Medicare in Louisiana: Plans and Coverage (2026)

Medicare in Louisiana follows federal rules, with free SHIIP counseling, LDH-administered savings programs, and plan availability that varies from New Orleans to rural north Louisiana. This guide covers Medicare in Louisiana for 2026: what each part costs, how the plan choices break down, and where to get help paying.

In This Guide

• Key Takeaways
• Original Medicare: Parts A and B
• Medicare Advantage in Louisiana (Part C)
• Medicare Part D: Prescription Drugs
• Medigap in Louisiana
• Help Paying for Medicare in Louisiana
• Medicare Enrollment Periods
• Free Medicare Help: Louisiana SHIIP
• Frequently Asked Questions

About these numbers: The premiums and deductibles below come from CMS for calendar year 2026, effective January 1. Medicare costs change every year; CMS announced these 2026 amounts on November 14, 2025, and posts each year's figures at medicare.gov.1 To talk through what they mean for your own coverage, call 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048), staffed 24 hours a day, 7 days a week.5 A free Louisiana SHIIP counselor at the Louisiana Department of Insurance can walk through them with you too.

Original Medicare: Parts A and B

Original Medicare is run directly by the federal government and has two parts. The costs and coverage rules are the same in Louisiana as in every other state.

Part A (Hospital Insurance)

Part A covers inpatient hospital stays, limited skilled nursing facility care, hospice, and some home health care.1

The hospital deductible rose $60 from 2025, to $1,736 per benefit period.1 A benefit period starts the day you're admitted and ends once you have not received inpatient hospital care or skilled care in a skilled nursing facility for 60 days in a row. That clock can run while you are still in a facility, so someone who drops from skilled to custodial care can begin a new benefit period without leaving. A second admission after that gap means the deductible applies again.

Part B (Medical Insurance)

Part B covers doctor visits, outpatient care, preventive services, durable medical equipment, and mental health care. Part B doesn't cover routine dental, vision, or hearing.6 Most Medicare Advantage plans offer routine dental, vision, and hearing benefits instead, so check what a specific plan actually covers before you count on it.7

• Monthly premium: $202.90 (higher if your 2024 income was above $109,000 single or $218,000 married, under the income-related adjustment)1
• Annual deductible: $2831
• After the deductible: you pay 20% of the Medicare-approved amount for most services1

Part B is technically optional, but almost everyone signs up. Delay without qualifying for a Special Enrollment Period or a Medicare Savings Program and you'll owe a late penalty of 10% for every 12 months you could have had it, for as long as you keep Part B. Creditable drug coverage is the Part D exception, not the Part B one.8

Medicare Advantage in Louisiana (Part C)

Medicare Advantage plans are offered by private insurers as an alternative to Original Medicare. They cover everything Parts A and B do, except hospice, which Original Medicare continues to cover. Most bundle in Part D drug coverage along with extras like dental, vision, and hearing.7

Plan availability in Louisiana is uneven by geography. Residents in the New Orleans metro and the Baton Rouge area generally have more plan choices, while beneficiaries in rural north and central Louisiana typically see a narrower set of options. Network coverage and plan availability differ by ZIP code, so what's available at one address may not be available 30 miles away.

How These Plans Work

• You keep paying your Part B premium ($202.90) on top of any plan premium, though CMS says some plans may help pay all or part of it. The CMS estimate for the average Medicare Advantage premium in 2026 is about $14 a month, and many plans charge $0 extra.1,7
• Plans run on provider networks (HMO or PPO). Confirm your doctors and hospitals are in-network before enrolling; emergency care, out-of-area urgent care, and temporary out-of-area dialysis are covered in or out of network.7
• Most plans require prior authorization for certain services or referrals, which Original Medicare generally does not.7
• Every plan caps your annual in-network out-of-pocket spending. The federal limit is $9,250 in 2026; many plans set it lower. Original Medicare has no cap. CMS puts it this way: there is no yearly limit on what you pay out of pocket unless you have supplemental coverage like Medigap, Medicaid, employer, retiree, or union coverage. With none of those, your exposure is open-ended.7

Use the Medicare Plan Finder at medicare.gov to compare plans by ZIP code. Enter your doctors and prescriptions to see which plans cover them and what your estimated costs would be. A Louisiana SHIIP counselor can walk through the results with you at no charge.

Medicare Part D: Prescription Drugs

Part D covers outpatient prescription drugs. You can get it as a standalone plan paired with Original Medicare, or bundled into a Medicare Advantage plan.

The Inflation Reduction Act eliminated the coverage gap, the donut hole, so that stage is gone.2 Part D now has three phases:

1. Deductible: you pay full price until you meet your plan's deductible (up to $615 in 2026).9
2. Initial coverage: you pay copays or coinsurance while your plan and drug makers cover the rest.
3. Catastrophic: once your out-of-pocket spending reaches $2,100, you pay $0 for covered drugs the rest of the year.2

The $2,100 cap is the figure that matters most. The projected average standalone Part D premium for 2026 runs roughly $34.50 a month, though actual plan premiums vary widely.1 Every plan must also offer the Medicare Prescription Payment Plan, which lets you spread your out-of-pocket drug costs into capped monthly payments across the year instead of paying a large lump sum at the pharmacy early in the year.2 People who qualify for Extra Help often pay much less, sometimes nothing.

Medigap in Louisiana

Medigap policies are sold by private insurers to cover the gaps in Original Medicare: the deductibles, coinsurance, and copays. They pair with Original Medicare only: a Medigap policy can't pay your Medicare Advantage copayments, coinsurance, deductibles, or premiums, and while you're in an Advantage plan it's illegal for anyone to sell you one unless you're switching back to Original Medicare.10,7

Louisiana follows the federal standardized plan letters (A-D, F, G, and K-N), and plans are regulated by the Louisiana Department of Insurance. Plans C and F are closed to anyone who first became Medicare-eligible on or after January 1, 2020.11 Plan G is the popular choice for newly eligible beneficiaries: it covers the Part A deductible, Part A and Part B coinsurance, and skilled nursing coinsurance, leaving only the $283 Part B deductible on you.10,1

Your first opening is the federal Medigap Open Enrollment Period: the six months that begin when you're 65 and enrolled in Part B. During that window, an insurer must sell you any plan at the standard rate regardless of health.10 Miss it, and you may face underwriting, higher rates, or a decline.

Louisiana also has a Medigap birthday rule (La. R.S. 22:1112): each year, a current Medigap policyholder gets a 63-day window starting on their birthday to buy any Medigap policy offered by the same insurer or one of its affiliated companies, not any insurer in the state. The no-health-questions protection is narrower than the window itself: if the plan letter you pick carries benefits equal to or less than the one you already have, the insurer cannot deny or condition the coverage, or price it differently, because of your health status, claims experience, receipt of health care, or a medical condition. Apply for a richer plan letter instead and you keep the right to apply, but not that statutory protection.3

Medigap or Medicare Advantage?

You can't run the two together. Medigap keeps you on Original Medicare with the freedom to see any provider nationwide who takes Medicare, at a higher monthly premium. Medicare Advantage trades some of that freedom for a network and often a lower upfront cost. The door back isn't sealed, though. If you join a Medicare Advantage plan for the first time and it isn't right, a federal trial right lets you return to Original Medicare within 12 months of joining and buy a Medigap policy; if you dropped a Medigap policy to join and have been in the plan under a year, you may be able to get that same policy back. Outside that trial window, dropping Medigap is usually one-way.7 For a side-by-side look at that trade-off, see Original Medicare vs. Medicare Advantage.

Help Paying for Medicare in Louisiana

Two programs can cut Medicare costs significantly for Louisiana residents on limited incomes.

Medicare Savings Programs

Louisiana administers the Medicare Savings Programs through Louisiana Department of Health (LDH) Medicaid, the same agency that runs Medicaid in the state. Louisiana uses the standard federal income tiers, and unlike many states it applies no asset or resource test at all for these three programs: LDH's own eligibility chart lists the resource limit for QMB, SLMB and QI as "Not applicable," and its MSP page states that "resources are disregarded when determining eligibility for the QMB, SLMB and QI programs." Income is still not the whole test, though. LDH separately requires that an applicant "must be eligible for and currently enrolled in Medicare Hospital Insurance (Part A)." QDWI, the fourth program, is the exception: it keeps a countable-resource limit of $4,000 for an individual and $6,000 for a couple, and LDH says the home you live in, one car, burial plots, furniture, and some life insurance are not counted against it.4

Louisiana's own chart prints smaller numbers, and the difference is not a stricter rule. LDH's Z-200 poverty-guideline chart gives, for a family of one, $1,330 at 100% of the guideline, $1,596 at 120% and $1,796 at 135%, and for a family of two, $1,804, $2,164 and $2,435. The $20 monthly SSI general income exclusion applies on top of each, which is exactly how you get the figures in the table. Social Security tells its own staff that "even if the individual's income or resources appear somewhat higher than the state limits, encourage them to apply for the MSPs."4

QMB is the most generous program: CMS says the QMB group gets Medicare coverage of Part A and Part B premiums and cost sharing, and federal law bars providers and suppliers from billing a QMB enrollee for that cost sharing.4,12 LDH's own description covers all four groups at once: people who qualify "receive help with the payment of their Medicare premiums (Part B) and all or part of their Medicare Prescription Drug Plan (Part D)," and "in some cases, the Medicare part A premium, deductibles and co-payments are covered."4 There is no asset or resource test for QMB, SLMB, or QI in Louisiana, so savings and property do not count against you.4 Every figure here is edition-specific: LDH's charts are dated 2026 issues, and the income one is marked for programs changing effective March 1, 2026, so check for a newer issue before you rely on it.4 Enrolling in QMB, SLMB, or QI automatically qualifies you for Extra Help with Part D.12 QDWI, the fourth Medicare Savings Program, is the exception: it pays the Part A premium for certain working people with disabilities who lost premium-free Part A, and it does not confer Extra Help, so a QDWI enrollee who wants Extra Help has to apply through Social Security.12,13 These are the federal income standards, not a hard cutoff to screen yourself against: states can effectively raise them by disregarding certain income and resources, so a Louisianan above these figures should apply rather than rule themselves out. QI is also the one tier you must reapply for every year; qualifying once does not carry you into the next.12

To apply, call LDH Medicaid Customer Service at 1-888-342-6207, apply through the LDH Medicaid self-service portal, or file by mail, by fax, or in person at a local Medicaid office.4

Extra Help for Part D

Extra Help, also called the Low-Income Subsidy, pays Part D premiums, deductibles, and copays for people with limited income and resources. Since 2024 the partial-subsidy tier is gone, so everyone who qualifies gets the full subsidy.13

• Income limit (2026): up to about $1,995 a month for an individual, $2,705 for a couple, in the 48 contiguous states and DC (Alaska and Hawaii run higher)13
• Resource limits: $16,590 for an individual, $33,100 for a married couple, or $18,090 and $36,100 if you tell Social Security you expect to use some of your resources for burial expenses13
• Qualifying for QMB, SLMB, or QI automatically enrolls you in Extra Help12

Apply through the Social Security Administration or call 1-800-772-1213.13

Medicare Enrollment Periods

Missing a deadline can mean coverage gaps or permanent penalties. These windows are federal and the same in Louisiana as everywhere else.14

Changes made during Annual Open Enrollment take effect January 1. If you're already receiving Social Security before 65, you're enrolled in Parts A and B automatically. If not, you sign up through Social Security.14

If you worked past 65 with employer coverage, you qualify for a Special Enrollment Period: you can sign up anytime while covered by the employer plan, plus an 8-month window counted from the month that job or coverage ends, whichever comes first. COBRA and retiree coverage don't count for this purpose, and if you're self-employed or your plan isn't available to everyone at the company, ask your insurer whether it counts as employer group health plan coverage before you delay; if it doesn't, sign up at 65. This Special Enrollment Period does not apply if you're eligible for Medicare based on End-Stage Renal Disease (ESRD).15

Free Medicare Help: Louisiana SHIIP

You don't have to figure Medicare out on your own, and you don't have to pay a broker. Louisiana runs SHIIP, the Senior Health Insurance Information Program, through the Louisiana Department of Insurance. It's the state's version of the federal State Health Insurance Assistance Program. SHIIP counselors give free, unbiased guidance by phone or in face-to-face sessions.5

A Louisiana SHIIP counselor can help you:

• Understand what each part of Medicare covers and what you'd pay out of pocket
• Compare Medicare Advantage, Part D, and Medigap plans side by side
• Apply for the Medicare Savings Programs and Extra Help
• Sort out billing questions, claims, and appeals

Contact Louisiana SHIIP (also branded LaSHIP) through the Louisiana Department of Insurance at ldi.la.gov or by calling (225) 342-5301 or 1-800-259-5300.5

Key Louisiana Medicare Contacts

Learn More

Find personalized help comparing your Medicare plan options in Louisiana at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.