Louisiana Medicare Advantage Plans – Top 5 Plans 2022
The best Medicare Advantage plans in Louisiana for 2022 have many benefits, but you’ll need to choose the right plan for your individual needs. If you’re going to be enrolled in Medicare Part A and Part B anytime soon, now is the time to start looking for a Medicare Advantage plan in Louisiana. First, take a look at this simple guide so that you’ll have a better understanding of how these Medicare plans work and why they’re often better than having Medicare coverage alone.
What is Medicare Advantage in Louisiana?
Medicare Advantage in Louisiana represents one of the coverage options you have in accessing Medicare benefits. Medicare Advantage (MA) plans, created and sold by private insurance companies, are becoming more popular year after year.
To enroll in Medicare Advantage in Louisiana, you must first be enrolled in Original Medicare (Medicare Part A and Medicare Part B). You will be required to pay the monthly Part B Premium which is $203 in 2021.
There will be a list of network providers including doctors, hospitals, and other health care facilities to choose from.
A Louisiana Medicare Advantage plan may include some extra benefits not covered by Original Medicare such as:
- Vision care benefits
- Dental care benefits
- Hearing exam and hearing aid assistance
- MAPD plans have built-in prescription drug coverage
- Gym memberships or other fitness and wellness benefits
What is the Best Medicare Advantage plan in Louisiana in 2022?
Best network freedom: Medicare Advantage PPO
- PPO plans offer a larger network and no referrals are required.
- PPO premiums range from $0 to $100 per month.
Best for Lowest out-of-pocket: Medicare Advantage HMO Plan
- HMO premiums are generally $0 per month.
- HMO plans have lower out-of-pocket costs because they use the HMO referral network.
Best for low income or health conditions: Medicare Advantage D-SNIP
Medicare Advantage D-SNIP plans are best for those on limited incomes or who have chronic health conditions. Enrollees on this type of plan can have Medicare AND Medicaid to lower out-of-pocket costs on things like copays, coinsurance, and premiums. Part B deductibles will usually be $0 to a small amount.
What Medicare Advantage plans are available in Louisiana?
Local HMO – 31
Local PPO – 17
Regional PPO – 3
What’s changing with Medicare Advantage in Louisiana for 2022?
Enhancements to the Part C and D Programs Beneficiary Real-Time Benefit Tool (RTBT)
Changes will be made in the Part C and D Programs Beneficiary Real-Time Benefit Tool in 2022. Medicare Part C and Part D recipients will be able to do online searching for more cost-efficient prescription medications for their particular health care needs.
If your healthcare providers prescribe a medication that has a high price or copay, you can look for a more affordable substitute that will meet your needs.
Permitting a Second, “Preferred,” Specialty Tier in Part D
The Centers for Medicare and Medicaid Services will endorse a Second “Preferred” Specialty Tier with lower cost-sharing in Medicare Part D starting on January 1, 2022.
This second “Preferred” Specialty Tier will provide a tool for brokering deals with prescription medication manufacturers in exchange for including their product on the “preferred” specialty tier.
Medicare Advantage (MA) and Part D Prescription Drug Program Quality Rating System
Quality Rating Scores are assigned by Part D drug plans to participating pharmacies. The Part D plan has not been required to publicize information about the standards used for determining these ratings.
The Pharmacy Rating Measures have been described as unfair and unrealistic by some pharmacies. The Quality Rating they receive has a direct bearing on the amount of reimbursement the pharmacy receives.
Beginning on January 1, 2022, Part D drug plans will be required to release the details of their Quality Rating Measures to the Centers for Medicare and Medicaid Services. CMS can share the information as they deem appropriate.
Establishing Pharmacy Performance Measures Reporting Requirements
Information obtained from the Part D prescription drug plans regarding their Pharmacy Rating Measures can be used by CMS to increase public transparency and assist the industry in implementing more equitable and uniform quality standards.
Implementing Several Opioid Provisions of the SUPPORT Act
The SUPPORT (Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment) Act has set forth new requirements for Medicare Part D plans to educate Medicare recipients about opioid risk factors, alternative pain relief modalities, and safe ways to discard prescription medications.
These sub-regulatory guidance policy measures have been codified by CMS to increase the stability and transparency of the Recovery and Treatment Program.
Codifying Existing Part C and D Program Policy for Supplemental Benefit Requirements
Beginning in 2022, the Centers for Medicare and Medicaid Services (CMS) will codify existing policy dealing with supplemental benefits as outlined in Chapter 4 of the Medicare Managed Care Manual.
The definitions of the terms “supplemental benefit” and “primarily health-related” will be expanded to present cost-sharing decreases as allowable supplemental benefits
How much does Medicare Advantage in Louisiana cost?
In most states, at least one HMO will have a $0 monthly premium.
Some states will offer a $0 monthly premium PPO plan, but it is becoming increasingly common for PPOs to have premiums.
Plan availability varies from county to county.
Louisiana has 44 MAPD (Medicare Advantage with Prescription Drug coverage) plans with an average plan premium that is $6 below the national average).
Louisiana’s average MAPD drug deductible of $349.81 annually is about $7 above the nationwide average, but is offset by premiums that are $2 lower at $39.50.
When can you enroll in a Louisiana Medicare Advantage plan?
Initial Enrollment Period
Your Initial Enrollment Period begins three months before your 65th birthday month and ends three months after your birthday month.
Once you enroll in Original Medicare, you can choose to purchase a Medicare Advantage plan. Many Medicare Advantage plans have built-in prescription drug coverage.
Alternatively, you may choose a Medicare Supplement plan (Medigap) to work alongside Original Medicare to help pay some of the out-of-pocket costs not covered by Original Medicare.
Open Enrollment Period – AKA Annual Election Period
The Medicare Annual Election Period (AEP) happens every year from October 15 to December 7. If you did not enroll in Medicare during your Initial Enrollment Period upon turning 65, you may have a second chance during the fall Annual Enrollment Period.
You can also change from one plan to another (MA or PD) or choose to drop either of these without replacing it.
Medicare Advantage Open Enrollment Period
The Medicare Advantage Open Enrollment Period goes from January 1 to March 31 annually. At this time, you can switch Medicare Advantage plans or return to Original Medicare.
Special Enrollment Periods – Special Circumstances
A Special Enrollment Period (SEP) can occur at any time of the year under certain circumstances. Some situations that might make you eligible for SEP would be:
- Medicare terminated your Medicare Advantage plan’s contract
- You lost your employment-based insurance coverage
- You moved to a location outside your current MA plan’s service area
5-star Special Enrollment Period
If you are enrolled in a Medicare Advantage plan that has a star rating below 5 stars and you find a five-star rated plan, you can change (one time only) to the 5-star plan any time between December 8 and the following year on November 30.
Consult a Medicare agent before making this change to be sure you do not lose your Prescription drug coverage or MA coverage when enrolling in a 5-star plan.
Special Enrollment Periods if you get “Extra Help”
People who qualify for “Extra Help” paying for prescription drug coverage can join, drop, or switch Medicare prescription drug plans one time during each of these time periods:
- January – March
- April – June
- July – September
The fourth annual quarter is not included, but all Medicare beneficiaries can make changes to their plans during the AEP from October 15 to December 7.
When can I make changes to my Medicare Advantage plan?
Once you are enrolled in Original Medicare (Medicare Part A and Part B), you have eligibility to enroll in a Medicare Advantage Plan in Louisiana during your Initial Enrollment Period.
If you pass up your Initial Enrollment Period, you get a second chance to choose a Louisiana Medicare Advantage plan (Medicare Part C) during the Annual Enrollment Period between October 15 and December 7.
You can also make changes to your existing Louisiana Medicare Advantage plan at this time. For example, if your 65th birthday is in March or April and you enroll in a Medicare Advantage Plan but later are dissatisfied with your Medicare coverage, you could be locked in to that plan for the remainder of the year.
Your next chance to change plans would be during the Open Enrollment Period from January 1 through March 31. The change would not become effective until July 1.
The fall Annual Enrollment Period allows you to make the change much sooner.
Are Medicare Advantage plans in Louisiana “bad”?
1. Number of lives enrollment in Medicare Advantage in Louisiana
In Louisiana, 291,668 Medicare beneficiaries were enrolled in Medicare Advantage Plans in 2018.
2. Number enrolled by plan specifically the 3 plans below.
Local HMO – 248,480
Local PPO – 27,103
Regional PPO – 16,085
3. Percentage of Medicare beneficiaries enrolled in Medicare advantage in Louisiana
In 2021, 44% of Medicare benificiaries in Louisiana were enrolled in Medicare Advantage Plans, an increase of 11% over 2020.
4. Number of lives enrollment in Medicare Advantage nationwide
Over 62 million people are enrolled in Medicare Advantage plans nationwide.
5. Percentage of Medicare beneficiaries enrolled in Medicare advantage Nationwide
In 2021, 42 percent of Medicare beneficiaries are enrolled in Medicare Advantage plans, an increase of 10% over the past five years.
Common Questions on Medicare Advantage in Louisiana
Are there disadvantages to Medicare Advantage?
1. Limited choice of doctors, hospitals, facilities, etc. due to network restrictions based on plan types. List of providers may be smaller for HMOs. A referral from your primary care physician may be required to see a specialist.
2. Less Financial Predictability – Medicare Advantage plans often have lower premiums than Medicare Supplement plans, but you will pay more out of pocket costs each time you utilize the plan.
3. Requires More Member Involvement – Verifying you’re staying in network, timely payment of copayments and Medicare bills, researching and making changes to your plan from year to year
4. Less Long Term stability – These plans renew every year. They usually have changes to benefits, networks, covered drugs, premiums etc. Unlike Medicare Supplement (Medigap) plans with unchanging, standardized benefits, MA plans change and you need to re-evaluate to make sure it is still the best policy for you.
What are the four types of Medicare Advantage policies available in Louisiana?
- Health Maintenance Organization (HMO) plans
- Preferred Provider Organization (PPO) plans
- Private Fee-For-Service (PFFS) plans
- Special Needs Plans (SNP)
Who are the top three Medicare Advantage plan providers?
The top three health plans for Medicare Advantage enrollment nation wide are:
- United Health Care (26)
- Humana (18%)
- BCBS plans (15%)
What are Medicare SNPs?
Special Needs Plans are specifically for people who:
- Reside in a nursing home or Skilled Nursing Facility or need nursing care full time at home
- Are eligible for Medicare and Medicaid
- Have a chronic, permanent medical condition like ESRD (end-stage renal disease)
Do Medicare Advantage plans include prescription drug coverage?
Medicare Advantage plans called MAPD (Medicare Advantage Prescription Drug Plans) are combo plans with built-in additional coverage for prescription drugs.
Do Medicare Advantage plans cover the SilverSneakers program in LA?
Many MA plans include SilverSneakers as a benefit. Confirm with your insurance agent that your plan includes this popular benefit if this matters to you.
Fitness benefits vary with insurance plans even if they are from the same company. Some health insurance plans may offer something similar, so consult your insurance company representative for details.
Louisiana State Links
Ready to Learn More?
We help educate Medicare beneficiaries on their Medicare Advantage options and help them go through the process of reviewing and comparing plans. We work with most of the nation’s top-rated Medicare Advantage carriers. Give us a call today, or request a quote online to learn more about plan options.
- In Louisiana, PPO Medicare Advantage Plans are very popular for many Medicare beneficiaries.
- You can make changes to your Advantage plan each year during the Annual Election Period.
- You must continue to pay your Medicare Part B Premium with most Medicare Advantage plans.