Louisiana Individual Health Insurance - Metairie, Lafayette, Baton Rouge

What is individual health insurance?

An individual Louisiana health insurance policy is a contract between an insurance company and an individual. The contract can be renewable annually or monthly. The type and amount of health care costs that will be covered by the health plan are specified in advance in the member contract or Evidence of Coverage booklet. The individual policy-holder's payment obligations may take several forms:

Premium

The amount the policy-holder pays to the health plan each month to purchase Louisiana health insurance.

Deductible

The amount that the policy-holder must pay out-of-pocket before the health plan pays its share. For example, a policy-holder might have to pay a $500 deductible per year before any of their health care is covered by the health plan. It may take several doctor’s visits or prescription refills before the policy-holder reaches the deductible and the health plan starts to pay for care.

Co-payment

The amount that the policy-holder must pay out-of-pocket before the health plan pays for a particular visit or service. For example, a policy-holder might pay a $45 co-payment for a doctor’s visit or to obtain a prescription. A co-payment must be paid each time a particular service is obtained.

Coinsurance

Instead of paying a fixed amount up front (a co-payment), the policy-holder must pay a percentage of the total cost. For example, the member might have to pay 20% of the cost of a surgery while the health plan pays the other 80%. Because there is no upper limit on coinsurance, the policy-holder can end up owing very little, or a significant amount, depending on the actual costs of the services they obtain.

Exclusions

Not all services are covered. The policy-holder is generally expected to pay the full cost of non-covered health insurance services out of their own pocket.

Coverage limits

Some health plans only pay for health care up to a certain dollar amount. The policy-holder may be expected to pay any charges in excess of the health plan’s maximum payment for a specific service. In addition, some plans have annual or lifetime coverage maximums. In these cases, the health plan will stop payment when they reach the benefit maximum and the policy-holder must pay all remaining costs.

Out-of-pocket maximums

Similar to coverage limits, except that in this care, the member’s payment obligation ends when they reach the out-of-pocket maximum, and the health plan pays all further covered costs. Out-of-pocket maximums can be limited to a specific benefit category (such as prescription drugs) or can apply to all coverage provided during a specific benefit year. Prescription drug plans are a form of insurance offered through many employer benefit plans in the US, where the patient pays a co-payment and the prescription drug insurance pays the rest.

Long Term Care Insurance

Long term care allows individuals to plan for care and assistance if needed during the later years of life. These Louisiana health insurance policies can help the ill or disabled to remain in the comfort of their own home’s (not a nursing home) and receive the care they need, doctors and nurses come to you, respiratory and physical therapist and this is just a few of the amenities of this type of insurance.

Prescription drug plans are a form of insurance offered through many employer benefit plans in the US, where the patient pays a co-payment and the prescription drug insurance pays the rest.

Some healthcare providers will agree to bill your Louisiana health insurance company if patients are willing to sign an agreement that they will be responsible for the amount that the insurance company doesn’t pay, as the insurance company pays according to "reasonable" or “customary” charges, which may be less than the provider’s usual fee.

Louisiana health insurance companies also often have a network of providers who agree to accept the reasonable and customary fee and waive the remainder. It will generally cost the patient less to use an in-network provider.

We can also assist clients 65 years & and older with health care supplement insurance that are low cost and help cover, services, visits, medication that your primary insurance, MediaCal or Medicare not cover.