Medicare in Louisiana

Analysis from the nonprofit Kaiser Permanente Foundation found that over the last decade, Louisiana has continually ranked among the country’s top 20% of states with the highest per-enrollee Medicare expenditures. As of early 2022, about 898,000 of the state’s residents (19% of all Louisiana residents) were enrolled in Medicare, and about half of Medicare users are enrolled in Medicare Advantage. The Original Medicare program is made up of two parts—A and B. Hospital coverage is provided by Part A, and Part B covers expenses like doctor’s office visits and treatment. Because the original plan doesn’t restrict services to the network surrounding the beneficiary’s primary residence, it’s often favored by older adults who move around often.

With Medicare Advantage Plans (Part C), seniors can access a wider set of benefits than they receive with Original Medicare; however, they’re limited to the network serving the geographical area of their primary residence. Medicare Part D for prescription drug coverage is purchased separately to those covered by Original Medicare. To help reduce out-of-pocket costs, some seniors may also benefit from purchasing a Medicare Supplement (Medigap) plan. Most Advantage Plans cover prescription drugs (Part D) and do not need to enroll in Medigap either. 

This guide provides a comprehensive overview of Medicare in Louisiana, covering its different types and plan options in the state. It also includes a handful of resources that may help seniors better understand Medicare and select the plan that best meets their health needs throughout retirement.

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)

Original Medicare is administered by the Centers for Medicare & Medicaid Services (CMS) and is open to seniors aged 65 and over, along with those under 65 years old, but with certain disabilities or end-stage kidney disease. It includes two parts. Part A covers inpatient hospital care, nursing home and skilled nursing care, hospice and home health care. Part B, or medical coverage, pays for medically necessary goods and services such as durable medical equipment, mental health services and emergency medical transportation. 

Unlike most private Medicare plans, Original Medicare’s provider network isn’t limited to the beneficiary’s geographic region, making it easier to obtain services while traveling within the country. In most cases, Medicare doesn’t pay for health services the individual receives outside the United States. 

Under this program, seniors pay for services as they receive them. They must pay an annual deductible, which is $1,556 for Part A and $233 for Part B in 2022. After they’ve paid this amount, Medicare covers all eligible services at 80%. Beneficiaries pay the remaining 20% out of pocket.

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)

As of early 2022, about half of Louisiana’s Medicare beneficiaries have Advantage plans. Also referred to as Part C, Medicare Advantage plans include the same coverage that comes with Medicare Parts A and B, except hospice care which Medicare Part A covers. Most Advantage plans cover prescription drugs (Plan D) and many plans also include dental and vision care.

Altogether, there are six different types of Medicare Advantage plans, but only four are particularly well known: Private Fee-for-Service (PFFS), Health Maintenance Organization (HMO), Preferred Provider Organization (PPO) and Special Needs Plan (SNP). While these different plans will all have at least the same coverages as original Medicare, the plans’ copays, deductibles and coinsurance can vary significantly.

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 April 2022. 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 2022 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.