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Louisiana Medicare & Medicaid

Louisiana Medicaid is administered by the Department of Health and Hospitals. DHH aims to offer Louisiana’s low-income population comprehensive, quality health care. Medicare is the federally administered health care program that was designed for the elderly and disabled citizens of the United States. Many disabled and elderly Americans qualify for both programs.

  1. Louisiana Medicaid Eligibility

    • Eligibility for Medicaid in Louisiana is based on income and asset guidelines. Those who are eligible for Medicare and Medicaid (known as “dual eligibles”) fall under the aged, blind disabled category of Medicaid. These individuals are subject to different eligibility guidelines. According to the Kaiser Family Foundation, in Louisiana, ABD applicants must prove that their income is less than 75 percent of the federal poverty guidelines if single and 83 percent of the federal poverty guidelines if married. In 2010, that amounts to only $674 per month for a single individual or $1,011 per month for a married couple. Applicants can also hold no more than $2,000 in assets if single or $3,000 in assets if married.

    Medicare Eligibility

    • To qualify for Medicare, an individual must either be 65 years of age and older, or disabled (receiving Social Security Disability Insurance or diagnosed with end-stage renal disease or amyotrophic lateral sclerosis). Medicare does not consider income or assets when determining eligibility.

    Coverage

    • Medicare is a comprehensive health care program. It includes three major components, including Part A, Part B and Part D. Part A is inpatient coverage that covers any hospital care. Part B is medical insurance that covers doctor’s visits and other medical expenses, and finally, Part D is prescription drug insurance. Traditional Medicare enrollees can see any doctor in the nation that accepts Medicare and does not require prior authorization for covered services.
      Louisiana Medicaid is a managed care program. Enrollees are confined to a network and can only see doctors who are in that network. Members might have to get prior authorization for some services. However, Louisiana Medicaid does cover many services that Medicare does not, including routine dental care, dentures and coverage of some prescription drugs that Medicare does not cover.

    Coordination

    • Medicare Interactive reports that when a provider performs a service for a dual eligible, they must bill Medicare first. After Medicare pays, all remaining charges (such as coinsurances or deductibles) should be billed to Medicaid.

    Extra Help

    • The dual-eligible population is automatically enrolled in a federal program administered by Social Security called Extra Help. According to Medicare Interactive, Extra Help aids Medicare enrollees with paying for costs associated with the Medicare Part D prescription drug program. Those in both Medicare and Medicaid can expect Extra Help to pay for their Part B premiums, and between Medicaid and Extra Help, drugs should be provided at no expense to the enrollee.

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