If you’re a Medicare beneficiary living in Louisiana, you have the option to receive your benefits through Medicare Advantage (Medicare Part C), which is private health insurance available to Medicare beneficiaries. Unlike Original Medicare, Part A and Part B, which is administered by the federal government, private insurance companies contracted with Medicare offer Medicare Advantage plans. You can choose among any Medicare Advantage plans that are available where you live. Not all Medicare Advantage plans in Louisiana may be available in the county or zip code where you reside.
How Medicare Advantage works in Louisiana
The government requires Medicare Advantage plans to offer at least the same benefits as Original Medicare, Part A (hospital insurance) and Part B (medical insurance), with one exception: hospice care continues to be covered under Part A. Some Medicare Advantage plans may offer extra benefits, like routine vision, hearing, dental, and prescription drug coverage.
To enroll in a Medicare Advantage plan in Louisiana, you must be (1) enrolled in Medicare Part A and Part B, and (2) reside in the Medicare Advantage plan’s service area. Usually, you cannot enroll in a Medicare Advantage plan if you have end-stage renal disease or ESRD (kidney failure) because Original Medicare has special coverage provisions for this condition and its treatment.
You should be mindful of four times when you may enroll in a Medicare Advantage plan, change Medicare Advantage plans, or disenroll from a Medicare Advantage plan. Two of these time frames are personalized to your particular circumstances.
You can sign up for a Medicare Advantage plan where you live in Louisiana when you first become eligible for Medicare. The best time to sign up for Original Medicare, or a Medicare Advantage plan is during your Initial Enrollment Period, which begins three months before you turn 65, includes your birthday month, and ends three months after your birthday month. Failure to enroll in Medicare during your Initial Enrollment Period may result in a late-enrollment penalty, which translates into higher monthly premiums. You may sign up for Medicare at a later date, during the annual General Enrollment Period, which runs from January 1 to March 31, each year in Louisiana and across the nation,but you may still have to pay the penalty.
You can switch from one Medicare Advantage plan in Louisiana to a different plan during the Fall Open Enrollment Period, which runs from October 15 to December 7. Your new coverage goes into effect on January 1 of the following year. You may also be allowed to switch Medicare Advantage plans in Louisiana during Special Election Periods, if you go through certain major life events. These include, but are not limited to, moving to a new address where your existing plan is not available, experiencing changes in your current plan that affect your health benefits, or losing your current employer or union sponsored health coverage. Special Election Periods vary according to the reason you need to change plans to ensure you continue to receive the Medicare benefits to which you are entitled.
Another opportunity to switch from one Medicare Advantage plan to another is during the Medicare Advantage Open Enrollment period. It runs from January 1 to March 31 each year. If you’re enrolled in a Medicare Advantage plan in Louisiana, but decide to switch back to Original Medicare, Part A and Part B, you’re also allowed to do that during the Medicare Advantage Open Enrollment Period. If you do that, you also can enroll in a stand-alone Part D Prescription Drug Plan during this period.
Types of Medicare Advantage plans in Louisiana
With the various Medicare Advantage plan options available in Louisiana, it’s a good idea to familiarize yourself with the basic types of Medicare Advantage plans so you can select the right plan for you. Not all types of Medicare Advantage plans may be available where you live but the more common types include the following.
- A Health Maintenance Organization (HMO) is a type of Medicare Advantage plan that uses a network of contracted health-care providers (i.e., physicians, hospitals and other health-care professionals) to deliver covered health-care services to plan members. Usually plan members are encouraged to choose a primary care physician who is responsible for coordinating the member’s care. You may have to get a referral from your primary care doctor to receive coverage for many health services he or she does not provide. To receive benefits for covered services, you normally have to use the plan’s providers, except in situations where you need emergency care or the plan authorizes medically necessary out-of-network care.
- An HMO Point-of-Service plan provides a little more flexibility. This type of plan has a network of plan-participating providers and usually encourages plan members to select a primary care physician. However an HMO Point-of-Service plan has a second, lower level of coverage that provides coverage for certain health care you receive from providers who are not participating in the plan’s network. Generally you pay more for health services from out-of-network providers than you would pay if you received the care from providers who participate in the plan’s network.
- A Preferred Provider Organization (PPO)* plan is similar to an HMO Point of Service plan. A PPO has two levels of benefit coverage, and the higher level of coverage is applied when you use plan-participating providers to provide covered services; when you go out-of-network, you typically have a higher out-of-pocket cost.
- A Private Fee-for-Service (PFFS) plan reserves the right to decide how much it will pay for your doctor, health-care provider, and hospital visits, as well as your share of each expense. Keep in mind that not all providers accept this type of plan; make sure you check with the provider before receiving services.
- A Medical Savings Account (MSA) plan combines a high deductible with a savings account, which you may use to pay your health-care expenses.
- A Medicare Special Needs Plan (SNP) is designed for Medicare beneficiaries who have certain chronic diseases, those living in institutions (like nursing homes), and people who qualify for both Medicare and Medicaid.
If you’re seeking both health and prescription drug coverage, you may want to seek a Medicare Advantage Prescription Drug (MAPD) plan, which combines health and Medicare prescription drug coverage in a single plan.
Always remember that even if you enroll in a Medicare Advantage plan in Louisiana, you must remain enrolled in Original Medicare and continue paying your Medicare Part B premium to keep your health coverage.
Comparing Medicare Advantage plans available in Louisiana
As a Medicare beneficiary in Louisiana, you may find it useful to compare all Medicare Advantage plans available in your area. The availability and cost of Medicare Advantage plans generally varies depending on your area of residence. It’s common for premiums of a Medicare Advantage plan with the same coverage and benefits to vary between different parishes within the state of Louisiana. You may find that some Medicare Advantage plans in Louisiana offer premiums as low as $0; but keep in mind that you have to continue paying your Medicare Part B premium, no matter which Medicare Advantage plan you choose, to keep your Medicare insurance coverage.
If the Medicare Advantage plans in your area include networks of participating providers (a prominent feature of HMO, HMO-POS and PPO type plans), you may want to check to see if your doctors, hospitals, and other health professionals participate in the Medicare Advantage plan’s network. Usually a Medicare Advantage plan’s coverage is at its fullest when you use providers that participate in the plan.
Some Medicare Advantage plans may offer additional benefits beyond what is included in Original Medicare, Part A and Part B, so you will need to determine exactly what kind of coverage you may require, plus whether or not you want prescription drug coverage with your Medicare Advantage plan through a Medicare Advantage Prescription Drug (MAPD) plan.
With all these options available in Louisiana, you can see why it’s a good idea to compare Medicare Advantage plans available where you live to determine which plan offers benefits and costs suited to your individual health and budget needs.
For more information about Medicare in Louisiana, you may access the following resources:
* Out-of-network/non-contracted providers are under no obligation to treat Preferred Provider Organization (PPO) plan members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.