Medicare in Louisiana

Medicare is a federally funded health insurance program that provides coverage to thousands of seniors nationwide, along with those who have certain disabilities or permanent kidney failure. In Louisiana, 924,320 people are eligible for this coverage, accounting for about a fifth of the state’s total population. This is 2.18% more than the number of people eligible for coverage in 2022, an uptick that’s relatively modest compared to the national increase of 2.66%.

Original Medicare consists of two parts. Part A provides coverage for hospital stays, along with nursing home care, home health care and hospice. Part B covers medical services, such as routine doctor’s office visits, diagnostic services and medical equipment. Neither of these coverage parts includes prescription drug insurance, so beneficiaries must purchase this coverage in a separate Part D plan.

Seniors with Medicare have cost-sharing responsibilities, including premiums, deductibles and copays or coinsurance. While most people get Part A coverage for free, a beneficiary may have to pay a monthly premium if neither they nor their spouse paid Medicare taxes for at least a decade. Those who don’t qualify for free Part A coverage pay $278 or $506, depending on whether or how long they paid taxes. Additionally, there’s a $1,600 deductible for each hospital stay and a copay for hospital stays beyond 60 days. The Part B premium is $164.90 per month, and the annual deductible is $226. On top of this, beneficiaries pay for 20% of the cost of each covered service.

Medicare Advantage, or Part C, is another option for accessing Medicare’s health insurance benefits. These plans are serviced by private health insurance companies and include Parts A and B. They may also include prescription drug, vision or dental coverage, along with benefits such as annual out-of-pocket maximums and $0 deductibles. In Louisiana, 54% of beneficiaries have a Medicare Advantage Plan, which is high compared to 48% nationwide and an increase of 7.56% over the number of Louisianans enrolled in this program in 2022. The number of enrollees in this program grew by 9.91% between 2022 and 2023, highlighting its popularity in the state.

This guide offers an exhaustive exploration of Medicare in Louisiana, including detailed information on Medicare coverage options, Medicare Advantage, considerations for who should opt for Medicare Advantage, top Medicare Advantage Plans, prescription drug coverage, Medigap, and useful Medicare resources. It is designed to help seniors make well-informed decisions about the plan that best suits their healthcare needs throughout their retirement years.

Options for Medicare Coverage in Louisiana

Seniors can enroll in the Original Medicare program offered by the federal government, but many of the state’s older adults choose to receive a more comprehensive set of coverage with one or more available choices. With the addition of private health insurance options, Medicare beneficiaries can craft a health policy that addresses their biggest concerns.

Original Medicare (Parts A & B)

In Louisiana and the rest of the nation, the Centers for Medicare & Medicaid Services administers Original Medicare. This program features two parts, including Part A hospital coverage and Part B medical coverage. Beneficiaries can go to any doctor who accepts Medicare, regardless of where they live, although Medicare generally doesn’t pay for medical costs received while traveling abroad. Medicare is a fee-for-service plan, so beneficiaries pay for services as they receive them. With Part A, they must pay a $1,600 deductible before their coverage kicks in, and with Part B, a $226 deductible applies.

Who Should Consider Original Medicare

Original Medicare may be a good option for those who:

• Travel frequently within the United States
• Don’t need extra benefits such as home-delivered meals and coverage for over-the-counter medication
• Want to choose their own prescription drug coverage

Medicare Advantage (Part C)

Over half of Louisianans receive their Medicare benefits through a Medicare Advantage Plan. These plans have gained in popularity for their convenience and cost-saving benefits. Most Medicare Advantage Plans include prescription drug coverage, eliminating the need to purchase a separate plan, and many also include vision and dental benefits. On top of this, some plans have $0 deductibles and no premiums beyond the standard Part B premium all beneficiaries pay. The four most popular Medicare Advantage Plans include HMOs, PPOs, SNPs and PFFS plans, although not all plan types are available statewide.

Who Should Consider Medicare Advantage

• Seniors without any major medical concerns
• People who want coverage left out of Original Medicare
• Are comfortable with managed care
• Want limits on their out-of-pocket expenses

The Top 10 Medicare Advantage Plans in Louisiana

The following table lists the 10 most popular Medicare Advantage Plans in Louisiana based on enrollment numbers as of August 2023. For more information about Medicare Part C, seniors can visit the state page for Medicare Advantage Plans in Louisiana. The cost ranges listed below represent what seniors can expect to spend across the different providers’ plan options.

Medicare Prescription Drug Coverage (Part D)

Original Medicare doesn’t pay for most prescription drugs through Part A or B coverage. Instead, seniors purchase separate prescription drug policies, also called Part D coverage. Medicare contracts with private health insurance companies to provide this coverage. There are multiple plans to choose from with varying monthly premiums, which beneficiaries pay in addition to their Original Medicare premiums. While seniors don’t have to purchase prescription drug coverage when they’re first eligible for Medicare, not obtaining this coverage at this time may result in late enrollment penalties they pay for as long as they have Medicare if they enroll later.

Each prescription drug plan has its own formulary, or list of covered drugs. Formularies are typically split up into tiers. The tier a medication is in determines how much the insurance company pays and how much the beneficiary pays for it. Lower-level tiers are usually made up of generic and low-cost brand name drugs, while higher tiers are composed of more expensive brand name and specialty drugs. In most cases, the lower the tier, the lower the policyholder’s cost-sharing responsibility.

Who Should Consider Medicare Prescription Drug Coverage

Seniors who may benefit from prescription drug coverage include those who:

• Currently take prescription medication or expect to in the future
• Want to avoid late enrollment penalties
• Want to reduce out-of-pocket prescription drug expenses

Medicare Supplement Insurance (Medigap)

While Original Medicare provides coverage for many medical costs, seniors may still have significant out-of-pocket expenses. These may include copays, coinsurance and deductibles. Seniors may be able to reduce their cost-sharing obligations by purchasing a Medigap plan. These plans can only be used with Original Medicare. It’s illegal for private insurance companies to sell Medigap plans to those with Medicare Advantage plans.

For more information on Medigap plans, seniors can refer to the Best Medicare Supplement Companies of 2023 page.

Who Should Consider Medicare Supplement Insurance

Good candidates for Medigap may be those who:

• Have ongoing health issues and expenses
• Travel overseas often
• Want to access an expanded network of health care providers
• Expect to need health services not covered by Original Medicare

Medicare Resources in Louisiana

Between the original version and Advantage plans, Medicare involves myriad different plans and components, and it’s easy to get lost in the details. The following resources may help seniors navigate the Medicare network and answer any remaining questions about costs and coverage. Most of the organizations listed are government agencies, but some programs are run by nonprofits. All provide free assistance.