Health Insurance Marketplace in Louisiana
Choosing the Right Health Insurance Plan
There are 5 categories of Marketplace insurance plans: Bronze, Silver, Gold, Platinum, and Catastrophic.
Plans range from bare bones “bronze” plans which cover 60% of pocket medical costs to “platinum” plans which have greater coverage but come with higher premiums. In general higher premiums mean lower out-of-pocket costs and a wider insurer network of doctors and hospitals.The plans are as listed below:
NOTE: All cost sharing is of out of pocket costs. Please see ObamaCare health benefits for services that are covered at no out of pocket charge on all plans. The maximum out-of-pocket costs for any Marketplace plan for 2014 are $6,350 for an individual plan and $12,700 for a family plan.
Bronze Plan: The bronze plan is the lowest cost plan available. It has the lowest premiums and in exchange has the lowest actuarial value. The actuarial value of a bronze plan is 60%. This means that 60% of medical costs are paid for by the insurance company, leaving the other 40% to be paid by you.
Silver Plan: The Silver plan is the second lowest cost plan, it has an actuarial value of 70%. This means that 70% of medical costs are paid for by the insurance company, leaving the other 30% to be paid by you. The Silver plan is the standard choice for most reasonably healthy families who historically use medical services.
Gold Plan: The Gold plan is the second most expensive plan, it has an actuarial value of 80%. This means that 80% of medical costs are paid for by the insurance company, leaving the other 20% to be paid by you.
Platinum Plan: The Platinum plan is the plan with the highest premiums offered on the insurance exchange. The Platinum plan as an actuarial value of 90%. This means that 90% of medical costs are paid for by the insurance company, leaving the other 10% to be paid by you. This plan is suggested to those with high incomes and those in poor health. Although coverage is more expensive up front the 90% coverage of costs will help those who use medical services frequently.
Catastrophic plans – which have very high deductibles and essentially provide protection from worst-case scenarios, like a serious accident or extended illness — are available to people under 30 years old and to people who have hardship exemptions from the fee that most people without health coverage must pay.
Louisiana has not chosen to expand its Medicaid program at this time. Read “What if my state isn’t expanding Medicaid?” to learn more. You can find out whether you qualify for Medicaid under Louisiana’s current rules 2 ways: Contact your state Medicaid agency right now or fill out an application for coverage in the Health Insurance Marketplace.
Who can help you (the Navigators)
Southern United Neighborhoods (SUN) is a public charity founded in March 2010 by low to moderate income people that uses research and training to combat the poverty, discrimination and community deterioration that keeps low income people from taking advantage of their rights and opportunities. Southern United Neighborhoods’ Tri-State Outreach Project will implement and fulfill Navigation duties in the Tri-State Region of Arkansas, Louisiana, and Texas in Public-Use Microdata Areas (PUMAs) with high considerations of low income uninsured adult populations.
The Martin Luther King Health Center (MLKHC) is a private non-profit primary health care center and pharmacy, incorporated in 1986, and domiciled in the parish of Caddo, Shreveport, Louisiana. Navigator program components include a mass media campaign, public informational education presentations, participating in health fairs & trade fairs, one-on-one interactions with consumers, and the dissemination of print materials through various outreach venues. All services, media, and print material will be offered in English and Spanish.
The Southwest Louisiana Area Health Education Center (SWLAHEC) was founded in 1991 and aims to improve health status in the region through access to information, education and health services. Their current services include programs on career and professional education, health interventions, preventive health, and public health support. They will help to educate Louisianans about their health coverage options and facilitate enrollment.
Capital Area Agency on Aging, District II will help individuals and small employers shop for, select and enroll in qualified health plans in Louisiana’s new competitive health insurance marketplace. The Agency plans to serve a variety of populations, including older and disabled
employees, small employers, and refugees being served by the Refugee Resettlement Program (statewide).
If you need more detailed analysis, identification of issues, solutions, and implementation of your health insurance plan please let us know with the form below and we’ll get right back to you.
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Consumer Operated and Oriented Plan Program
Consumer Operated and Oriented Plan (CO-OP) Program are qualified nonprofit health insurance issuers that offer competitive health plans in the individual and small group markets. CO-OP in Louisiana:
Accountable Care Organizations in Louisiana
ACOs are profit-driven health innovators primarily serving Medicare patients who are financially rewarded by the government and private insurance companies for delivering medical services that lead to better health outcomes for less money.
- Ochsner Clinic Foundation LA – Health Care Innovation Award
- University Of North Texas Health Science Center LA – Health Care Innovation Award
Health care facilities where Innovation Models are being tested
- Our Lady of the Lake Regional Medical Center Baton Rouge, LA – BPCI Initiative: Model 2
- Amedisys Home Health Care Hammond, LA – BCPI Initiative: Model 3
- Amedisys Home Health Baton Rouge, LA – BCPI Initiative: Model 3
- Capital Area Agency on Aging (CAAA) Baton Rouge, LA – Community-based Care Transition Program
- David Raines Community Health Center, Inc. – Bossier Bossier City, LA – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- David Raines Community Health Center, Inc. – Shreveport Shreveport, LA – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- RKM Primary Care Clinton, LA – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- Southeast Community Health Systems Greensburg, LA – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- Abbeville Community Health Center Abbeville, LA – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- Julie Lewis MBA Baton Rouge, LA – Innovation Advisors Program
- LSU New Orleans – Satellite II New Orleans, LA – Strong Start for Mothers and Newborns Initiative
- Ochsner Clinic Foundation New Orleans, LA – Strong Start for Mothers and Newborns Initiative
- LSU New Orleans – Mobile Healthcare Center New Orleans, LA – Strong Start for Mothers and Newborns Initiative
- LSU New Orleans – Satellite I New Orleans, LA – Strong Start for Mothers and Newborns Initiative
- LSU Shreveport Shreveport, LA – Strong Start for Mothers and Newborns Initiative
- Woman’s Hospital Baton Rouge, LA – Strong Start for Mothers and Newborns Initiative
The Insurance Exchange/Marketplace
What has been done, not been done, or left up to the federal government to do.
Establishing the Exchange in Louisiana
Governor Bobby Jindal (R) announced that Louisiana will not pursue the establishment of a state-based health insurance exchange and instead will allow the federal government to operate an exchange in the state.1 While a bill establishing an exchange was introduced in the 2012 legislative session, it was not supported by the Governor and failed when the legislative session ended (SB 744).2,3 Prior to the announcement that the state would not operate its own exchange, Governor Jindal signed into law a bill prohibiting plans operating in a state-based exchange from offering abortions, with no exceptions (HB 1247).4
Essential Health Benefits (EHB): The ACA requires that all non-grandfathered individual and small-group plans sold in a state, including those offered through the Exchange, cover certain defined health benefits. Since Louisiana has not put forward a recommendation, the state’s benchmark EHB plan will default to the largest small-group plan in the state, Blue Cross Blue Shield of Louisiana- GroupCare PPO.
In September 2010, the Louisiana State Department of Health and Hospitals was awarded an almost $1 million federal Exchange Planning grant; the Department announced in March this money would be returned to the federal government.
Expansion of Medicaid
From 2014 to 2017, the federal government will pay for 100% of the difference between a state’s current Medicaid eligibility level and the ACA minimum. Federal contributions to the expansion will drop to 95% in 2017 and remain at 90% after 2020, according to the ACA.
As the ACA was originally written, states would lose all Medicaid funding if they refused to expand their program to the ACA minimum.
However, the Supreme Court in June 2012 ruled that the federal government could not withhold Medicaid funding for states that chose not to expand their programs. The decision effectively allowed state officials to opt out of the expansion, and some have said they will do just that.
Louisiana is not participating in Medicaid expansion.
The federal government will assume full responsibility for running a health insurance exchange in Louisiana beginning in 2014.
1. Barrow, Bill. “Jindal Takes Stage in GOP Initiative Against Health Law.” The Times-Picayune, July 2, 2012. http://www.nola.com/politics/index.ssf/2012/07/jindal_takes_stage_in_gop_init.html.
2. Senate Bill 744. Regular Session 2012. Creates the Louisiana Health Insurance Exchange.http://www.legis.state.la.us/billdata/streamdocument.asp?did=794947
3. Barrow, Bill. “Louisiana Senate Panel Sinks Plan to Set Up Health Insurance Exchange.” The Times-Picayune, May 16, 2012.http://www.nola.com/politics/index.ssf/2012/05/louisiana_senate_panel_sinks_p.html
4.House Bill 1247. Regular Session, 2010. http://www.legis.state.la.us/billdata/streamdocument.asp?did=722961
5. Moller, J. ‘Louisiana to opt out of health insurance exchanges in federal law.’ The Times-Picayune. March 23, 2011.http://www.nola.com/politics/index.ssf/2011/03/louisiana_to_opt_out_of_health.html
Also of interest
Provided by the Henry J. Kaiser Family Foundation