Medicare in Louisiana

One in five Louisiana Medicare beneficiaries is under 65. Medigap insurers are required to offer them coverage, but the premiums are substantially higher

Photo credit: Bart Everson | Flickr

At a glance: Medicare health insurance in Louisiana

Medicare enrollment in Louisiana

2020 Medicare enrollment datesAs of December 2018, there were 856,497 Louisiana residents enrolled in Medicare. That’s a little more than 18 percent of the state’s population, which is roughly the same as the percentage of the total US population enrolled in Medicare.

Most Americans become eligible for Medicare when they turn 65. But Medicare eligibility is also triggered for younger people if they’re disabled and have been receiving disability benefits for 24 months. 20 percent of Louisiana’s Medicare beneficiaries are eligible due to disability rather than age. That’s the same as the rate in Tennessee, but higher than the nationwide average of 16 percent; only five states have a higher rate of disabled Medicare beneficiaries.

Medicare Advantage in Louisiana

Private Medicare Advantage plans are an alternative to Original Medicare, and are available throughout Louisiana. Every county in Louisiana has at least 11 Medicare Advantage plans available, and as many as 27 plans are for sale in some counties.

33 percent of the state’s Medicare beneficiaries were enrolled in Advantage plans as of 2017, which was the same as the percentage of Medicare beneficiaries with Advantage plans nationwide. As of December 2018, private Medicare enrollment in Louisiana stood at 306,868 people; the other 549,629 had Original Medicare.

People who enroll in Original Medicare get their coverage directly from the federal government, and have access to a nationwide network of providers. But Original Medicare enrollees need supplemental coverage (from an employer-sponsored plan, Medicaid, or privately purchased plans) for things like prescription drugs and out-of-pocket costs.

Original Medicare includes Medicare Parts A and B. Medicare Advantage includes all of the benefits of Medicare Parts A and B, and the plans usually also have additional benefits, such as integrated Part D prescription drug coverage and coverage for things like dental and vision care. But provider networks are limited with Medicare Advantage, and out-of-pocket costs are often higher than they would be under Original Medicare plus a Medigap plan. There are pros and cons to either alternative, and no single solution that works for everyone.

Medicare’s annual election period (October 15 to December 7 each year) allows Medicare beneficiaries the chance to switch between Medicare Advantage and Original Medicare (and add, drop, or switch to a different Medicare Part D prescription plan). Starting in 2019, people who are already enrolled in Medicare Advantage also have the option to switch to a different Advantage plan or to Original Medicare during the Medicare Advantage open enrollment period, which runs from January 1 to March 31.

Medigap in Louisiana

Original Medicare does not limit out-of-pocket costs, so most enrollees maintain some form of supplemental coverage. More than half of Original Medicare beneficiaries get their supplemental coverage through an employer-sponsored plan or Medicaid. But for those who don’t, Medigap plans (also known as Medicare supplement plans) will pay some or all of the out-of-pocket costs they would otherwise have to pay if they had only Original Medicare. According to an AHIP analysis, about 16 percent of Louisiana’s Medicare beneficiaries (141,012 people) had supplemental coverage under Medigap plans as of 2016.

Medigap plans are sold by private insurers, but the plans are standardized under federal rules. There are ten different plan designs (differentiated by letters, A through N), and the benefits offered by a particular plan (Plan A, Plan F, etc.) are the same regardless of which insurer sells the plan.

There are 35 insurers that offer Medigap plans in Louisiana. Medigap insurers in the state are required to maintain minimum loss ratios of at least 65 percent for individual policies, and at least 75 percent for employer group policies. This means that at least 65 percent (or 75 percent for group plans) of the premium revenue that the insurers bring in must be spent on enrollees’ medical claims.

Unlike other private Medicare coverage (Medicare Advantage and Medicare Part D plans), there is no annual open enrollment window for Medigap plans. Instead, federal rules provide a one-time six-month window when Medigap coverage is guaranteed-issue. This window starts when a person is at least 65 and enrolled in Medicare Part B (you must be enrolled in both Part A and Part B to buy a Medigap plan).

People who aren’t yet 65 can enroll in Medicare if they’re disabled and have been receiving disability benefits for at least two years, and one out of every five Louisiana Medicare beneficiaries is under age 65. Federal rules do not guarantee access to Medigap plans for people who are under 65, but the majority of the states have implemented rules to ensure that disabled Medicare beneficiaries have at least some access to Medigap plans. Louisiana is among them, although the state’s 2017 Medigap guide indicates that is a fairly recent development in the state.

In Louisiana, disabled Medicare beneficiaries under the age of 65 have the same six-month open enrollment period for Medigap plans as a person who becomes eligible for Medicare due to age. But premiums are dramatically higher for enrollees under the age of 65 (in most cases, several times higher). People who are enrolled in Medicare prior to age 65 have another Medigap open enrollment period when they turn 65. At that point, they can switch to a plan with the lower premiums that apply to people who are aging into Medicare, rather than qualifying due to disability.

Disabled Medicare beneficiaries can opt for Medicare Advantage instead, as long as they don’t have kidney failure. Medicare Advantage plans are otherwise available to anyone who is eligible for Medicare, and the premiums are not higher for those under 65. But as noted above, Advantage plans have more limited provider networks than Original Medicare, and total out-of-pocket costs can be as high as $6,700 per year for in-network care.

Although the Affordable Care Act eliminated pre-existing condition exclusions in most of the private health insurance market, those rules don’t apply to Medigap plans. Medigap insurers can impose a pre-existing condition waiting period of up to six months if you didn’t have at least six months of continuous coverage prior to your enrollment. And if you apply for a Medigap plan after your initial enrollment window closes (assuming you aren’t eligible for one of the limited guaranteed-issue rights), the Medigap insurer can consider your medical history in determining whether to accept your application, and at what premium.

Medicare Part D in Louisiana

Original Medicare does not provide coverage for outpatient prescription drugs. More than half of Original Medicare beneficiaries have supplemental coverage via an employer-sponsored plan (from a current or former employer or spouse’s employer) or Medicaid, and these plans often include prescription coverage.

But Medicare beneficiaries who do not have drug coverage through Medicaid or an employer-sponsored plan need to obtain Medicare Part D in order to have coverage for prescriptions. It can be purchased as a stand-alone plan, or as part of a Medicare Advantage plan with integrated Part D prescription drug coverage.

There are 26 stand-alone Part D plans for sale in Louisiana in 2019, with premiums that range from about $17 to $88/month.

349,768 Louisiana Medicare beneficiaries — nearly 41 percent of the state’s total Medicare population — had prescription coverage under stand-alone Part D plans as of late 2018. Another 295,017 had Part D prescription coverage integrated with their Medicare Advantage plans.

Medicare spending in Louisiana

Original Medicare’s average per-beneficiary spending in Louisiana was $11,399 in 2016, based on data that were standardized to eliminate regional differences in payment rates, and did not include costs for Medicare Advantage. Per-beneficiary Medicare spending in Louisiana was the highest in the nation, and 20 percent higher than the national average. At the other end of the spectrum, per-beneficary Medicare spending was lowest in Hawaii, at just $6,441.

You can read more about Medicare in Louisiana in our state Medicare guide. You can also contact the Louisiana Senior Health Insurance Information Program with questions related to Medicare coverage in Louisiana, and review the handy stoplight-style quick guide to private Medicare options that the state has created.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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