Medicare is the leading health insurance plan available in Louisiana. The federally approved health coverage is designed to help senior citizens, and disabled receive affordable healthcare in this country. The health plans cover a diverse range of medical expenses and offer multiple resources to those in need.
Stats show that over 843,951 beneficiaries in Louisiana were enrolled in Medicare Health Plans by the year 2018. The figure has since then multiplied and continues to increase every year.
Let’s look at more stats associated with Medicare health plans in the state:
In a nutshell, the popularity of Medicare health insurance surges every year with the increase of citizens aged 65+ in this state. Also, the plan offers equal coverage to adults with disabilities. That makes it easier for them to receive the required medical care.
The question is what type of health coverage you should opt for when you turn 65. We demystify the complexities of Medicare health plans by answering your frequently asked questions.
Medicare Health Plans are divided into multiple parts. Each section offers beneficiaries with different services and coverage. Most of which align with their required treatment plan. This is especially true for enrollees that have a prolonged disability or are suffering from a severe condition.
At O’Neal Insurance Group, we advise everyone eligible for Medicare, to consider the pros and cons of each type of health plan. That way, they can maximize their medical coverage and attain more benefits than before.
Part A is dubbed as the ‘hospital insurance’ part of the Original Medicare Plan. Beneficiaries in this plan receive coverage for standard hospital care (such as medications, semi-private rooms, bedside nurses, and meals). The coverage also consists of a skilled nursing facility, inpatient care, and hospice environment. Certain plans also extend coverage to home health services for critical patients.
It’s important to remember that your coverage requires you to pay copayments, deductibles, and coinsurance for individual services.
The second part of the Original Medicare Plan is labeled as medical insurance. The plan consists of a diverse range of medical services for outpatients. These include everything from doctor appointments, required therapy to specific medical supplies (e.g. wheelchair). In some instances, the coverage can cover home health care expenses too.
Part A and B are considered the foundational health coverage for Medicare beneficiaries. The restrictive nature of these plans required the enrollees to opt for additional plans. That’s because the Original Medicare Plan doesn’t cover routine exams and checkups (e.g. eye, dental, and hearing tests).
Looking for extra coverage? Then Medicare Advantage Plan could be the right choice for you. The health insurance plan is managed by private insurance companies that are affiliated with Medicare. These organizations offer clients an alternative health plan that covers medical expenses included in the original plan, along with more benefits.
The benefits include routine checkups (e.g. vision, dental, and hearing) and health wellness programs (e.g. fitness class).
The health plan bridges the gap between basic Medicare Health Plans and out-of-pocket expenses. Their benefits consist of coinsurance, deductibles, copayments, and other medical costs that your primary health plan doesn’t cover.
Beneficiaries with chronic illnesses, permanent disabilities, and other severe conditions often chose the Part D Plan. This health plan covers the cost of prescriptions, which is often disregarded in the original medical coverage. The list of drugs in the plan varies from one zip code to another.
There are two ways to enroll in this program. You can either opt for a standalone health plan that is compatible with your Original Medicare Health Plan. The other option is to apply for Part D as an extension of your Medicare Advantage Plan.
As you can see, Medicare Health Plans covers a wide range of medical services. The selection of your health plan should align with services that apply to your treatment/health condition. Also, think of ways in which each plan benefits you financially. Then choose the one that is most cost-effective for your retirement budget.
The eligibility of Medicare Health Plans is dependent on your age, citizenship, and medical condition. Taxes and enrollment in the foundation health plans also come into play in some situations.
In short, if you are over 65 or have a disability, then you can enroll in a Medicare Health Plan. The only condition is that your chosen health plan must be available in your service area. Otherwise, you will have to apply for extra medical coverage from your insurance company.
Hint: Medicare disability refers to permanent physical and mental impairment that requires lifelong medical support
You have the right to select additional medical coverage with the assistance of an affiliated healthcare insurance provider. The medical plan includes basic coverage from the Original Medicare Plan, along with extra benefits. These include everything from routine appointments to fitness classes, and more.
Apart from receiving extra medical coverage, you will have to pay a lower premium on deductibles, copayments, and coinsurance associated with the medical services. For this reason, this type of health insurance plan is called a budget-friendly option for the residents of Louisiana.
Here are the primary Medicare Advantage Plans in Louisiana:
Beneficiaries of this health plan are provided with a list of healthcare providers and facilities. They get discounted rates and medical coverage when they receive treatments from this network of healthcare providers. The enrollees are also required to choose a primary care provider, who can refer them to specialists whenever required.
The advantages of this healthcare plan include lower premiums, access to licensed healthcare providers, and great rates and full coverage.
Despite its many benefits, many people find the rules and regulations of this health plan restrictive. That’s especially true for individuals who’re forced to pay the full medical bill if they get treated outside the network. This can be costly for people who are receiving care from specialists not available in their health insurance company’s list.
The PPO is a flexible rendition of the previous health plan. The only difference is that beneficiaries in this plan can get coverage for the chosen healthcare provider (even if they aren’t in the network). The recipients will, however, have to pay a higher amount of copayments, deductibles, and coinsurance. The premium costs depend on the terms and conditions of their healthcare insurance policy.
The advantages of this healthcare plan include flexible offerings and more options, no need for referrals and additional steps, and access to licensed healthcare providers.
If you’re interested in more versatility, then you can sign up for the Private Fee-for-Service (PFFS) plan. The plan gives you a chance to choose out-of-network healthcare providers with minimum restrictions. The healthcare provider must, however, comply with a few insurance guidelines if you want proper medical coverage.
Apart from this, residents of Louisiana have access to the Special Needs Plan (SNP). The hybrid healthcare plan is for beneficiaries who require specific medical services to treat disabilities, chronic illnesses, or other critical conditions.
The best idea is to consult your primary care provider before you make the final decision.
Residents of Louisiana have several opportunities to register for Medicare Original and Advanced Health plans. If you receive Social Security, then your enrollment to the foundational health plans is automatic. Others have to seek assistance from Social Security headquarters in the state to enroll in both federal programs.
The three enrollment periods to sign up for Medicare are as follows:
It’s the first chance for eligible candidates to join the Medicare health plan. The 7 month enrollment period begins there months before your 65th birthday and lasts 3 months after your birthday.
For instance, if you are born in March then your initial enrollment will start in Dec and end in June.
If you’re registered with group coverage or receive health benefits from a spouse, then you can enroll in the Medicare Health Plan after that coverage expires.
The delayed enrollment period lasts for 8 months after the prior coverage ends.
All eligible beneficiaries can register for Medicare health plans at the start of each year. The general enrollment period lasts from Jan to March. Applicants can expect their medical coverage to start in July after successful enrollment.
Disclaimer: Residents who don’t sign up for Part B during their initial enrollment are penalized for the delay. The penalty fee varies according to the date of their registration. It’s generally 10% of their premium, and it lasts throughout their Medicare coverage.
O’Neal Insurance Group offers free consultation services to the residents of Louisiana. Our specialists guide you through the enrollment process and answer your queries. We also nudge you in the right direction if you’re considering a supplemental plan.