Medicare Advantage plans (Medicare Part C) are health insurance plans offered by private insurance companies that provide the same healthcare coverage as Medicare Part A and Medicare Part B (Original Medicare) and some plan options include additional benefits such as dental, vision, and prescription drug coverage (part d).
Overview of Medicare Advantage Plan (Part C)
Medicare is a federal government program in the United States that provides health insurance for people 65 and older, and younger people who meet certain qualifying conditions such as extra help for prescription drugs. Medicare is managed by the Center for Medicare and Medicaid services (CMS).
Medicare Advantage Plans are managed by private companies that are paid by Medicare to assume financial liability. These private companies are incentivized to keep Medicare beneficiaries healthy which is why the coverage options they offer often include additional benefits that original Medicare doesn’t cover, which is 80% of hospital insurance and 80% of medical insurance.
Below is a summary of the four parts of Medicare.
Four Parts of Medicare
- Medicare Part A covers your hospital.
- Medicare Part B covers your medical such as doctor visits and outpatient.
- Medicare Part C represents Medicare Advantage plans (private health plans).
- Medicare Part D specifically focuses on prescription drug coverage.
It’s common to hear the word Original Medicare which means the combination of Part A and Part B which is listed on your red, white and blue card.
Important Tips About Medicare Advantage Plans
Below are some key tips and details to remember about these plans.
- Medicare Advantage Plans are sold by insurance agents that must be licensed in your state of residence. For example, our Medicare agents that live in New Orleans and the surrounding areas like Slidell and Baton Rouge are required to have a Louisiana license. However, if they cross state lines, they are required to be licensed in that state in order to process enrollments.
- The most common plan types are HMO plans (referrals required) which stands for health maintenance organization and PPO plans which stands for preferred provider organization. Both HMO and PPO have unique network providers for both primary care and specialists and should be thoroughly reviewed for copayments, coinsurance, monthly premiums and deductibles before enrollment. All plans are different, so it’s important to review.
- Medicare beneficiaries cannot have both Medicare Advantage plan and Medicare Supplement plans (Medigap) at the same time. And, Medicare Supplements do not include drug coverage, so if you get a Medicare Supplement, you’ll also likely need a prescription drug plan as well.
- Eligibility can change for Medicare beneficiaries also receiving Medicaid services. These plans are referred to a special needs plans or snps for short. Health care providers often accept special needs plans as well as traditional Medicare coverage.
- Open enrollment period occurs annually from October 15th through December 7th. This is the time to review you plan and make sure your prescription drugs are listed in the plan formulary and your providers are within your plan’s service area.
Medicare Advantage Options in Louisiana
Medicare Advantage plans offer a comprehensive approach to healthcare, bundling hospital insurance (Part A), medical insurance (Part B), and often prescription drug coverage (Part D) into one convenient plan. Here’s an overview of what’s currently available if you live in Louisiana.
Total Companies Offering Plans: 12
Total Plans Available: 62
Summary of Louisiana Medicare Advantage Plan Types:
- HMO (Health Maintenance Organization): 38.7%
- PPO (Preferred Provider Organization): 27.4%
- HMO-POS (Point-of-Service): 16.1%
- HMO D-SNP (Dual Special Needs Plans): 9.7%
- HMO C-SNP (Chronic Special Needs Plans): 4.8%
- Regional PPO: 3.3%
No matter where you’re located—whether in Baton Rouge, New Orleans, or Shreveport and beyond, there are Medicare Advantage plans tailored to fit your needs.
Understanding Maximum Out-of-Pocket Costs
One of the standout features of part c plans is the annual maximum out-of-pocket (MOOP) limits, which protect you from excessive healthcare costs, protection that is not available in the traditional Medicare program (Parts A and B). In Louisiana, plans have MOOP limits distributed as follows:
- $0–$3,000: 12% of plans
- $3,001–$4,500: 35% of plans
- $4,501–$6,000: 40% of plans
- $6,001–$9,350: 13% of plans
This means 87% of the plans available across Louisiana have maximum out of pocket costs at $6,000 or less, providing you a lot of options to find a plan that best fits your needs
Lower MOOP plans are especially beneficial for cost-conscious retirees. Whether you prioritize low premiums or additional benefits, we’ll help you compare plans to find the best fit for your healthcare and financial needs.
Louisiana Parishes with Medicare Advantage Plans
| Acadia | De Soto | Lincoln | Saint Helena | West Baton Rouge |
| Allen | East Baton Rouge | Livingston | Saint James | West Carroll |
| Ascension | East Carroll | Madison | Saint Landry | West Feliciana |
| Assumption | East Feliciana | Morehouse | Saint Martin | Winn |
| Avoyelles | Evangeline | Natchitoches | Saint Mary | |
| Beauregard | Franklin | Orleans | Saint Tammany | |
| Bienville | Grant | Ouachita | St John The Baptist | |
| Bossier | Iberia | Plaquemines | Tangipahoa | |
| Caddo | Iberville | Pointe Coupee | Tensas | |
| Calcasieu | Jackson | Rapides | Terrebonne | |
| Caldwell | Jefferson | Red River | Union | |
| Cameron | Jefferson Davis | Richland | Vermilion | |
| Catahoula | La Salle | Sabine | Vernon | |
| Claiborne | Lafayette | Saint Bernard | Washington | |
| Concordia | Lafourche | Saint Charles | Webster |
Meet with an Agent
Regardless of the parish you live in, our local, Louisiana based team of insurance brokers are ready to help you understand and reduce the stress of figuring out Medicare.
