What is a Louisiana Medicare Advantage Plan?
The advantages of Medicare Advantage (MA) health plans are found in what they can cover that Original Medicare cannot. Specifically, the MA plans (aka, Part C) available in Louisiana can include minor healthcare benefits such as prescription drug coverage, vision, hearing, dental, fitness, telehealth, and more. In contrast, Original Medicare only covers major medical healthcare services. To join an MA plan you must first be enrolled in both Medicare Part A and Part B.
Many people love the extra benefits they get with their MA plan, particularly a prescription drug plan. However, before you jump in with both feet, take the time to fully understand the trade-offs. The extra benefits and perks are nice, but they come at a cost. Specifically, when you join a Medicare Advantage plan in Louisiana you are agreeing to accept the plan's managed care health system. As an MA plan member, you agree to let the insurance plan be a gatekeeper and fully control your access to doctors and other healthcare providers.
Original Medicare vs. Medicare Advantage
One way to better understand how different Original Medicare coverage is from Medicare Advantage is to have a look at the pros and cons of each type of health insurance. So, let's do that.
The Pros and Cons of Louisiana Medicare Advantage Plans vs Original Medicare
- With Medicare Advantage you must use Louisiana healthcare providers within the plan's network. With Original Medicare, you can use the Medicare-approved provider of your choice.
- If you travel and have a medical emergency, Medicare Advantage covers you. However, if you are a snowbird and winter or summer in another state, non-emergency doctor outside of your plan's network won't be covered.
- All Medicare Advantage plans sold in Louisiana protect you with an annual maximum out-of-pocket (MOOP) limit. Once you reach this spending limit the plan pays all additional copays and coinsurance that you'd normally pay out-of-pocket. Original Medicare does not have an out-of-pocket maximum.
- Most Medicare Advantage plans come bundled with a Louisiana Medicare Part D plan for prescription coverage. With Original Medicare, you must enroll in a stand-alone Part D plan. But, the stand-alone plans offer more choices to get lower-cost prescriptions.
- With Original Medicare your costs (copays, coinsurance, etc) are predictable, and you can get a Medicare supplement to help pay these costs. In the Medicare Advantage program, each plan can charge what they want for copays and coinsurance, making it very difficult to compare actual costs.
- There are eligibility requirements with Medicare Advantage plans. For example, you must have both Medicare Part A and Medicare Part B to join, and you cannot have end-stage renal disease (ESRD) or one of a handful of other diseases.
Medicare Supplements vs. Medicare Advantage
We're frequently asked:
- Why are Medicare Advantage plans bad?
- What are the disadvantages of Medicare Advantage plans?
- Is it better to have Medicare Advantage or Medigap?
Let's take just a minute to dispel any misconception that these plans are bad or might have serious disadvantages.
Why Louisiana Medicare Advantage Plans are Bad
This is a myth. There's nothing wrong with Medicare Advantage plans. In fact, over 20 percent of all Medicare beneficiaries in Louisiana choose Medicare Advantage enrollment over traditional Medicare.
What you really need to know is that these plans are not for everyone. Some people are better served with traditional Medicare and a Medicare supplement. The question is, which option is best for you?
RELATED: Why Medicare Advantage Plans are Bad
MedicareWire advises people who have one or more serious chronic conditions to keep their Original Medicare, particularly if you have specialists treating you and you want to stay with them. Our opinion is that Medicare Advantage is an excellent option for those who qualify for both Medicare and Medicaid (dual eligible), for those with retiree healthcare benefits, and for extremely healthy, active seniors.
Similarly, traditional Medicare, plus Medicare supplement insurance, work best for people with chronic health conditions, as well as those who can afford a higher monthly premium. Most experts agree that this is the best health insurance seniors can get in Louisiana.
The Disadvantage of Medicare Advantage Plans if You Live in Louisiana
The disadvantage of Medicare Advantage plans is the strength of Louisiana Medigap plans. You see, when you take doctor choice out of the equation, the big difference between Medicare Advantage and Medigap is when you pay for services. It's that same no matter what type of Medicare Advantage plan you're evaluating (e.g., HMO, PPO, PFFS, Cost, or HSA).
Medicare Advantage plans have a monthly premium, but it's generally less than a Medicare supplement, and some plans even have a $0 premium. But, you also pay when you use health care. These are the copayments. It does not matter if you have a Health Maintenance Organization (HMO) plan or a Preferred Provider Plan (PPO). Most of your out-of-pocket costs come when you use healthcare services.
With a Medicare supplement plan you pay most of your costs in advance with monthly premiums. Depending on the level of coverage you choose, the plan can cover all of your copays, coinsurance, and deductibles except the annual Part B deductible. This makes your monthly healthcare costs more predictable, particularly if or when you have serious health problems.
Which is Best in Louisiana, Medicare Advantage or Medicare Supplement Insurance?
- If you can afford Medigap Plan F or G, then keep your Original Medicare and add one of these supplements. These plans help you manage your out-of-pocket costs the best, giving you complete peace-of-mind.
- If you are a healthy senior and have good health in your family heritage, Medigap Plan N will let you save money by sharing some costs when you see your doctor. The plan benefits are excellent and pay just a little to see your doctor (up to $25 per visit).
- If you are a healthy senior but you cannot afford a Medigap Plan F, G, or N, Medicare Advantage is a good choice. Both Original Medicare and Medicare Advantage cover preventive care at no additional cost to keep you healthy
- If you are turning age 65, have one or more chronic health conditions that require frequent doctor visits, and you do not qualify for both Medicare and Medicaid (dual eligible), the most Medigap coverage you can afford is the best option.
- If you qualify for both Medicare and Medicaid, regardless of your health condition, Medicare Advantage is your best option.
- If you have special needs (i.e., a full-time nursing home resident, diabetes, etc.) and an appropriate Medicare Advantage Special Needs Plan (SNP) is available, this is your best option.
- With both Medigap and Medicare Advantage, you must continue to pay your Medicare Part B premium (it typically comes straight out of your Social Security income, unless you're not yet taking it).
- With Medicare supplement insurance there are no service area restrictions. With Medicare Advantage, you must receive care within the plan's provider network unless you need emergency care.
- Medicare Advantage plans have an enrollment period. You get an individual enrollment period when you're first eligible. After that, there's an annual enrollment period to switch plans or go back to Original Medicare. Medigap plans do not have the same restrictions, but you can be turned down if you leave a Medigap plan and later want to come back. Medicare Advantage plans cannot generally turn you down as a Medicare supplement insurance company can.
Frequently Asked Questions About Louisiana Medicare Advantage Plans
Medicare Advantage plans vary from Parish to Parish in Louisiana. This is due to the local nature of healthcare provider networks. If you enter your zipcode into this tool it will show you all of your plan options and 5-star ratings.
More than 90% of all Medicare Advantage plans in Louisiana include a Part D plan for prescriptions, but not all. However, coverage is different with each plan. It is very important to verify that a plan covers your most important medications before you join. You can do so using this tool.
To understand the pros and cons of Medicare Advantage, you need to compare it with Original Medicare and factor in your health and financial situation. This article can help you compare which type of plan is best.