Louisiana Health Insurance Consumer Guide

If these apply to you, you can buy individual and family health insurance from Louisiana’s Marketplace:

• You live in Louisiana.
• You are lawfully present in the U.S.
• You’re not enrolled in Medicare.
• You’re not incarcerated.

Many people, like early retirees not yet on Medicare, self-employed people, and those who work for small businesses without health benefits, buy health insurance on the Marketplace.

Eligibility for financial assistance, such as premium subsidies and cost-sharing reductions, is based on your income and how it compares with the cost of the second-lowest-cost Silver plan in your area (which depends on your age and location). In addition, you may qualify for financial assistance in the Marketplace if:

• You don’t have access to affordable health coverage through your employer. If your employer offers coverage, but you feel it’s too expensive, our Employer Health Plan Affordability Calculator can help you understand if you might qualify for premium subsidies. 
• You’re not eligible for Medicaid/CHIP.
• You’re not eligible for premium-free Medicare Part A.²
• You file a joint tax return with your spouse, if you’re married.³
• You can’t be claimed by someone else as a tax dependent.³

You can sign up for ACA-compliant individual and family health plans in Louisiana between November 1 and January 15. This is known as open enrollment.⁴ 

• Coverage starts on January 1 if you enroll by December 15.
• Coverage starts February 1 if you enroll between December 16 and January 15.

After January 15, you can sign up for or make changes to an ACA Marketplace health through a special enrollment period (SEP). To qualify for a SEP, you’ll generally need a qualifying life event.

But there are instances where you don’t need a qualifying life event to apply outside of open enrollment. For example:

• If you’re eligible for premium tax credits and your income is not more than 150% of the poverty level, you can enroll anytime.
• If you’re a Native American, you can enroll whenever necessary.⁵
• If you lose Medicaid or CHIP between March 31, 2023 and November 30, 2024, you can enroll through the extended SEP.⁶

You can enroll in a Louisiana health insurance Marketplace plan:

• Directly through HealthCare.gov, the ACA exchange website
• By phone at (800) 318-2596 (TTY: 1-855-889-4325). Talk to an agent 24 hours a day, seven days a week, except for holidays.
• With the help of agents, navigators, or certified application counselors (available over the phone or online; some offer in-person meetings as well).
• Via an approved enhanced direct enrollment entity.⁷

In Louisiana, people who can’t get health plans through an employer may find affordable coverage on the ACA Marketplace (HealthCare.gov). Under the ACA, you may qualify for income-based premium subsidies called Advance Premium Tax Credits (APTC). Premium subsidies have been enhanced under the American Rescue Plan and Inflation Reduction Act, making them larger and more widely available through 2025.

As of early 2024, 96% of Marketplace enrollees in Louisiana were receiving APTC. The average subsidy amounted to $666/month, reducing the average net premium to about $107/month (including the 4% of enrollees who paid full price).⁸

(Note that the numbers in the graphic below are based on total enrollment during the open enrollment period for 2024, with different metrics and data than the effectuated enrollment details described above.)

Source: CMS.gov⁹

In addition to APTC, you may qualify for cost-sharing reductions (CSR), which help you pay for your deductibles and out-of-pocket expenses.¹⁰ CSR benefits are only available on Silver-level plans, and your income must be no more than 250% of the federal poverty level to be eligible for CSR.¹¹ 

Another way to find affordable health insurance in Louisiana is through the state’s Medicaid program. Louisiana has expanded Medicaid under the ACA, so adults under age 65 are eligible for Medicaid with household income up to 138% of the poverty level.

Short-term plans may be a low-cost alternative for those who are not eligible for employer coverage, Medicare, Medicaid, or Marketplace subsidies. However, short-term plans are not subject to ACA regulations, so they generally offer less robust benefits and fewer consumer protections. And starting in September 2024, new short-term plans will be limited to total durations of no more than four months, including renewals.

Five insurers are offering 2024 health coverage through Louisiana’s Marketplace, according to the federal data file for Marketplace insurer participation.¹²

All five plan to continue to offer coverage in 2025, and four of the five have proposed overall average rate decreases¹ (more details below).

There were six insurers in the Louisiana Marketplace in 2023, but Vantage Health Plan was acquired by Blue Cross Blue Shield of Louisiana and Vantage policies were not offered for 2024 (members could transition to a BCBSLA policy or pick a different replacement policy during open enrollment).¹³

Louisiana’s individual market insurers have proposed the following average rate changes for 2025.¹ (Proposed rates are under review by state regulators and will be finalized before open enrollment begins in November 2024.)

Source: RateReview.HealthCare.gov¹

Rate changes are calculated based on full-price premiums (i.e. before any premium subsidies are applied). However, because most people using Louisiana’s exchange receive premium tax credits, they don’t pay the full cost of their coverage.¹⁴ 

If you qualify for these subsidies, your actual rate change depends on your plan’s cost and the subsidy amount you receive. In other words, your plan’s full-price rate might be decreasing for 2025, but it’s possible that the amount you pay could increase, if your subsidy amount also decreases.

For perspective, here’s a summary of how average full-price premiums have changed over time for individual/family health insurance in Louisiana:

• 2015: Average increase of 12%¹⁵
• 2016: Average preliminary increase of 15.4%¹⁶
• 2017: Average increase of 26.8%¹⁷
• 2018: Average increase of 21.4%¹⁸
• 2019: Average decrease of 6.4%¹⁹
• 2020: Average increase of 11.7%²⁰
• 2021: Average increase of 6.9%²¹
• 2022: Average increase of 4.8%²²
• 2023: Average increase of 2.5%²³
• 2024: Average increase of 1.3%²⁴

During the open enrollment period for 2024 coverage, 212,493 people enrolled in private health plans through the Marketplace in Louisiana.²⁵

This dwarfed enrollment in recent years (see chart below), and was almost as high as enrollment had been in 2016, just before Medicaid expansion took effect in Louisiana (Medicaid expansion generally results in a decrease in Marketplace enrollment, as people with income between 100% and 138% of the poverty level transition from being eligible for Marketplace subsidies to being eligible for Medicaid.)

The enrollment growth in recent years is due in part to the subsidy enhancements created by the American Rescue Plan and Inflation Reduction Act.

And the enrollment growth for 2024 is also partially due to the “unwinding” of the pandemic-era Medicaid continuous coverage rule. Louisiana Medicaid began to disenroll people from the program in mid-2023. CMS reported that by April 2024, more than 112,000 Louisiana residents had transitioned from Medicaid to Marketplace coverage.²⁶

Source: 2014,²⁷ 2015,²⁸ 2016,²⁹ 2017,³⁰ 2018,³¹ 2019,³² 2020,³³ 2021,³⁴ 2022,³⁵ 2023,³⁶ 2024³⁷

HealthCare.gov
The official website where residents of Louisiana can shop for and buy health insurance plans that meet their needs. 

Department of Health & Hospitals
This is a governmental body responsible for health services and programs in Louisiana.

Louisiana Department of Insurance
The Louisiana Department of Insurance provides various resources related to health insurance, helping people understand their options and make informed choices.

Medicare Rights Center
A national organization that offers assistance and information about Medicare through its website and call center.

Louisiana Senior Health Insurance Information Program (SHIP)
Assists people on Medicare, providing information and guidance about their health insurance options.

Louisiana Department of Health – Medicaid
Oversees the state’s Medicaid program, which provides health coverage for eligible low-income individuals and families.