Louisiana health insurance marketplace guide 2023

Louisiana uses the federally facilitated exchange, so residents use HealthCare.gov to enroll in exchange plans.

Louisiana is among the 26 states that initially left all responsibility for its health insurance marketplace to the federal government. Former Gov. Bobby Jindal repeatedly rejected a state-run exchange and even returned a $1 million federal planning grant. He also refused to expand Medicaid under the ACA, although Governor John Bel Edwards reversed Jindal’s position on Medicaid expansion, and eligibility was expanded in mid-2016.

The open enrollment period for individual/family coverage runs from November 1 through January 15 in Louisiana. This is true both on-exchange and off-exchange.

Enrollments need to be completed by December 15 in order to have coverage effective January 1; enrollments completed in the final month of open enrollment have February 1 effective dates. 

Outside of open enrollment, a qualifying event is generally necessary to enroll or make changes to your coverage. But through at least the end of 2025, there’s an ongoing enrollment opportunity for people who are eligible for premium subsidies and whose household income doesn’t exceed 150% of the poverty level.

If you have questions about enrollment opportunities, you can learn more in our comprehensive guide to open enrollment and our comprehensive guide to special enrollment periods. 

Before premium subsidies are applied, the average premium in Louisiana’s exchange was $764/month as of early 2022. But nearly 93% of Louisiana exchange enrollees received premium subsidies at that point, which offset the vast majority of the cost (the average subsidy was about $655/month). Subsidies are larger than they used to be, thanks to the American Rescue Plan.

Subsidies are based on the cost of the benchmark plan, so they vary from one year to the next. For 2023, the average benchmark plan in Louisiana costs $565/month, up from $541 in 2022. So subsidies are a bit larger for 2023.

There are six insurers that offer exchange plans in Louisiana for 2023, and all of them also offered coverage in 2022 (two were new that year; UnitedHealthcare and Ambetter from Louisiana Healthcare Connections both joined the exchange for 2022).

The following insurers offer plans in the Louisiana exchange, with plan availability varying from one location to another:

• Ambetter from Louisiana Healthcare Connections
• Blue Cross Blue Shield of Louisiana (merging with Elevance/Anthem in 2023)
• HMO Louisiana
• Vantage Health Plan
• Christus
• UnitedHealthcare

In 2014, plans were available in Louisiana’s exchange from Louisiana Health Service and Indemnity Company (LHSIC), HMO Louisiana, Louisiana Health Cooperative (an ACA-created CO-OP), Humana, and Vantage Health Plans.

UnitedHealthcare joined the exchange in Louisiana for 2015, bringing the total number of participating insurers to six.

But in July 2015, the Louisiana Health Cooperative announced that it would not participate in 2016, and that existing policies would terminate at the end of 2015. Louisiana Health Cooperative was only the second CO-OP to fail (after CoOpportunity in Nebraska and Iowa), but ultimately ten more CO-OPs closed their doors by the end of 2015, and only three (out of an original 23) were still operational as of 2022.

At the end of 2016, UnitedHealthcare also exited the individual market in Louisiana, as was the case in most states where United offered exchange plans in 2016. United insured about 13% of the people who enrolled in exchange plans in Louisiana for 2016.

Humana announced on February 14, 2017, that they would exit the individual market nationwide at the end of 2017, so their plans were no longer available in Louisiana as of 2018. By 2018, coverage was only available from LHSIC, HMO Louisiana (both owned by the same parent company), and Vantage Health Plans.

That continued to be the case in 2019, but Christus joined the exchange for 2020, bringing the total number of insurers back up to four.

And for 2022, UnitedHealthcare returned to the exchange in Louisiana, and Ambetter from Louisiana Healthcare Connections also joined the exchange, bringing the number of participating insurers to six.

According to ratereview.healthcare.gov, Louisiana’s exchange insurers implemented the following average rate changes for 2023:

• Blue Cross Blue Shield of Louisiana (Louisiana Health Service and Indemnity Company): 21.9% decrease.
• HMO Louisiana (a subsidiary of Blue Cross Blue Shield of Louisiana):  2.2% increase.
• Vantage Health Plan: 5.8% increase.
• Christus Health Plans: 9.6% increase.
• Ambetter from Louisiana Healthcare Connections: 10.4% increase.
• UnitedHealthcare: 9.1% increase.

The rates were reviewed by the Louisiana Department of Insurance for actuarial justification and compliance with state and federal requirements. But as is the case in many states, Louisiana officials don’t have the authority to reject rate increases, they can only deem them justified or unjustified.

Although average rate changes and the overall weighted average rate change can give us an indication of how stable a state’s market is, these numbers aren’t particularly useful in terms of understanding how a given enrollee’s rates will change. There are a few reasons for this:

• Average rate changes only apply to full-price premiums, and most enrollees don’t pay full price. They receive subsidies that offset a portion of the cost, and those subsidy amounts can fluctuate from one year to the next.
• Overall average rate changes do not account for the fact that premiums increase with age. A person whose plan has a 0% rate change will still see higher premiums each year, just due to their increasing age (subsidies also grow to keep pace with the age-related increase in premiums).
• A weighted average, by definition, lumps all the plans together. But different insurers offer plans in different parts of the state, and each insurer’s rate change is different. So the specific rate change that applies to a given enrollee can vary quite a bit from the average.

At the end of the open enrollment period for 2022 coverage, there were 99,626 people enrolled in plans through Louisiana’s exchange, up from  83,159 people the year before. 

2021 enrollment had been a record low, but 2022 enrollment climbed to the highest it had been since 2018.

Enrollment in Louisiana’s exchange had dropped substantially since 2016, but much of the decline in enrollment is due to the state’s expansion of Medicaid, which took effect in mid-2016 (as opposed to 2014, as was the case in many other states). During the COVID pandemic, states cannot terminate Medicaid enrollments even if a person’s income increases, and the widespread income/job losses have resulted in a much higher percentage of the population being deemed eligible for Medicaid nationwide. In Louisiana, Medicaid enrollment under the ACA’s Medicaid expansion rules had grown to more than 732,000 people by May 2022.

Here’s a look at how enrollment (during open enrollment) in private plans in Louisiana’s exchange has changed over time:

• 2014: 101,778 people enrolled.
• 2015: 186,277 people enrolled.
• 2016: 214,148 people enrolled. Enrollment peaked in Louisiana’s exchange in 2016, as was the case in most states that use HealthCare.gov (in most of them, enrollment grew to a new record high in 2022, but Louisiana’s late expansion of Medicaid meant that 2016 continues to be the exchange’s peak enrollment year).
• 2017: 143,577 people enrolled. The drop in enrollment was due mostly to the fact that Louisiana expanded Medicaid as of mid-2016. People with household income between 100% and 138% of the poverty level were eligible for premium subsidies and cost-sharing subsidies in the exchange during the 2016 open enrollment period, but they became eligible for Medicaid instead in July 2016, and did not need to enroll in private plans during the 2017 open enrollment period.
• 2018: 109,855 people enrolled. Open enrollment was only half as long for 2018 coverage, and federal funding for HealthCare.gov’s marketing and enrollment assistance was sharply curtailed. The result was lower total enrollment in most states that use HealthCare.gov. But while the average enrollment drop was about 5%, enrollment in Louisiana’s exchange dropped by more than 23% — the largest drop in the country. This was likely due in part to the fact that enrollment in the state’s expanded Medicaid program continued to grow sharply in 2017 and 2018.
• 2019: 92,948 people enrolled. Some of the drop-off is likely related to the state’s implementation of Medicaid expansion, but enrollment declines in 2019 can also be attributed to the elimination of the individual mandate penalty (via federal legislation) and the expansion of short-term health plans (via Trump administration regulations).
• 2020: 87,748 people enrolled.
• 2021: 83,159 people enrolled. This was a record low and was down 58% from peak enrollment in 2016. But Medicaid expansion enrollment had grown by more than 170,000 people from mid-2020 to the fall of 2021.
• 2022: 99,626 people enrolled. And by October 2022, Medicaid expansion enrollment stood at more than 750,000 people, which was up more than 228,000 from where it had been in mid-2020.

For perspective, here’s a look at how premiums have changed in Louisiana’s exchange since ACA-compliant plans debuted in 2014:

• 2015: Average increase of 12% That was according to an analysis from the Commonwealth Fund, which found, by comparison, a 0% change in premiums nationally.
• 2016: Average increase of 15.4% In the Louisiana exchange, two individual market carriers requested rate increases of 10% or more for 2016: HMO Louisiana, and Louisiana Health Service & Indemnity (Blue Cross Blue Shield of Louisiana). For both carriers, the rates were finalized as-requested (Louisiana Health Cooperative had requested rate increases of about 23%, but the CO-OP stopped offering coverage at the end of 2015). The Louisiana Department of Insurance published proposed and final rate changes for all of the carriers in their individual and small group markets, including on and off-exchange carriers. For the insurers that offered plans in the exchange in 2016, rate increases ranged from just over 4% for Humana, to 15-20% for BCBSLA.
• 2017: Average increases ranged from 23% to 41% Average rate increases were steep for 2017, as was the case in most states. In Louisiana, BCBSLA increased premiums by an average of 41%, HMO Louisiana increased rates by 23-30%, Humana increased rates by an average of 29.5%, and Vantage Health Plan increased premiums by an average of 31.5%.
• 2018: Average increase of 21.4% On average, Louisiana rate increases would have been in the single digits (a little over 7%) if cost-sharing reduction (CSR) funding had been committed (rather than eliminated) and the individual mandate was being strongly enforced. Instead, the average rate increase was more than 21%.But because the cost of CSR was added to silver plan rates, 2018 premium subsidies in Louisiana were much larger than they would otherwise have been. People who purchased bronze or gold plans with the help of a premium subsidy may have after-subsidy rates are lower than they were in 2017, due to the larger premium subsidies. Some states waited until CSR funding was officially eliminated before they allowed insurers to add the cost to premiums for 2018, and other states had back-up plans in place, given the uncertainty. But the Louisiana Department of Insurance confirmed in September 2017 that there was no contingency plan in place in Louisiana to allow insurers to refile new (lower) rates if CSR funding had been allocated. The rates that were filed were based on the (correct) assumption that CSRs would not be funded, and were slated to take effect (assuming the Department of Insurance deemed them justified, which they did) regardless of what might have happened with CSR funding. The Department of Insurance noted that if CSR funding had ultimately been allocated in 2018 by the federal government (which did not happen), the situation would have been worked out via the medical loss ratio rebates, with rebates sent to consumers to account for that fact that premiums would have been too high.
• 2019: Average decrease of 6.4% In August 2018, the Louisiana Department of Insurance announced that average rates for individual market plans sold through Louisiana’s exchange would be 6.4% lower in 2019 than they had been in 2018. That decrease came despite the fact that rates were still higher than they would otherwise have been if the GOP tax bill hadn’t repealed the individual mandate penalty as of 2019, and if short-term plans and association plans hadn’t been expanded by the Trump Administration. At ACA Signups, Charles Gaba estimates that premiums in Louisiana would have dropped by nearly 16% without those factors.
• 2020: Average increase of 11.7% For 2020, Louisiana was one of just three states (the other two are Indiana and Vermont) where average premiums increased by double-digit percentages. Louisiana’s exchange had four insurers offering plans in 2020 (two are part of the same parent company), including newcomer Christus Health Plans, which joined the exchange in the Shreveport/Bossier, Lake Charles, and Alexandria areas (off-exchange plans are available in the “entire western third of the state”). Christus already had “an established hospital and primary care presence” in these areas of the state, so the introduction of their health plans was anticipated to be a good fit in those areas. This was the first time since 2015 (when UnitedHealthcare joined the exchange) that Louisiana’s exchange had a new insurer join the market. Christus Health Plans previously offered exchange plans in Texas and New Mexico, but they stopped offering coverage in New Mexico at the end of 2019, after failing to meet the state’s QHP certification requirements. So as of 2020, Christus plans were available in Louisiana and Texas, but not in New Mexico. Rate filings are publicly available on the Louisiana Department of Insurance website. The average increase of 11.7% applied across the three existing insurers.
• 2021: Average increase of 6.9%. The approved rates were the same as the rates the insurers initially proposed, amounting to a 6.9% average increase.
• 2022: Average increase of 4.75%. The rate changes for 2022 amounted to a weighted average increase of about 4.75%.

Seven insurers currently offer dental plans through the Louisiana marketplace. Learn about dental coverage options in Louisiana.