Brad Goins Thursday, October 3, 2013 0

The Basics 

By Brad Goins


Each state will have its own version of the new Affordable Health Care plan. If you’re a Louisiana resident, this guide should give you the info you need to start making decisions about the state’s version of the plan.

Like every other state, Louisiana will have its own marketplace for health insurance. (These marketplaces are also sometimes called exchanges.)

The marketplace will enable citizens to shop for and buy insurance. The marketplace is mainly for people who don’t have insurance, people who aren’t insured by their employer, people with pre-existing conditions who may have had  trouble getting insurance before and some small businesses that will benefit from its provisions.

The federal government will operate Louisiana’s health insurance marketplace.


When You Can Enroll

You can enroll from Oct. 1 to Dec. 31, 2013. Coverage will begin in 2014. If you want your coverage to begin Jan. 1, 2014, you’ll have to sign up by Dec. 15, 2013.


Louisiana’s Plans, Benefits And Costs

Companies can offer four types of plans: bronze, silver, gold and platinum. These “metal level” plans all have the same benefits. What differs is how much they pay on average toward the costs of the services the plan provides.

— Bronze Plan: You pay 40 percent and the plan pays 60.

— Silver Plan: You pay 30 percent and the plan pays 70.

— Gold Plan: You pay 20 percent and the plan pays 80.

Catastrophic plans may be available, especially for those who are younger than 30 and healthy. These plans cost less up front, but don’t give you as much coverage. They generally require you to pay more out-of-pocket costs.

Companies may offer several plans in the same metal level. The plans and premiums would vary based on the deductible amount, co-payments, co-insurance and other factors.

You must have at least a bronze-level plan to meet minimum requirements under the Affordable Care Act and avoid the penalty for not having health insurance.

A Platinum Plan, for which one pays 10 percent and the plan pays 90, is not available in Louisiana.


Tobacco Surcharge

Louisiana allows insurance companies to charge tobacco users 50 percent more than non-tobacco users.


Who Sells The Insurance?  

Five companies submitted plans for the Louisiana Marketplace: Blue Cross Blue Shield of Louisiana, Coventry, Humana, Vantage and Louisiana Health Cooperative.


What’s Covered

All plans in the state must cover the same package of benefits, which are called essential health benefits. In Louisiana, these benefits include:

— Outpatient services, such as doctor visits or tests done outside a hospital.

— Emergency services.

— Hospital stays.

— Pregnancy and baby care.

— Mental health and substance abuse services, including behavioral health treatment.

— Prescription drugs, including  generic and certain brand-name drugs, except fertility drugs, oral contraceptives and growth hormones.

— Rehab and habilitative services and services that help people with developmental issues. This includes services for people diagnosed with autism spectrum disorder.

— Lab tests.

— Preventive and wellness services, along with services that help people manage chronic conditions.

— Services for children, including dental  and eye care.

Some services that are not included are those for infertility, long-term care and cosmetic surgery.

Make sure to read the summary of benefits of the plans you are considering to see if they include the coverage you need.


Financial Aid

You may qualify for a subsidy: money to help pay your health insurance premium each month. The subsidy, which is available on insurance bought in the state’s health insurance marketplace, may be sent directly to your health insurance company. In general, you’ll be eligible for a subsidy if you’re single and make $45,960 or less a year, or if you have a family of four and make $94,200 or less a year.

Depending on your income, you may also qualify for cost-sharing subsidies that will reduce your costs when you receive medical care. Note that cost-sharing subsidies are available only with silver plans.

The Children’s Health Insurance Program (CHIP) provides coverage for children of some families who have a low income but aren’t eligible for Medicaid.



Navigators are people who will teach you about the marketplace and guide you through your decision about health insurance. They are supposed to be fair and impartial helpers. They can’t take money from insurance companies.

These organizations are approved to operate navigator programs in Louisiana:

— Southern United Neighborhoods (with $486,123 grant money for the project).

— Martin Luther King Health Center ($81,066).

— Southwest Louisiana Area Health Education Center ($1,099,985.80).

— Capital Area Agency on Aging, District II ($100,000).



Certified Application Counselors (CACs) work for community-based programs. They will help you fill out insurance applications.

Consumer Assistance Programs will help you understand your rights under the new law. They can help you resolve problems and make appeals.


Other Resources

Call center: you can call the federal government’s help line, 800-318-2596, which is open 24 hours a day, seven days a week for information. You can also find information at HealthCare.gov. Remember, each state has its own plan, so if you can’t find what you need on the general site, locate the information for Louisiana’s plan.