Contact Information: Website | 504-821-4121
Aging and Disability Resource Center
The statewide ADRC serves as a single point of contact for older adults with questions about community-based services and programs, health care services, and Medicare benefits. Through the ADRC, you can find contact information for SHIIP counselors in your region. While these counselors aren’t licensed to sell insurance plans, they can provide free, unbiased information about Medicare, including benefits, cost comparisons, and assistance with disputing denied claims or canceled policies.
Contact Information: Website | 877-340-9100
Southeast Louisiana Legal Services
Medicare beneficiaries in the southeastern region of the state may be eligible for free civil legal assistance and representation through Southeast Louisiana Legal Services. This nonprofit law firm offers professional assistance comparing different Medicare, Medicare Advantage, and Medigap plans and enrolling for coverage. Staff can help you navigate the appeals process if an eligible medical service is denied coverage or if your policy is canceled.
Contact Information: Website | 504-529-1000 or 877-521-6242
Learn More from Our Sources
- Medicare | How Original Medicare Works
- Medicare | What Part A Covers
- Medicare | What Part B Covers
- Medicare | Medicare Advantage Plans
- Medicare | Drug Coverage (Part D)
- Medicare | What Medicare Part D Drug Plans Cover
- Medicare | Drug Plan Coverage Rules
- Medicare | How to Get Prescription Drug Coverage
- Medicare | What’s Medicare Supplement Insurance (Medigap)?
- Medicare | How to Compare Medigap Policies