With most of the Affordable Care Act’s major provisions now in effect, the nation’s health insurance marketplace has undergone a significant transformation. Obamacare impacts individuals, families and small business owners alike. Most Americans are required to have minimum essential coverage unless they qualify for an exemption; however, the law is designed to make health insurance more accessible and affordable with income-based financial assistance and one-stop shopping via state-based and federally facilitated exchanges. Meanwhile, the private marketplace remains a place to shop for quality, affordable health insurance plans that meet ACA requirements.
The following guide offers a glimpse at the various types of ACA-compliant health insurance in Louisiana, including individual and family health plans, small group health plans, coverage for high-risk applicants, mini-COBRA continuation coverage, Medicaid, and CHIP.
Health and healthcare in Louisiana
Louisiana ranked 48th in United Health Foundation’s 2014 America’s Health Rankings.1 Its strengths include a small disparity in health status by educational attainment, high immunization coverage among adolescents, and a low incidence of pertussis infections (whooping cough). Challenges include the state’s high prevalences of physical inactivity, obesity and diabetes; a high percentage of children in poverty; and a high infant mortality rate and high prevalence of low birthweight.
The U.S. Department of Health and Human Services reported that 101,778 individuals in Louisiana selected a marketplace plan through the exchange from Oct. 1, 2013, through April 19, 2014.2 In 2015, the number of individuals in Louisiana enrolled in a marketplace plan increased to 186,277 during the open enrollment period.3
Louisiana individual and family health insurance
When given the option, Louisiana elected to participate in the federally facilitated health insurance exchange rather than run its own or create a state-federal partnership. Louisiana’s residents may use the federal Health Insurance Marketplace website to shop for individual and family coverage. Those who buy health insurance through the federally facilitated exchange may be eligible for income-based subsidies, including premium tax credits that may be applied to any metal plan and cost-sharing subsidies that apply to silver plans. Individuals who go without health insurance may face a tax penalty known as the shared responsibility payment.
Louisianans can also buy qualified health insurance plans in the private marketplace through websites such as HealthCare.com. To find out if you qualify for an Obamacare tax credit, use HealthCare.com’s tax subsidy calculator. If you do, visit Louisiana’s health insurance exchange to shop and enroll in health insurance coverage.
|Louisiana’s health insurance exchange:||healthcare.gov|
|Louisiana department of insurance:||ldi.louisiana.gov|
Louisiana small group health insurance plans
Louisiana’s small businesses with 50 or fewer employees may purchase small group health insurance plans through the federally facilitated Small Business Health Options Program marketplace, at healthcare.gov/marketplace/shop and in the private marketplace. Small businesses that use SHOP and have 25 or fewer employees may qualify for a Small Business Healthcare Tax Credit.
Self-employed individuals with no employees must apply for an individual health insurance plan on or away from Louisiana’s federally facilitated exchange.
Louisiana state COBRA variations for small groups
The Consolidated Omnibus Reconciliation Act (COBRA) allows those employed by businesses with 20 or more employees to continue their group health insurance plan for a limited time should they lose coverage due to qualifying events such as termination of employment due to reasons other than gross misconduct, a reduction in work hours, divorce or legal separation, and loss of dependency status. To learn more about the federal COBRA program, visit dol.gov/ebsa/cobra.html.
In some states, those who work for a small business and lose health insurance coverage due to a qualifying event may be eligible for health insurance continuation through mini-COBRA or a similar state continuation program. In a few states, these programs may also be extended to those who work for larger companies and exhaust their federal COBRA continuation coverage limit. Mini-COBRA generally works like the federal COBRA continuation coverage, but its terms may vary.
Louisiana’s small group COBRA continuation variations are as follows4:
|Eligible group sizes||All group sizes that are not eligible for federal COBRA plans|
|Maximum continuation period – standard||12 months|
|Maximum premium Increase||100 percent|
|State legislation reference||LA Rev. Stat. Sec. 22:1046|
|More information||800-259-5300 – Louisiana Department of Insurance|
|Additional notes||Eligible employees must be covered under the group policy for at least three consecutive months prior to the qualifying event.|
Louisiana high-risk pools
It used to be that health insurance companies could deny applicants or charge them more based on health history and preexisting conditions. When the Affordable Care Act was passed in 2010, many states created federally funded preexisting condition insurance programs or accepted federal funding to assist with similar high-risk pool programs they already operated.5
The Affordable Care Act prohibits this practice for health insurance plans considered minimum essential coverage with effective dates beginning Jan. 1, 2014, and later. As such, the PCIPs and state high-risk pools created to provide health insurance for those once considered uninsurable are being phased out.
Medicaid is a state health insurance program for low-income individuals under age 65, pregnant women, children, disabled individuals, and seniors over age 65; it is partially funded by the federal government. In 2014, states were given the option to accept additional federal funding and expand their Medicaid program eligibility to those who make up to 133 percent of the federal poverty level (effectively 138 percent due to how it is calculated, according to HealthCare.gov).6
Louisiana did not expand its Medicaid program in 2014.7 A resulting coverage gap exists for those whose incomes are too high for Medicaid but too low to receive federal premium and cost-sharing assistance when shopping the state’s federally facilitated health insurance exchange.
The information below is specific to Louisiana’s Medicaid program:
|Governing agency||Centers for Medicare & Medicaid|
|Administrator||Louisiana Department of Health & Hospitals|
|Where to apply||new.dhh.louisiana.gov/index.cfm/page/237|
|Additional application options||dhh.louisiana.gov/index.cfm/page/220/n/20, under “How Do I Apply?”|
|Open-enrollment period||Year-round in all states|
|Eligibility8||Based on federal poverty level income guidelines and other criteria, which may include those who:
Receive Medicare coverage and are low-income
The Children’s Health Insurance Program is a partnership between the states and federal government. CHIP provides health insurance to uninsured children who meet certain eligibility guidelines.
The information below is specific to LaCHIP, Louisiana’s health insurance program for low-income children:
|Where to apply||dhh.la.gov/index.cfm/page/237|
|Additional application options||kancare.ks.gov/apply.htm|
|Phone number||877-2LaCHIP (877-252-2447) / TTY 800-220-5404|
|Eligibility9||Uninsured, under age 19 and meet household income limits|
1 United Health Foundation. 2014 America’s Health Rankings Annual Edition. “Annual State Health Rankings.” http://www.americashealthrankings.org
2 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2014/.
3 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2015/.
4 Louisiana State Legislature. RS 22:1046. “§ 1046: Group Health Insurance Continuation.” Last revised Jan 1, 2013. http://www.legis.state.la.us/lss/lss.asp?doc=507886.
5 National Conference of State Legislators. Coverage of Uninsurable Pre-Existing Conditions: State and Federal High-Risk Pools. Updated April 2014. http://www.ncsl.org/research/health/high-risk-pools-for-health-coverage.aspx.
6 Centers for Medicare & Medicaid Services. “Medicaid Expansion & What It Means for You.” HealthCare.gov. N.D. https://www.healthcare.gov/what-if-my-state-is-not-expanding-medicaid/.
7 Centers for Medicare & Medicaid Services. “Louisiana.” Medicaid.gov. N.D. http://medicaid.gov/Medicaid-CHIP-Program-Information/By-State/louisiana.html.
8 Louisiana Department of Health & Hospitals. “About Medicaid.” http://dhh.louisiana.gov/index.cfm/page/220/n/20.
9 Louisiana Department of Health & Hospitals. “LaCHIP.” http://new.dhh.louisiana.gov/index.cfm/page/222.