Are you looking for comprehensive, affordable health insurance in Louisiana? We understand that the process can be a little confusing, especially these days. You have more choices than ever before – which also gives you more opportunities to get lost, confused, and frustrated by the process. But we’re here to help. This article will succinctly describe and explain the best healthcare options that are available for Louisiana residents like you. By the end of it, you’ll learn a ton of helpful information which can assist you in your search for the best healthcare coverage for you and your family.
Major Medical Insurance in Louisiana
In the year 2010, the Patient Protection and Affordable Care Act (AKA “Obamacare”) established standards and a mandate for health care coverage in the United States. The individual mandate may not be around anymore for most people, but it did establish the Health Insurance Marketplace and defined what it means to be an ACA compliant major medical health insurance policy. These policies adhere to a much higher and more comprehensive standard of care compared to many of the other options out there. For some, these health plans are an affordable way to meet their and their family’s medical needs; for others, it can be a little bit trickier.
Open Enrollment is when Louisiana residents can apply for an ACA major medical plan. Open Enrollment starts on November 1st each year and usually ends on December 15th. However, there are special enrollment periods (SEPs) that you may qualify for if you move to a new residence in a different zip code or if you experience other life-altering events, such as having a baby. It’s easier to qualify for a special enrollment period than most people think. All you have to do is visit HealthCare.gov in order to see whether or not you qualify.
The health care plans available through the Exchange (otherwise known as the Health Insurance Marketplace) have some special advantages that you won’t get with things like short-term health insurance or a health share plan. For one, these policies are guaranteed issue. This means that even if you have a pre-existing condition or you are currently ill, you won’t get rejected for coverage. And the only conditions which your insurance company is allowed to charge you a higher premium under include:
- Your age
- Your location
- Your use of tobacco products
- Whether you are applying for an individual policy or a family policy
Major medical plans are also the only health insurance policies which come with the 10 guaranteed Essential Health and Wellness Benefits. These benefits are the bare minimum that medical experts agree you need in order to receive the preventative and holistic care necessary to lower your medical costs over time. And those benefits are:
- Ambulatory/outpatient services
- Emergency services
- maternity/newborn care
- Mental health and substance abuse
- Prescription drugs
- hab/rehab services and devices
- Lab tests
- Preventive and wellness services and chronic disease management
- Pediatrics (including oral and vision)
Unfortunately, offering things like Essential Health and Wellness Benefits and guaranteed issue status can get expensive for the average person. That’s where the federal subsidies come in. For households making anywhere between 138% and 400% of the federal poverty level, there are generous federal subsidies available which will significantly lower the cost of your monthly insurance premiums. For people making below 138% of this income threshold, you’ll be pleased to know that Louisiana accepted federal funds back in 2016 to help low-income individuals and families afford Medicaid.
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One good thing about Medicaid in Louisiana is that qualifying for the program is largely based on your income. Even if you are not disabled, pregnant, the parent of a child under the age of 19, or dealing with a reproductive cancer without medical insurance, you may still qualify based on income alone. To find out more information, however, you’ll have to visit The Louisiana Department of Health website and fill out an application. Alternatively, you can also contact the Department of Health directly to find out how to apply in person or over the phone.
Short Term Health Insurance in Louisiana
Between the federal health subsidies and the Medicaid expansion, most working families in Louisiana will qualify for a subsidized, low-cost, major medical plan. but not everyone will be so lucky. Furthermore, some people may choose not to accept one of these plans for their own personal reasons. In this event, you have options like short-term health insurance. These plans are provided by private insurance companies and subjected to only the bare minimum of federal and state government regulations. But they’re not a legal equivalent to major medical coverage, and they operate a little bit differently compared to major medical plans.
For starters, these plans can be more affordable than an unsubsidized ACA plan if you have to pay 100% of your monthly premiums out-of-pocket. They can cost up to 33% less, making them more affordable for some people. They also come with consumer protections which allow you to go to court and collect money for unpaid claims if your short-term health insurance provider denies you benefits for an unjust or illegal reason. Some short-term health plans will even allow you to customize your coverage – but it is rare to find a short-term health insurance company that will allow you to purchase enough coverage to equal the 10 guaranteed Health and Wellness Benefits of an ACA plan. Lastly, you won’t need to fill out an application at HealthCare.gov if you want to apply – you simply approach the company directly and subject yourself to whatever medical underwriting they require of you.
When it comes to pre-existing conditions and short-term health insurance, Louisiana has some different rules. On the federal level, short-term health insurance companies are allowed to discriminate and either charge you more or reject you for coverage based on pre-existing conditions. To an extent, they are still allowed to do this in Louisiana. But they can only review the last 12 months of your medical history if the short-term plan duration is longer than 6 months. Anything before that doesn’t count against you. For any short-term health insurance company that wants to take a deeper dive into your medical history, the maximum term they can give you is a 6-month health insurance policy. On top of that, short-term health insurance has benefit caps on annual and lifetime payouts, as well as high deductibles before your benefits kick in (usually starting at around $5,000 or more). These are the reasons why short-term health insurance isn’t considered a legally adequate alternative to a major medical plan through the ACA. The upfront and out-of-pocket costs to get the most out of your short-term health insurance coverage can be prohibitively expensive for some, and these policies are more useful as a way of curbing out-of-pocket costs for healthy people who find themselves with an unexpected medical emergency.
Christian Health Plans/Health Share Plans in Louisiana
Are you thinking about a Christian health plan instead? The truth is that Christian health plans were a more attractive option a few years ago when the individual mandate was still a requirement on the federal level. But it was removed as of 2019, and there are no state mandates in Louisiana which require health insurance to be purchased. That being said, if you are a person of faith or if a Christian health plan in your area is cost competitive with alternative options like short-term health insurance, you might be able to find a Christian health plan which helps you and your family meet your medical needs.
When compared to full price ACA plans, health share plans are considerably cheaper and usually on par with short-term health insurance. But you should know that health share plans come with the following caveats:
- These plans are NOT guaranteed issue
- They will likely have unlimited out-of-pocket costs
- Almost all plans come with lifetime and annual benefit caps
- These plans do not include guaranteed Essential Health Benefits
But that does not mean these plans are identical. Far from it, in fact. The differences start with the “participation guidelines” which are imposed with most health share plans. Many guidelines include declaring a specific faith, usually a Christian one, and promising that you will give up any tobacco use if you are currently using any. Some plants have even more extensive and complicated stipulations than that, usually based on a biblical lifestyle. The lingo is also a little bit different; you pay a “monthly share amount” instead of a monthly premium, and you typically pay an “unshared amount” or a “personal responsibility amount” instead of a deductible, copay, or coinsurance payment. Lastly, consumers don’t have consumer protection laws on their side with a Christian health plan the way they would with short-term health insurance. If your health share plan provider ever decides not to honor the benefits they promised you when you signed up, your ability to take them to court and get the money you are owed is almost nonexistent. That being said, there are many good faith actors out there who will honor their promises and not put you through that rigmarole.
Fixed Indemnity Plans in Louisiana
Fixed indemnity plans usually pertain to hospital expenses or doctor expenses; some plans may incorporate both together, or you may have to purchase different supplements separately. But at the end of the day, these plans are supplements – they are not a legal substitute for major medical coverage. As a matter of fact, most people with a fixed indemnity plan purchase it alongside major medical, short-term health insurance, or a health share plan in order to keep their out-of-pocket costs low. But more and more people these days are flocking to these plans as a low-cost alternative to those three options we just discussed.
Fixed indemnity plans are not guaranteed issue, you cannot get all 10 of the Essential Health Benefits that you would get through the ACA, and they come with many of the same annual and lifetime benefit caps that you would get with short term insurance or a Christian health plan. They pay out benefits on a per event, per visit, per month, per week, or per day basis. But these plans do come with pretty low monthly premiums for the average person, even in the face of medical underwriting. So fixed indemnity plans can be a low-cost option for healthy people who don’t anticipate much medical care, but want a backup in case something unexpected happens.
Discount Cards in Louisiana
Then you have the option to purchase a medical discount card. It doesn’t matter what other type of health insurance you currently have, or if you have no coverage at all; any resident of Louisiana is eligible to purchase a medical discount card if you find a good deal available in your area. But not all of these are great deals. Some medical discount card companies will lie and say that they are a viable alternative to major medical insurance, even though they are not. They may also exaggerate the discounts available, or lie about who’s participating in their program. But you can be a smart shopper and call ahead to verify the discounts and the providers they advertise. If you find that they’re telling the truth, a medical discount card is great way to help reduce your out-of-pocket costs.
Using a medical discount card is simple. Most programs only require a monthly or an annual fee, and as long as you pay your dues, you will receive a medical discount card in the mail and be able to use it for instant discounts at qualifying providers and pharmacies. Because these cards aren’t Insurance, you won’t be filing any claims or waiting for reimbursements. But they also won’t take care of the majority of your medical expenses, either. However, as long as the discounts you receive are worth as much or more than your membership fee, medical discount cards can be a tool in your toolbox for protecting yourself and your family from out of control medical costs.