Over the next two years, all states will be charged with implementing the provisions of the 2010 Patient Protection and Affordable Care Act, the legislation designing health care reform in the United States. Major changes have already been made regarding children’s health, specifically pre-existing conditions, which are no longer a valid basis for denial of coverage. Additionally, children can stay on their parents’ policies up to age 26, regardless of educational or marital status.
Immediately after the passage of the Affordable Care Act, the states began working with the federal government to put in place high-risk pools for people denied coverage due to pre-existing conditions. Those pools will stay in place until January 1, 2014 when the new health care exchanges go into effect.
General Insurance Regulations
Due to a high instance of fraud in Louisiana in the past, the requirements for licensed insurance sellers in the state are stringent. Consumers should be careful to be certain they are dealing with a licensed insurance seller. Currently, insurers can exclude for pre-existing conditions for a period of up to a year, but guaranteed renewability is required so long as the premiums have been paid on time.
Health Care Exchanges
Louisiana has opted not to create a state-based health insurance exchange, and will allow the federal government to administer such an exchange on behalf of the state.
Pre-Existing Condition Insurance
The U.S. Department of Health and Human Services administers the Pre-Existing Condition Insurance Plan for Louisiana, which includes coverage for primary and specialty care, prescription drugs, and hospitalization. According to age and option, premiums range from $129 to $397. Deductibles are $1000 to $3000, and in some instance there is a second deductible for drugs only. The total out-of-pocket expenses inside and outside the network can’t exceed $7000.
Medicaid benefits are calculated by income as a percentage of the Federal Poverty Level, as are Children’s CHIP-funded Medicaid Expansions. Children under the age of 5 qualify for Medicaid at 133% FPL and for CHIP at 200%. In the 6-19 age group, the percentages are 100 and 200 respectively.
Pregnant women are eligible for Medicaid at 200% FPL, parents at 11%, and non-elderly disabled Social Security recipients at 74%.
Approximately 15 percent of the population of Louisiana draws Medicare benefits, with 659,000 accessing Medicare prescription drug coverage. (Additional assistance with medication expenses can be sought through Louisiana’s SenioRx Program.) Medicare enrollees can seek help in selecting their coverage plans and getting the maximum benefits available to them through the State Health Insurance Information Program.