- In 2019, there were 51 Medicare Advantage Plans available in Louisiana.
- 34% of the total Medicare population in Louisiana was enrolled in Medicare Advantage Plans as of 2018.
- In 2018, Original Medicare spent an average of $11,932 per beneficiary in Louisiana, which is 18% higher than the national average.
- Available Medicare Advantage Plans range from 17 to 36 across Louisiana’s 64 counties.
With Medicare Advantage, plan availability depends on where you live and what kind of coverage you need. You may be able to save money by buying an inexpensive plan with a high deductible, but if you have ongoing medical needs, you may save more in the long run by choosing a plan with a lower deductible and a higher monthly premium. It all depends on your overall health and how often you typically see a doctor.
Medicare Advantage Plans in Louisiana
Types of Medicare Advantage Plans
One of the advantages of choosing Medicare Advantage over Original Medicare is that Louisiana’s Medicare Advantage program offers several types of insurance coverage. Some plans require you to use providers in a specific network, while others give you the freedom to choose doctors based on their credentials and proximity to where you live.
Health Maintenance Organizations (HMO)
HMO plans tend to have more restrictions than other plans but are often less costly. If you sign up for an HMO, you’ll have to choose a primary care provider, a medical professional who’s responsible for your care. You’ll also have to ask your PCP to give you a referral if you need to see any medical specialists. If you go to a provider outside your HMO network, your plan probably won’t cover the cost.
Preferred Provider Organizations (PPO)
If the restrictions of an HMO won’t work with your health needs, a PPO may be a better choice. When you enroll in a PPO plan, you don’t have to choose a PCP, nor do you have to request referrals to see specialists. It typically costs less to see a provider in your plan’s network. PPO plans don’t prevent you from seeing out-of-network providers, but you’ll have to pay a higher percentage of the cost if you do.
Private Fee-for-Service Plans (PFFS)
With a private fee-for-service plan, providers receive a set amount of money for their services. The Centers for Medicare & Medicaid Services determines these amounts based on each provider’s location and specialty. CMS may also vary the fees to encourage members to get certain preventive services. If your doctor won’t agree to accept the set fee for his or her services, then you’ll have to choose a new provider or pay the full cost of the service.
Special Needs Plans (SNP)
Not all Medicare-eligible individuals qualify for a special needs plan, which is a plan established exclusively for people with certain health conditions. When you enroll in an SNP, you may be assigned a care coordinator who can give you accurate health information and make sure you get the care you need. SNPs are available for people who are dually eligible for Medicare and Medicaid, live in an institutional setting or have cancer, heart failure, and other chronic illnesses.
Enrollment and eligibility for Medicare Advantage Plans in Louisiana
You may qualify for Medicare Advantage if all of the following apply:
- You’re eligible for Medicare Part A and Part B.
- You’re at least 65 years old, or you’ve been receiving disability benefits for at least two years.
- You’re not enrolled in a Medigap plan.
- You live in the service area of the plan you want to join.
Enrolling in Medicare Advantage
Unless you qualify for a special enrollment period, you must sign up for Medicare Advantage during one of the following periods:
- Initial enrollment: Your initial enrollment period starts three months before your 65th birthday and ends three months after you turn 65. If you’ve never had Medicare before, you can sign up for Medicare Advantage or Medicare Part D. If you had Medicare coverage before you turned 65, you can switch plans during your IEP.
- Open enrollment: You can switch Medicare Advantage plans or join a Medicare Advantage plan between October 15th and December 7th each year.
- Medicare Advantage open enrollment: From January 1st to March 31st, you can switch Medicare Advantage Plans or disenroll from Medicare Advantage and sign up for Original Medicare.
You may qualify for a special enrollment period if any of the following apply:
- You lose your previous health coverage.
- You move outside your plan’s service area or to a place with new Medicare Advantage options.
- Medicare takes adverse action against your plan.
- You have the opportunity to enroll in other coverage.
- You lose your eligibility to participate in an SNP.
Prescription drug coverage
Prescription coverage is an important consideration when choosing a Medicare plan. Medicare Advantage Plans are considered an all-in-one option, meaning most of them cover prescriptions. If you choose a PFFS plan, however, it may not cover the cost of your medications. In that case, you can purchase a Medicare Part D prescription supplement plan. You must pay a separate premium for Medicare Part D, and you may also have to pay an annual deductible and a copay for each medication you need. Be advised that you can’t sign up for a Part D plan if you also have a Medicare Advantage Plan that comes with prescription coverage.
Medicare Advantage Resources in Louisiana
Before committing to a specific Medicare plan, it’s wise to discuss your options with an unbiased individual. Louisiana has several organizations with trained staff and volunteers available to help you compare plans and estimate your total cost including premiums, copays, deductibles, and coinsurance. These organizations include the New Orleans Council on Aging, the Senior Health Insurance Information Program, and Senior Medicare Patrol. Many organizations also publish educational materials for you to share with your loved ones.
New Orleans Council on Aging
The New Orleans Council on Aging protects the rights of older adults living in Orleans Parish and helps local residents maintain their independence. It does this by coordinating a variety of services for seniors and their caregivers. Although NOCA doesn’t provide insurance counseling, staff members can refer you to reliable resources on Medicare benefits and enrollment. If you live outside NOCA’s service area, you can contact the Area Agency on Aging in your area of Louisiana for assistance.
Contact Information: Website | 504-821-4121
Senior Health Insurance Information Program
Louisiana’s Senior Health Insurance Information Program ensures that residents have access to reliable, unbiased information regarding their health insurance options. If you aren’t sure whether to enroll in Original Medicare or Medicare Advantage, or you don’t know whether you can buy Medicare Part D or a Medigap supplement with your current plan, contact SHIIP to speak with a trained counselor. SHIIP partners with agencies across the state to ensure older adults have access to its services.
Contact Information: Website | 225-342-5301
Senior Medicare Patrol
Louisiana, Mississippi, and Georgia residents share a regional Senior Medicare Patrol program, which is funded by a grant from the Administration for Community Living and sponsored by eQHealth AdviseWell. The program is designed to help older adults and their loved ones prevent Medicare fraud and identify fraud quickly if it does occur. Counselors are on hand to help you understand your Medicare statements and teach you how to reduce your risk of identity theft. SMP also has webinars on topics of interest to Medicare-eligible individuals.
Contact Information: Website | 225-248-7077
Learn More From Our Sources
- Medicare.gov | Your Medicare coverage choices | Last accessed June 2021
- Medicare.gov | Understanding Medicare Advantage Plans | Last accessed June 2021
- CMS.gov | Private Fee-for-Service Plans | Last accessed June 2021
- Medicare.gov | How Medicare Special Needs Plans (SNPs) work | Last accessed June 2021
- SSA.gov | Medicare | Last accessed June 2021
- Medicare.gov | Special circumstances (Special Enrollment Periods) | Last accessed June 2021
- Medicare.gov | Drug coverage (Part D) | Last accessed June 2021