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Medicare Plans in Louisiana – Coverage and Benefits

Any Louisiana resident who is at least 65 years of age has the option to enroll in Medicare. When you enroll, you automatically start receiving benefits from Parts A and B (see the table below for specific descriptions on what each part provides). These first two parts, often labeled as “Traditional” or “Original” Medicare, are designed to cover the majority of your health care needs during your retirement years.

Original Medicare starts out as a fairly affordable policy. Part B requires a monthly premium and an annual deductible, and you can find out what those costs are by visiting this page. Part A might be free for anyone with a lengthy work history. You’ll need at least 10 years (or 40 quarters) of experience, otherwise you might have to pay a fee for Part A benefits.

Medicare Part A (Hospital Coverage)

  • Inpatient care in hospitals
  • Skilled nursing facility care
  • Hospice care
  • Home health care
Medicare Part B (Medical Insurance)

  • Services from doctors and health providers
  • Outpatient care
  • Home health care
  • Durable medical equipment
  • Some preventive services
Medicare Part C (Medicare Advantage)

  • Includes all benefits and services covered under Part A and Part B
  • Usually includes Medicare prescription drug coverage (Part D) as part of the plan
  • Run by Medicare-approved private insurance companies
  • May include extra benefits and services for an extra cost
Medicare Part D (Drug Coverage)

  • Helps cover the cost of prescription drugs
  • Run by Medicare-approved private insurance companies
  • May help lower your prescription drug costs and help protect against higher costs in the future

The Variety of Medicare Insurance Programs in Louisiana

If you are a retirement-aged individual living in Louisiana right now, then odds are you are one of the 718,037 people currently receiving Medicare benefits. Of those, 28% (201,050 people) are getting their Medicare benefits from a Medicare Part C, or Medicare Advantage policy. And additional 16% (115,640 individuals) are supplementing their Medicare with a Medigap supplement insurance policy. Finally, 56% of Louisiana Medicare recipients are either supplementing their health care needs with some sort of employer benefit, or have no protection from the disastrous gaps in Medicare coverage at all.

Are you new to the federal Medicare program? For more information on Medicare enrollment and benefits, click the provided link.

If I Live in Louisiana, Will I Need Medicare Supplement Insurance?

No matter where you live, purchasing supplement coverage for your Medicare benefits is a good idea. For the record, though, it is not a requirement, legally or otherwise. The decision is yours to make. If you are relatively young and still fairly healthy, you might not think you need the extra expense per month. But if you don’t have it, and you are relying on Original Medicare alone, any sudden catastrophic change in your health could leave you vulnerable to the following expenses:

Medicare Part A Costs Medicare Part B Costs
  • $1,184 (as of 2014) Part A Annual Deductible for access to Basic Hospital Services
  • $296/day for an Inpatient hospital Stay between 61-90 days long
  • $147 Annual Deductible (as of 2014) for basic Part B Medical Coverage
  • 80/20 Coinsurance costs for all Medicare coverage; Medicare pays 80%, you pay 20% Out-of-Pocket

Supplemental policies protect you and your finances from the expensive gaps in Original Medicare. Without coverage, the dollar amounts quoted above are just the tip of the iceberg. There’s no telling how many thousands of dollars you may be required to pay if you suffer an unforeseen medical emergency.

Coverage Option #1: Medicare Supplement Plans in Louisiana

Medigap – which is a clever amalgamation of the words “Medicare” and “gap” – is a type of supplemental policy designed to protect you from the coverage gaps associated with Original Medicare. It is separate from your Medicare benefits, and is underwritten by a private insurance company. The federal government has worked closely with health insurance providers to design ten plans which will give you the best protection at the most affordable cost: Plans A-D, F, G, and K-N. Each plan is identical, regardless of your location. But the overall expense and the company offering your policy will vary by location.

For a comprehensive description of what each plan offers, take a look at the table below:

[chart category=”supplement” name=”planTypes” state=”LA” zipcode=”70119″]

Coverage Option #2: Medicare Advantage Plans in Louisiana

Medicare Part C, sometimes also referred to as Medicare Advantage, is a private alternative to your government-sponsored Medicare Parts A & B. When you purchase a Medicare Advantage policy, you begin receiving your benefits from a private health insurance company and the government is no longer responsible for your care. The good news, however, is that your benefits will be protected by law. It is illegal for anyone offering a Medicare Advantage policy to give you fewer benefits or inferior coverage compared to Traditional Medicare.

Some of the pros associated with Medicare Advantage are its simplicity and possible additional benefits (although many of those benefits come at an additional cost). Only dealing with one company is a relief for some. And the added benefits, such as prescription drug coverage or dental which are not offered by Original Medicare, are a nice touch – even if you do have to pay a little extra for them. However, if you are particularly attached to your current doctor, then do a little digging into your Medicare Advantage plan’s network before you buy a policy. Some of their PPO and HMO networks are notoriously limited, and you may have to switch physicians.

Are you familiar with Health Maintenance and Preferred Provider (HMO and PPO) Organizations? The charts below display some of the more affordable networks in your area:

[chart category=”advantage” name=”topHMOPlans” zipcode=”70119″ state=”LA”]

[chart category=”advantage” name=”topPPOPlans” zipcode=”70119″ state=”LA”]

Comparing Louisiana Medigap vs. Medicare Advantage

In the table below, we’ve highlighted some important differences between these two popular forms of supplemental insurance. Plan cancellations, monthly premiums, and budgeting ability are all very important, yet very different aspects of each plan:

Questions Medicare Advantage Medicare Supplement
How are the plans funded? Medicare will pay your insurance company a fixed amount based on average healthcare costs for your region. You may also be required to pay a premium based on your location and insurance company. Your monthly premium takes care of the majority of your expenses.
Do I continue paying for Part B? Yes Yes
What does it cost me? Some plans offer a zero-dollar premium (because the government subsidy covers the full cost). Other plans may cost up to 0-0 monthly. While each plan does require a monthly premium, many of them are affordably priced.
What does the plan cover? Depending on your plan, it will cover at least the same benefits offered by Medicare parts A & B. Possibly other benefits; but the more benefits you sign up for, the higher your out-of-pocket expenses may be. All eligible expenses are split between Medicare, and your Medicare Supplement plan. If you have a comprehensive plan, such as Plan F, 100% of eligible expenses not covered by Medicare will be covered by your supplement insurance.
Can I budget my health care expenses? It’s challenging; the more often you require medical care, the more often you may be required to pay out-of-pocket. Budgeting is much easier with a Medicare supplement. You have fewer out-of-pocket expenses, and one simple monthly premium.
Can my plan be cancelled? Yes. Unfortunately, your health insurance company has the legal right to review their Medicare Advantage services annually and decide whether or not they wish to continue providing coverage. No – not unless you fail to pay your monthly premium, or your insurance company goes bankrupt. Only under such extenuating circumstances could your plan be cancelled.
Are pre-approvals or pre-certifications required? Unfortunately, yes. These Plans usually require pre-certification or other qualification for some specific types of care. No pre-approvals are required. If you qualify for Medicare, you will qualify for a Medicare supplement plan.
Can I use any doctor or hospital? Usually, you choose from a network of pre-approved providers. These networks can fluctuate over time. Yes. You are free to choose any doctor and/or hospital in the U.S. which accepts Medicare.
Can drug, vision, or dental coverage be included in the policy? Yes. No. These forms of coverage must be purchased separately.
Who is this plan type generally best suited for? If you are relatively young, healthy, live in an urban area, and have a limited income, a Medicare Advantage plan could work for you. If you live in a rural area without easy access to provider networks, if you like to budget your finances, or if you want comprehensive coverage, you might prefer a Medicare supplement plan.

Additional Medicare Resources in Louisiana

If you have any further questions, please take a minute to look at the directory below. In it you will find a plethora of resources and contact information for experts in the Medicare field. They will be more than happy to answer any questions or concerns you may have regarding your health care benefits.

[chart category=”general” name=”usefulContacts”]

Important Medicare Terms

  • HMO: Health Maintenance Organization, this refers to a network of doctors and hospitals with a plans’ network.
  • PPO: Preferred Provider Organization, this refers to a network of doctors and hospitals with a plans’ network.
  • Co-Pay: Amount of money charged per visit to doctor, specialist, etc.
  • Co-Insurance: A percentage required by the policyholder to pay out-of-pocket. For example, 80/20 coinsurance means the insurance company will cover 80% of the charges, and the policyholder pays the remaining 20% of the charges.
  • Deductible: This is the amount of money required out-of-pocket by the policyholder before the insurance will kick-in and pay for any remaining charges. For example, a policy with a $1,000 deductible means that you must pay full healthcare costs out-of-pocket up to $1,000 before the plan will start coverage.




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