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Louisiana Health Insurance

Louisiana Medical Insurance Overview

Louisiana happens to be the worst state in the entire country when it comes to the overall health of the residents living there.  It has been ranked in 50th place by the United Health Foundation and it is hoped that the new healthcare law will offer changes that will provide for more insurance coverage to Louisiana’s residents.

The goal of the Affordable Care Act is to take states like Louisiana and turn around the numbers with regard to those who are uninsured and have low quality of life because of their health situations.

Through 2020, the country will still see gradual changes as a result of the ACA, and it has been estimated that 30 million more citizens in the U.S. will be able to obtain adequate health coverage.

Louisiana’s Health Care Issues
Louisiana’s ranking is the lowest in the whole country and it has a great deal of room for the improvement of the health of its people.  The state does have some strengths regarding its overall health and those are its low disparity of health status by education, high immunization percentage of adolescents and its low levels of air pollution.  Conversely, its problems include a high percentage of young children living in poverty, high rates of smoking and obesity issues.

Understanding Louisiana’s Uninsured Population
Currently, 13% of the population of Louisiana is not covered by any insurance plan.

Provided below are some facts regarding the uninsured population of the state of Louisiana:

  • 13% lacks health insurance benefits, which is down from 20% in 2010.
  • 51% of the uninsured population in Louisiana is comprised of poor adults.
  • Adults earning under 139% of the Federal Poverty Level lack insurance coverage.

Group Health Plans
In the state of Louisiana, employers who offer group health coverage for their workers is at 45%, which leaves over half of the companies without group coverage options.  Despite that low number, you should be encouraged to follow up with your employer and ask if insurance benefits are provided as a result of your employment with the company.  The Louisiana Dept. of Insurance regulates HMOs and insurance plans in the state.  Getting covered under a group health plan is the best option for workers because of the employer contribution to the cost of premiums.  In addition, this type of plan usually offers a great amount of coverage to people who it covers.

Signing Up
When you go to sign up for insurance benefits through your employer, you are going to want to ask when the open enrollment period is.  Usually this time frame is once a year and gives you the chance to look over your options and configure a plan that is right for you.  Ask your Human Resources representative for information pertaining to the open enrollment period and the features that insurance through a group plan offers.

Prior to signing up for coverage, familiarize yourself with these aspects of the company’s health benefits packages:

  • Are the benefits affordable?  You will usually be responsible for a portion of the costs and that is shared with the employer, but some plans can be costly.
  • Will you get a comprehensive enough insurance policy?  If you are looking to get covered for a pre-existing condition, you want to ensure that you can get the medical services you need for proper treatment.
  • Will you need to cover your spouse or dependents under your group plan?  If so, talk to your rep about any dependents to ensure they are included in the plan.

Pre-Existing Condition Exclusion Periods
If you have a pre-existing condition, you may not be able to get turned down for coverage under a group benefits package, but you will have to wait for up to a year to pass before you can use your insurance benefits.  In the state of Louisiana, the look back period is six months for insurance companies to see if you have any pre-existing conditions.  Even though the exclusion period applies to adults covered under the plan, dependents 19 years of age and younger are not subject to waiting.

Affiliation or Waiting Periods
Waiting periods go into effect after the enrollment period has been completed.  For persons enrolling into the plan late, this period can run up to three months, but otherwise it shouldn’t last longer than two months total.

Individual Health Plans
Individual health coverage is available to residents in Louisiana who do not qualify for coverage under a group plan and are self-employed, unemployed or employed with a company that doesn’t offer benefits.  Five percent of the population of Louisiana is covered under individual policies.

Benefits under this plan type are limited because of the ability for the insurance company to do underwriting on the policy.  The exclusion and look back period for insurance companies in this state are both 12 months long and the law allows for elimination riders on this type of policy agreement.
It is estimated that a plan that covers catastrophic medical issues with a high deductible for a young, healthy person in Louisiana can cost around $32 monthly.

Continuation Coverage
Continuation coverage under COBRA is available to people who have had a change in marital, job or dependent status.  No matter the reason, you can obtain benefits that last up to 18 months under COBRA.

If the company that offered the original benefits package has over 20 employees, then COBRA coverage is available to those who have lost their insurance coverage.  Conversion plans are also available in the event that the COBRA benefits have expired.  Conversion plans simply modify the original group contract into an individual policy that is through the same insurance company.

Louisiana Health Benefits Exchange
In the beginning, Louisiana opted to allow the federal government to manage its benefits exchange, but has since changed to a state-run marketplace.  The Louisiana Health Insurance Exchange was established to provide insurance options and comparison tools so that residents can learn their choices and find one that best suits their situation.

Louisiana State Insurance Programs
Residents in the state of Louisiana can select from a variety of health insurance programs that are funded by the state.  If you are unable to obtain coverage through your workplace or an individual insurance policy, then you could look through each plan to determine whether or not you qualify for coverage.  Eligibility typically is factored on your income level, health status, age, gender and pre-existing conditions.

Among the state-funded options are the Pre-Existing Condition Insurance Plan (PCIP), Medicaid, LaCHIP, WIC, Children’s Special Health Services (CSHS), Breast & Cervical Cancer Prevention (BCCP), LaMOMS, Take Charge Plus, Medicare, the VA Medical Benefits Package, the Partnership for Prescription Assistance, BAYOU HEALTH, and the National Association of Mental Illness (NAMI) Helpline.

Below is a breakdown of each program:

Pre-Existing Condition Insurance Plan (PCIP)
This plan is for people who have had trouble getting insurance coverage due to a pre-existing health condition.  There are a large amount of services offered and monthly premiums can cost hundreds of dollars.

Medicaid offers a plethora of medical services to individuals and low income families living in the state of Louisiana.  Eligibility is largely based on the person’s income level.

This program offers health insurance benefits to uninsured children that are part of low income families up to the age of 19.

Women, Infants, and Children (WIC)
The WIC program was established as a means to feed and educate women on infant safety, care and nutrition.  It also allows for women to receive free food products for themselves (while pregnant) and for their children up to the age of five.

Children’s Special Health Services (CSHS)
This program is for children who have special health care needs to ensure that they have access to proper medical care that works to minimize their disabilities and maximize their ability  to enjoy their lives.

Income is a qualifying factor as well as health condition.

Breast & Cervical Cancer Prevention (BCCP)
This program offers screening services just for the female population in the state of Louisiana.  You can obtain breast exams, mammograms and pelvic exams through BCCP.  In order to qualify, you must meet the income requirements and be between the ages of 50 and 64.

LaMOMS will cover the costs associated with doctor’s visits, lab work, prescription medications, delivery and hospital care for pregnant women living in Louisiana.  You can also apply for coverage that lasts 60 days beyond the birth of your child.

Take Charge Plus
This program offers family planning services and a list of medications and supplies for those who qualify.  Women who are between 19 and 44 years of age with incomes below 200% of the Federal Poverty Level are able to obtain benefits under this plan.

Medicare and the Medicare Prescription Drug Program
Medicare coverage is offered to seniors over 65, disabled persons and persons suffering from end-stage renal disease.  There are four parts to the Medicare program, each with its vary coverage options and cost.

VA Medical Benefits Package
The VA Medical Benefits Package is strictly for military vets who have completed their active duty requirement and have received an honorable discharge from the service.

Partnership for Prescription Assistance
The Partnership for Prescription Assistance has access to nearly 475 programs that can pay some or all of the costs of your medications.

Bayou Health assists people who are enrolled in the Medicaid and LaCHIP programs and facilitates the issuance of the benefits provided.

National Association of Mental Illness (NAMI) Helpline
The National Association of Mental Illness Helpline is a volunteer-run service that dispenses informational guidance to those persons suffering from mental illnesses.

The Health Insurance Portability and Accountability Act (HIPAA)
HIPAA has created an environment that protects the medical records of individuals all across the country.  With the enactment of the Affordable Care Act, HIPAA also regulates insurance companies throughout the country.  In Louisiana, it governs the lengths of time allotted for exclusionary and affiliation periods, controls the costs of premiums and allows for continuation coverage through and after COBRA benefits have gone into effect and have been exhausted.