- Open enrollment for 2022 coverage in Louisiana: November 1, 2021 through January 15, 2022.
- UnitedHealthcare rejoining Louisiana’s marketplace, after leaving at the end of 2016.
- Average rates increasing by about 4.75% for 2022
- Short-term health plans can be sold in Louisiana with initial plan terms up to 12 months.
- Louisiana has enacted legislation to codify ACA consumer protections if the ACA is overturned… while also backing the lawsuit that seeks to overturn the ACA.
- Lawmakers considered – but rejected – reinsurance to stabilize individual market
- Enrollment peaked in 2016, but had dropped to a record low by 2021. The decrease is partially due to Medicaid expansion, which covered more than 617,000 people as of early 2021.
- State law provides added transparency for out-of-network charges
What type of health insurance exchange does Louisiana have?
Louisiana uses the federally facilitated exchange, so residents use HealthCare.gov to enroll in exchange plans.
When can I enroll in health insurance in Louisiana?
Open enrollment for 2022 health plans in Louisiana started November 1, 2021 and continues through January 15, 2022. This is a month longer than the enrollment window has been in recent years, and this extended window will continue to be used in future years. If you enrolled or made a plan change by December 15, 2021, your new coverage will take effect January 1, 2022. Enrollments and plan changes completed between December 16 and January 15 will have coverage effective February 1, 2022.
The open enrollment period in the fall of 2021 is an excellent opportunity to take advantage of the American Rescue Plan’s subsidy enhancements, which will still be in effect throughout 2022. As a result of the enhancements, subsidies are larger and more widely available than they were in previous years.
If you have questions about open enrollment, you can learn more in our comprehensive guide to open enrollment.
If you need coverage in Louisiana for the final months of 2021, you may still be able to enroll if you experience a qualifying life event, or if you’ve received unemployment compensation at any point in 2021.
How much does health insurance cost in Louisiana?
Before premium subsidies are applied, the average premium in Louisiana’s exchange was $741/month as of early 2021. But 91% of Louisiana exchange enrollees received premium subsidies at that point, which offset the vast majority of the cost (the average subsidy was about $628/month). And those subsidies have since increased and become more widely available, thanks to the American Rescue Plan.
Which health insurance carriers offer 2022 coverage in the Louisiana marketplace?
As of 2022, there are five insurers that offer exchange plans in Louisiana. The most recent addition was UnitedHealthcare, which has joined the exchange for 2022. UnitedHealthcare previously offered coverage in the Louisiana exchange in 2015 and 2016, but did not participate from 2017 through 2021.
The following insurers offer plans in the Louisiana exchange for 2022, with plan availability varying from one location to another:
- Blue Cross Blue Shield of Louisiana
- HMO Louisiana
- Vantage Health Plan
How are health insurance premiums changing in Louisiana for 2022?
Louisiana’s exchange insurers implemented the following average rate changes for 2022:
- Blue Cross Blue Shield of Louisiana (Louisiana Health Service and Indemnity Company): 4% average increase.
- HMO Louisiana (a subsidiary of Blue Cross Blue Shield of Louisiana): 5% average increase.
- Vantage Health Plan: 3% average increase.
- Christus Health Plans: 8.5% average increase.
- UnitedHealthcare: New for 2022, so no applicable rate change.
The rate changes amount to a weighted average increase of about 4.75% for 2022. 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.
Average rate changes in previous years
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 are 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.
New state law codifies ACA consumer protections (but funding is a stumbling block) despite the fact that Louisiana was one of the states fighting in court to overturn the ACA
Louisiana enacted legislation in 2019 (SB173/Act412) that codified a variety of ACA consumer protections into state law in the event that the ACA had been struck down in the Texas v. Azar/US lawsuit. The Supreme Court ultimately upheld the ACA in a 6-3 ruling, but if the ACA had been overturned, Louisiana’s law called for plans to continue to be guaranteed-issue (regardless of medical history) and include coverage for the essential health benefits. Insurers would have been able to use a 5:1 age-based rating ratio (as opposed to the ACA’s 3:1 ratio), but would not have been able to place dollar caps on lifetime or annual benefits.
The legislation contained a significant catch however, in that it notes that the various consumer protections (such as guaranteed-issue coverage and essential health benefits mandates) would only continue to apply if premium subsidies continued to be available from the federal government, or in a similar amount from the state government.
That latter option is unlikely, given the amount of funding that would be needed, but the law tasks Louisiana’s Insurance Commissioner with establishing the Louisiana Guaranteed Benefits Pool, which would be a risk-sharing program that would cover some of the cost of insuring people with high-cost health care needs in the individual market. This concept is often referred to as “invisible risk-sharing” and it’s the basic concept behind reinsurance, which several states have established (Louisiana was interested in the model that Maine uses). If the ACA had been overturned in full, premium subsidies would have disappeared, and so would federal funding for Medicaid expansion. But Louisiana was working on an actuarial analysis of an invisible risk-sharing program to be presented to lawmakers as a means of keeping coverage more affordable than it would otherwise be.
After Act 412 was enacted, Louisiana’s Attorney General, Jeff Landry, praised its passage, saying that “Louisiana has now become the country’s leader in protecting patients with pre-existing conditions.” While there are several states that had enacted similar legislation well before Louisiana, the great irony in Landry’s comment was that he was among the plaintiffs in the lawsuit that sought to overturn the ACA. Without the Texas v. US (California v. Texas) case — in which Louisiana argued that the ACA was unconstitutional — there would not have been a need for states to scramble to enact their own laws, with woefully inadequate funding, in an effort to protect people with pre-existing conditions.
Senate did not pass legislation to create reinsurance program in Louisiana, draft 1332 waiver proposal wasn’t submitted to CMS
Reinsurance is a system under which insurers are compensated for high-cost claims, and the result is lower premiums for everyone in the insurance pool. The ACA included a federal reinsurance program, but it was temporary and only lasted through the end of 2016. To mitigate rising premiums and stabilize their individual insurance markets, several states have since implemented reinsurance programs, and have seen either very small premium increases or premium decreases as a result.
Louisiana appeared poised to implement reinsurance for 2019 as well; the concept had bipartisan support in the legislature and was also supported by Insurance Commissioner James Donelon.
H.B.246, which passed and was signed into law in late May, authorized the state to seek a 1332 waiver to implement a reinsurance program. But H.B.472, which would have created the Louisiana Health Reinsurance Association and authorized the state to levy a fee on Louisiana health insurers to fund the state’s portion of the cost of the reinsurance program, passed the House but stalled in the Senate.
While the bills to authorize the reinsurance program and 1332 waiver were still making their way through the legislature, the Louisiana Department of Insurance had already drafted a 1332 waiver and opened it up for public comment, through May 9. But since the legislation to create and fund the state reinsurance program did not pass, the proposed 1332 waiver wasn’t submitted to CMS. It’s unclear whether the issue might be reconsidered in 2019, as it will likely depend on the state of the insurance market at that point. But for the time being, reinsurance isn’t going anywhere in Louisiana.
If lawmakers had passed H.B.472, the Louisiana Health Reinsurance Association would have sought federal funding for the reinsurance program with a 1332 waiver, and would have imposed a fee on health insurers in Louisiana (including those in the individual and group markets, as well as self-insurers and third-party administrators, but not on private Medicaid or Medicare insurers), of not more than $2.50 per member per month, and projected to be about $1.40 per member per month.
The federal funding, estimated at $100 million, would have been generated by the savings that the federal government would have realized due to the lower premiums that would have applied in Louisiana if the reinsurance program had been implemented. Since premiums would have been lower than they’ll be without the reinsurance program, premium subsidies (paid by the federal government) would also have been lower. Instead of having the federal government keep the savings, a 1332 waiver would have sought to allow the state to use the savings to fund the reinsurance program, as other states have done.
The Louisiana Department of Insurance projected that premiums would be an average of 17.3 percent lower with reinsurance. There would have been no significant change in net (after subsidy) premiums for people who get premium subsidies, but premiums would have been lower for people who have to pay the full premium without the help of premium subsidies. This would likely have resulted in more people enrolled in coverage, since coverage would have become more affordable for that population. The draft 1332 waiver noted that enrollment was expected to be up to 7.5 percent higher in 2019 if the reinsurance program had been enacted. All of this is a moot point now, however, since the state did not enact the legislation to create the reinsurance program.
Insurer participation in Louisiana’s exchange: 2014-2022
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 the 2016 period, 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 four (out of an original 23) were still operational by 2019.
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 is continuing to offer off-exchange small group plans in Louisiana). United insured about 13 percent 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 has returned to the exchange in Louisiana, bringing the participating number of insurers to five.
How many people are enrolled in Louisiana's exchange?
Enrollment in Louisiana’s exchange has 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 has increased by more than 170,000 people from mid-2020 to late 2021.
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 is the case in most states that use HealthCare.gov.
- 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 percent and 138 percent 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 percent, enrollment in Louisiana’s exchange dropped by more than 23 percent — 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. Enrollment in Louisiana’s exchange is the lowest its ever been, and is down 58% from peak enrollment in 2016. But more than 17,000 people enrolled in Louisiana exchange plans during the COVID-related enrollment window that ran from mid-February to mid-August 2021. And Medicaid expansion was covering more than 690,000 people as of October 2021, which was up more than 170,000 from where it had been in mid-2020.
To stabilize the individual market and minimize future rate increases, Louisiana lawmakers considered legislation that would have implemented a reinsurance program, with federal funding contingent on the approval of a waiver proposal. Several states have already taken this approach, But the Louisiana bill that would have authorized state funding for the reinsurance program did not succeed. So although the state had already posted a draft 1332 waiver proposal, it did not end up being submitted to CMS.
Legislation enacted to allow brokers to charge fees
In April 2017, the Louisiana House of Representatives passed H.B.407 almost unanimously, by a 94-3 vote. In May, the Senate passed it, 32-4, and the Governor signed it into law in early June. The measure allows insurance brokers in the individual market to charge fees — paid by consumers — in trade for their assistance. The practice of charging broker fees was previously banned under Louisiana law (as is the case in most states), because the general wisdom has long been that brokers receive adequate compensation via commissions from insurance companies.
But the ACA resulted in sharply lower commissions in the individual market, which were eliminated altogether by some insurers after the first few unprofitable years of ACA-compliant coverage.
The commission reductions began in 2011 when the medical loss ratio rules went into effect, limiting individual market insurers’ administrative costs (including broker commissions) to no more than 20% of premiums collected.
And in the early years of ACA-compliant plans, insurers struggled to make a profit with the sicker-than-expected risk pool in the individual market, which is now guaranteed-issue, regardless of applicants’ medical history. As a result, insurers sharply scaled back broker commissions, and eliminated them altogether in some areas.
H.B.407 allows brokers to set their own fees. But brokers have to disclose their fees to prospective clients, and would have to inform them that they could avoid the broker fee by using a navigator or HealthCare.gov.
The individual insurance market started to become profitable again in 2017/2018. Starting in 2019, insurers began joining or rejoining the exchanges in many states, and that trend has continued ever since. Broker commissions have rebounded and some insurers even offer bonuses to high-performing brokers in the individual market. So there is much less need for broker fees, and it’s unlikely that many brokers pursue this option anymore, given the competitive disadvantage it would give them.
Legislation enacted to provide additional transparency for out-of-network charges (federal law protects consumers as of 2022)
The Louisiana House of Representatives also passed H.B.435 in 2017, by a vote of 92-1, and sent it to the Senate, which approved it by a vote of 36-1. The Governor signed the legislation in June, and it took effect August 1, 2017. The new law helps to create transparency around the situation that arises when patients go to a hospital that’s in their insurance network, and are treated by health providers who aren’t in the patient’s insurance plan network. Many consumers aren’t even aware that this circumstance can arise at in-network hospitals, and the resulting “surprise balance bill” catches people off-guard.
New York took steps in 2015 to protect insureds on state-regulated plans from being subject to surprise balance bills, but by and large, this is still a significant problem in most states. Louisiana’s H.B.435 is all about informing patients, but it does not protect them from receiving balance bills from out-of-network providers who perform services at in-network facilities.
The legislation includes disclosure language that must be provided to patients, along with a list of all the providers who perform services at the hospital. It is then up to the patient to confirm whether those providers are in-network. But in some scenarios, there’s no way to avoid being treated by an out-of-network provider — for example, if you need anesthetic for surgery, and the only anesthesiologist on duty isn’t in your plan’s network.
As of 2022, federal law will prevent surprise balance billing in emergency situations and in situations where a person goes to an in-network facility but receives treatment from an out-of-network provider.
Medicaid expansion by executive order
Former Governor Bobby Jindal staunchly opposed Medicaid expansion under the ACA, and refused to accept federal funding to expand coverage to adults with income up to 138 percent of the federal poverty level. As a result, Louisiana was among 20 states that were still refusing Medicaid expansion as of the end of 2015.
But in November 2015, John Bel Edwards was elected governor of Louisiana; he took office in January 2016. During the campaign, Edwards noted that one of his first priorities as governor would be Medicaid expansion, and true to his word, he signed an executive order on his second day in office, expanding Medicaid in Louisiana.
Louisiana passed House Concurrent Resolution 75 in 2015, which allows hospitals to generate revenue—via a new fee—to pay the state’s portion of the cost of expanding Medicaid. HCR75 gave Edwards until April 1, 2016 to propose a plan to expand Medicaid, but he did so much sooner than that.
The state expected about 375,000 people to gain coverage under expanded Medicaid, adding to the roughly 1 million people who already had Medicaid or CHIP coverage in Louisiana. Nearly 200,000 people in Louisiana were previously in the coverage gap – they had been locked out of Medicaid, and were also not eligible for subsidies in the exchange because their income was below the poverty level. That changed as of July 1, 2016, when Medicaid expansion took effect in Louisiana (enrollment began June 1, but the earliest coverage effective date was July 1).
Louisiana’s Department of Health and Hospitals used SNAP (food stamp) data to auto-enroll an estimated 105,000 Louisiana residents in Medicaid when the new eligibility guidelines took effect. Several states have used SNAP data to automatically enroll people in expanded Medicaid, but Louisiana is the first state to obtain HHS approval to use SNAP data to verify eligibility for Medicaid automatically for both the initial enrollment and ongoing annual renewals (the other states have only used auto-enrollment for the initial enrollment).
As of May 2016, the state’s Medicaid program was renamed “Healthy Louisiana.” Previously, Louisiana Medicaid was known as Bayou Health. By August 2016, Louisiana had enrolled 74% of the newly-eligible population. By February 2017, enrollment in expanded Medicaid had reached 398,193 — surpassing the state’s total projected enrollment in under eight months. By August 2019, enrollment in expanded Medicaid stood at more than 450,000 people. And amid the COVID-19 pandemic, that number had grown to more than 690,000 people by October 2021. Medicaid enrollment has grown in every state due to COVID, in part because states cannot redetermine eligibility or disenroll anyone from Medicaid until the COVID public health emergency period ends.
ACA and exchange implementation in Louisiana
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.
Louisiana health insurance exchange links
State Exchange Profile: Louisiana
The Henry J. Kaiser Family Foundation overview of Louisiana’s progress toward creating a state health insurance exchange.
Louisiana Department of Insurance, Office of Health Insurance
Assists consumers who have purchased insurance on the individual market or who have insurance through an employer who only does business in Louisiana.
(225) 219-4770 / Toll Free: (800) 259-5301