What should you expect when it comes to health care in Louisiana? According to a study by U.S. News, Louisiana has the fourth worst health care in the nation. That study considers access, quality, and good public health. But residents still have plenty of health care options.
Health insurance options in Louisiana
According to the LA Department of Insurance, there are several ways for residents to get health care:
Employer-provided
- From your employer
- Through your spouse's employer
Individual or family plans
- Through HealthCare.gov
- Directly from a health insurance company
Government-assisted
- Medicare
- Medicaid
Where do most Louisianans get their health insurance coverage?
| Sources | Percent | ||
|---|---|---|---|
| Employer-Provided | 42% | ||
| Individual or family | 5% | ||
| Medicaid | 29% | ||
| Medicare | 13% | ||
| Uninsured | 8% | ||
| Source: Kaiser Family Foundation, Health Insurance Coverage of the Total Population | |||
Eight percent of LA residents have no insurance, just under the national average. That's good for policyholders, as the more uninsured people there are, the higher rates are for insured people.
Louisiana health insurance companies
LA is full of providers that offer individual and family plans. These are the top health insurance companies in the state:
- Blue Cross and Blue Shield of Louisiana
- HMO Louisiana
- Vantage
- Christus
Louisiana health insurance costs and rate factors
Louisiana residents spend an average of $7,815 every year on health care, slightly less than the national average. What determines your health insurance cost? Monthly premiums differ person to person, mainly based on these factors:
Plan type
The more health care coverage you want, the more you’ll pay in monthly premiums. Marketplace plans come in metal tiers: bronze, silver, gold, and platinum.
How much should you expect to pay for health insurance in LA? These are the average monthly premiums for a middle-aged, non-smoking state resident in 2020:
| Bronze | Silver | Gold | |
|---|---|---|---|
| $376 | $467 | $571 | |
| Source: Kaiser Family Foundation, Change in Average Marketplace Premiums by Metal Tier | |||
Premiums for gold plans cost nearly 52 percent more than bronze plans. That price jump is because gold plans cover 80 percent of medical costs, whereas bronze plans cover 60 percent of costs.
You may also qualify for a catastrophic plan, the lowest level of coverage available. Catastrophic plans have low monthly premiums but a yearly deductible of $8,150. Because of that high deductible, it may actually save you money to invest in a bronze or silver plan.
Body mass index
Health insurance companies analyze your body mass to determine your risk-level. That’s because a high BMI can lead to serious health conditions. As a result, a high BMI also leads to high insurance rates.
In 2018, LA had a 35.9 percent obesity rate, the ninth highest rate in the nation. Of thousands of Louisianans who used QuoteWizard to compare health insurance plans, 38 percent have a BMI in the obese range.
Tobacco use
Smokers pay more for health insurance because of the serious illnesses it causes. About 23.1 percent of LA residents are smokers, the third highest rate in the nation.
Age
Health insurance plans for older people tend to cost up to three times more than for younger people. State residents who used QuoteWizard to shop for health insurance are, on average, 41 years old.
Location
One of the most important factors in determining your health care prices is where you live. Every state has different rules, regulations, and providers surrounding their marketplace.
Health insurance rates are community-rated, which means costs are partly based on the combined claims everyone files. So, if a neighbor files a high number of claims, your prices could increase.
The health of your state also plays a role. According to America’s Health Rankings, LA is the second unhealthiest state in the country.
Louisiana health insurance laws
The Affordable Care Act aims to protect residents from unfair policy pricing. There are some factors that the ACA limits providers from considering while determining your rates.
- Pre-existing conditions: Before the ACA, people with pre-existing conditions were charged a lot more for coverage. Now, your prices can’t be affected by a pre-existing condition.
- Gender: According to a study that looked at health care costs over time, women historically pay more for health care. But the ACA limits health insurance companies from charging women and men different prices for the same plan.
- Insurance and medical history: Insurance companies also analyzed your previous medical history and any lapses in insurance. People who fell into these categories had a hard time finding coverage. The ACA mandates that insurance companies can’t use those factors to price your policy.
There’s a limit to how much you can pay out-of-pocket for a marketplace plan. In 2020, the out-of-pocket maximum is $8,150 for an individual plan and $16,300 for a family plan.
Louisiana state law requires health insurance companies to offer at least some coverage for the following services:
- Emergency room service
- Hearing aids for minors
- Maternity minimum stay
- Severe mental illness
- Cancer screenings
- Immunizations for children up to age six
There are additional services that insurers need to offer coverage for. Find the full list on cms.gov.
Medicare and Medicaid in Louisiana
Medicare and Medicaid are both government-funded health care programs. They aim to offer affordable care for different groups of residents. Medicare helps seniors, whereas Medicaid aids low-income families and children.
Medicare
Medicare aids LA residents 65 and older. There are several coverage options within Medicare. These options include parts A, B, C, D, and supplemental coverage plans. You may also be eligible for one of these Medicare Savings Programs with these income limits:
- Individual monthly income limit: $1,456
- Married couple monthly income limit: $1,960
Medicaid
Nationally, the rate of uninsured Americans has improved considerably since the Affordable Care Act (ACA) became law in 2010. In Louisiana, Medicaid expansion was influential in reducing the state’s overall uninsured rate.
In 2015, 12.1% of Louisiana’s residents did not have medical insurance. After Louisiana expanded its Medicaid program in 2016, the state’s uninsured rate dropped 13.2% by 2019. The primary cause of this was a 14.9% increase — or 170,600 Louisiana residents — in Medicaid enrollment from 2016 to 2019.
Medicaid aids low-income families and children. These are the state’s Medicaid financial requirements:
| Household Size | Maximum Yearly Income |
|---|---|
| 1 | $16,971 |
| 2 | $22,930 |
| 3 | $28,888 |
| 4 | $34,846 |
| 5 | $40,805 |
| 6 | $46,763 |
| 7 | $52,722 |
| 8 | $58,680 |
Louisiana Office of the Insurance Commissioner
- Website:
- Homepage
- Insurance Commissioner:
- Jim Donelon
- Insurance Hotline:
- (800) 259 - 5300
- Office Hours:
- Monday - Friday
8:00 am to 4:30 pm
- File a Consumer Insurance Complaint
- Complaint Page
Sources:
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