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. For the most current figures, contact Medicare at 1-800-633-4227 (1-800-MEDICARE) or Louisiana SHIIP at the Louisiana Department of Insurance.
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.
| Cost | Amount |
|---|---|
| Monthly premium | $0 for most people (40+ quarters of work history) |
| Hospital deductible | $1,736 per benefit period |
| Hospital coinsurance, days 61-90 | $434 per day |
| Lifetime reserve days | $868 per day |
| SNF coinsurance, days 21-100 | $217 per day |
The hospital deductible rose $60 from 2025. A benefit period starts the day you're admitted and ends 60 days after you leave the hospital or SNF. 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. It doesn't cover routine dental, vision, or hearing.
- Monthly premium: $202.90 (higher if your 2024 income was above $109,000 single or $218,000 married, under the income-related adjustment)
- Annual deductible: $283
- After the deductible: you pay 20% of the Medicare-approved amount for most services
Part B is technically optional, but almost everyone signs up. Delay without creditable coverage 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.
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.
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. The CMS estimate for the average Medicare Advantage premium in 2026 is about $14 a month, and many plans charge $0 extra.
- Plans run on provider networks (HMO or PPO). Confirm your doctors and hospitals are in-network before enrolling.
- Most plans require prior authorization for certain services or referrals, which Original Medicare generally does not.
- 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.
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. Part D now has three phases:
- Deductible: you pay full price until you meet your plan's deductible (up to $615 in 2026).
- Initial coverage: you pay copays or coinsurance while your plan and drug makers cover the rest.
- Catastrophic: once your out-of-pocket spending reaches $2,100, you pay $0 for covered drugs the rest of the year.
The $2,100 cap is the figure that matters most. The average standalone Part D premium for 2026 is about $46.50 a month, though actual plan premiums vary. 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. People who qualify for Extra Help often pay much less, sometimes nothing.
Not sure which Part D plan fits your prescriptions? Chat with Brevy's care navigator at brevy.com.
Medigap in Louisiana
Medigap policies are sold by private insurers to cover the gaps in Original Medicare: the deductibles, coinsurance, and copays. They work only with Original Medicare, not with Medicare Advantage.
Louisiana follows the federal standardized plan letters (A through 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. 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.
Louisiana has no confirmed birthday rule (a provision some states use that lets beneficiaries switch Medigap plans without medical underwriting each year around their birthday). Outside the federal open-enrollment windows, Louisiana insurers may use medical underwriting when you apply.
Your strongest 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. Miss it, and you may face underwriting, higher rates, or a decline.
Medigap or Medicare Advantage?
You can't hold both. 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. 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. Louisiana uses the standard federal income tiers and resource limits, not higher state-set ones.
| Program | Individual | Couple | What it pays |
|---|---|---|---|
| QMB | Up to about $1,350 | Up to about $1,824 | Part A and B premiums, deductibles, coinsurance |
| SLMB | Up to about $1,616 | Up to about $2,184 | Part B premium |
| QI | Up to about $1,816 | Up to about $2,455 | Part B premium |
QMB is the most generous program: it covers your Part B premium and your deductibles and coinsurance, and federal law bars providers from billing a QMB enrollee for that cost-sharing. The 2026 resource limit is $9,950 for one person and $14,910 for a couple for all three programs. The income figures are tied to the Federal Poverty Level and update each April. Enrolling in any of the three programs automatically qualifies you for Extra Help with Part D.
To apply, call LDH Medicaid Customer Service at 1-888-342-6207 or contact the Louisiana Department of Health directly.
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.
- Income limit (2026): up to about $1,995 a month for an individual, $2,705 for a couple
- Resource limits: $16,590 for an individual, $33,100 for a married couple
- Qualifying for QMB, SLMB, or QI automatically enrolls you in Extra Help
Apply through Social Security at ssa.gov or call 1-800-772-1213.
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.
| Period | Dates | What you can do |
|---|---|---|
| Initial Enrollment | 7 months around your 65th birthday | Sign up for Parts A, B, and D; pick MA or Medigap |
| Annual Open Enrollment | Oct 15 - Dec 7 | Switch MA plans, move between MA and Original Medicare, change Part D |
| MA Open Enrollment | Jan 1 - Mar 31 | Switch MA plans or drop MA for Original Medicare (if already in MA) |
| General Enrollment | Jan 1 - Mar 31 | Sign up for Part B if you missed your initial window |
| Medigap Open Enrollment | 6 months from age 65 + Part B | Buy any Medigap plan at the standard rate, no health screening |
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.
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 after that coverage ends. COBRA and retiree coverage don't count for this purpose.
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 are trained volunteers who give free, unbiased help and don't sell insurance.
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 through the Louisiana Department of Insurance at ldi.la.gov or by calling the department directly.
Frequently Asked Questions
Most people pay $0 for Part A. The standard Part B premium is $202.90 a month with a $283 annual deductible. Part D premiums vary by plan (the 2026 average is about $46.50), and many Medicare Advantage plans charge no extra premium. Your total depends on which plan you pick and the care you use.
No. Louisiana does not have a confirmed birthday rule. Outside the federal Medigap Open Enrollment Period (the six months starting when you're 65 and enrolled in Part B), insurers in Louisiana may use medical underwriting. Buying Medigap during your open-enrollment window is when you have the strongest guaranteed-issue rights.
Call LDH Medicaid Customer Service at 1-888-342-6207 or contact the Louisiana Department of Health. Louisiana uses the standard federal income and resource limits for QMB, SLMB, and QI. Enrolling automatically qualifies you for Extra Help with Part D.
Generally, yes. Beneficiaries in the New Orleans metro and Baton Rouge area tend to have wider Medicare Advantage plan options compared to rural north and central Louisiana, where fewer plans operate. Use the Medicare Plan Finder at medicare.gov and enter your ZIP code to see what's available at your specific address.
Louisiana SHIIP, the Senior Health Insurance Information Program inside the Louisiana Department of Insurance, provides free and unbiased Medicare counseling statewide through trained counselors who don't sell insurance. Contact SHIIP through the Louisiana Department of Insurance at ldi.la.gov.
Learn More
- Medicare: The National Guide
- Original Medicare vs. Medicare Advantage
- How Medigap Works
- Medicare Part D Drug Coverage
- Medicare Enrollment Periods
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.