Louisiana Department of Insurance Consumer Alert LDI Website James J. Donelon Follow us on Twitter Become a Fan on Facebook
Volume 4, Issue 10

Outreach Event & Medicare Information
Vernon Parish Senior Day at the Fair
Date: October 2, 2013
Location: West LA Forestry Festival Fairgrounds
276 HM Stevens Blvd., Leesville, LA 71446

Outreach Event & Medicare Information
Beauregard Parish Senior Day at the Fair (Exhibit Hall)
Date: October 3, 2013
Time: 8:00 a.m. - 2:00 p.m.
Location: 506 West Dr.
DeRidder, LA

Consumer Advocacy Outreach Event & Medicare Information
Woman's Hospital - Living with Cancer
Date: October 5, 2013
Time: 8:00 a.m. - 1:15 p.m.
Location: Renaissance Hotel
7000 Bluebonnet Blvd., Baton Rouge, LA 70810

Health & Awareness Fair
: Affordable Care Act
Date: October 5, 2013 Time: 10:00 a.m. Location: Mount Moriah Baptist Church 2412 Louisa St., New Orleans, LA

Consumer Advocacy Outreach Event & Medicare Information
Beauregard Council on Aging
Date: October 21, 2013
Time: 10:00 a.m. - 1:00 p.m.
Location: War Memorial Civic Center
250 West 7th, DeRidder, LA 70634

Consumer Advocacy Outreach Event & Medicare Information
The Lafourche Council on Aging 2013 Annual Health Fair/Flu Shots
Date: October 22, 2013
Time: 10:00 a.m. - 2:00 p.m.
Location: Lockport Volunteer Fire Station
810 Crescent Ave., Lockport, LA 70374

St. James Parish Government Department of H.R. Topic: Homeowners Insurance
Date: October 22, 2013; October 29, 2013
Time: 2:00 p.m. - 5:00 p.m.
Location: 5153 Canatella St. Convent, LA 70723

Louisiana Health Care Commission (LHCC)
: October 25, 2013
Time: 9:00 a.m.
Location: Plaza Hearing Room, Poydras Building
1702 N. Third St., Baton Rouge, LA 70802

Consumer Advocacy Outreach Event & Medicare Information
South Regional Library
Date: October 31, 2013
Time: 10:00 a.m. - 12:00 p.m.
Location: 6101 Johnston St.
Lafayette, LA 70503

To find out if Consumer Advocacy will be in your area or to request a speaker for your organization or group, call (225) 219-0619 or send an email to

If you no longer wish to receive this newsletter please send an email to the following address with "REMOVE FROM CONSUMER ADVOCACY MAILING LIST" in the subject line.

About the Federal Health Insurance Marketplace

On October 1, open enrollment for the Health Insurance Marketplace began and consumers across the nation were invited to visit the new online portals where they could shop for and purchase health insurance. The creation of these online Marketplaces was a key component of the Affordable Care Act (ACA) that was signed into law by President Barack Obama in 2010.

Every state has its own Marketplace and was given the option of creating a state-based marketplace, partnering with the federal government, or allowing the federal government to run the Marketplace. Louisiana has a federally facilitated Marketplace which can be accessed on the U.S. Department of Health and Human Services (HHS) website www.healthcare.gov.

Insurance plans in the Marketplace are offered by private companies and cover the same core set of benefits called essential health benefits. When you apply to enter the Health Insurance Marketplace, you’ll be asked to provide information about yourself such as household size, income, age and location. This is done so you can see all the health plans available in your area and also to find out if you qualify for subsidies that can lower your premium and out-of-pocket costs.

Here are some other things to know about the Health Insurance Marketplace:

There is a penalty fee for not having health insurance.
The ACA requires individuals to have minimum essential health insurance coverage by January 1, 2014. The penalty for not having insurance for 2014 is $95 per adult or 1% of the family annual income. Employers with greater than 50 employees are mandated to offer health insurance to employees or pay a penalty beginning in 2015.

Subsidies are available for those who qualify.
Consumers purchasing insurance through the individual Marketplace may qualify for a federal subsidy if their income is between 100 percent and 400 percent of the Federal Poverty Level. For example, the maximum income level for a family of four to receive a premium subsidy in the federal marketplace is $94,200. Some uninsured lower income, elderly or disabled individuals may not need to purchase health insurance through the Marketplace, as they may qualify for other programs such as Medicaid and/or the Louisiana Children’s Health Insurance Program (LaCHIP) based on their household income. If an individual qualifies for Medicaid, they may obtain health insurance through the Bayou Health Plan.

Health Insurance Marketplace plans will be categorized allowing for apples-to-apples comparisons.
Plans available will vary in coverage with four “metal” levels offered: Bronze, Silver, Gold and Platinum. All plans offer the same set of essential health benefits, but the category affects premium costs and how much is paid out of pocket for things such as doctor and hospital visits and prescription medication. Bronze and Silver plans require patients to pay more of the costs, while Gold or Platinum plans have higher premiums but lower out-of-pocket costs. The Marketplace also offers bare bones plans known as “catastrophic” plans to people under 30 years old and those with very low incomes.

Health insurance companies are required to offer policies to all who apply, regardless of their medical condition.
Companies can no longer place limits on coverage based on a person’s health condition, often called “pre-existing condition exclusions” nor can they charge a higher premium because of a person’s health condition. These protections apply whether a person buys coverage through the Marketplace or outside of the Marketplace.

In addition to the individual Marketplace, the Small Business Health Options Program (SHOP) was created for small businesses to purchase health insurance for their employees.
SHOP will be available to employers with 50 or fewer full-time-equivalent employees beginning on October 1. The SHOP online Marketplace will be available for use in November. SHOP is optional and if employers plan to use SHOP, they must offer coverage to all full-time employees – generally those working 30 or more hours per week on average. Beginning in 2014, at least 70 percent of the full-time employees must enroll in the SHOP plan and small businesses must pay at least 50 percent of its full-time employee’s premium costs in order for them to qualify for a small business health care tax credit. Also beginning in 2014 the tax credit is available, but only for plans purchased through SHOP.

The open enrollment period will continue through March 31, 2014. If you enroll in a health insurance plan between October 1 and December 15 and have made your first premium payment, your coverage will begin on January 1, 2014.

During the rest of the open enrollment, if you enroll between the 1st and 15th day of the month and pay your premium, your coverage begins the first day of the next month. If you enroll between 16th and the last day of the month, your coverage will begin the first day of the second following month. So if you enroll on January 9, 2014, your coverage begins February 1, 2014. If you enroll on January 17, 2014, your coverage begins on March 1, 2014.

After open enrollment ends, individuals who have not had a qualifying event will not be able to purchase health insurance through the Health Insurance Marketplace until the next annual enrollment period.

More information on the Health Insurance Marketplace is available on the HHS website www.healthcare.gov. If you have questions about how to enroll in a health insurance plan, you can call our Office of Health Insurance or contact a licensed producer (agent).


Spot the Scam

Ever since the Affordable Care Act (ACA) was signed into law by President Barack Obama on March 23, 2010, unscrupulous scammers have been creating ways to take advantage of consumers, preying on their uncertainty about the law. Often posing as insurance agents or representatives of the federal government, these scam artists attempt to sell fraudulent insurance policies or obtain sensitive information such as Social Security and bank account numbers.  

Below are a few common scams and red flags to be on the lookout for as well as information to help you avoid becoming a victim.

The Health Insurance Marketplace Scam

One of the key components of the ACA is the creation of new Health Insurance Marketplaces, or exchanges, where consumers can purchase health insurance policies.  These online Marketplaces ask consumers to enter information about themselves and select the level of coverage they desire to receive a list of plans they can enroll in.

Open enrollment for the new Marketplaces began on October 1. However, bogus websites claiming to be part of the exchanges have been appearing online for more than a year.  Do not enter any personal or financial information into these websites. Regardless of whether a state has chosen to run its own exchange or partner with the federal government, a link to the official Marketplace for each state can be found at www.healthcare.gov

The “Obamacare” Insurance or Medicare Card Scam

Another common ploy involves unsolicited phone calls from scammers who claim to have your new “Obamacare” insurance card and they just need to get some information before they can send it to you. The caller then asks for credit card numbers, bank account information or your Social Security number. A variation of this scam specifically targets Medicare beneficiaries. The scam artist claims that in order to get your new Medicare card and continue receiving your benefits, you must verify your bank account and routing numbers. Some callers ask for your Medicare numbers, which are identical to Social Security numbers.

Please note that you are not required to obtain a new insurance or Medicare card under the ACA. Also, anyone who is a legitimate representative of the federal government will already have your personal and financial information and should not ask you to provide it.

Here are some other important red flags to watch out for:

  • The salesperson says the premium offer is only good for a limited time.
    • Enrollment in the exchanges will be open from Oct. 1 to March 31, and rates for plans in the exchanges will have been approved for the entire enrollment period. Be skeptical of someone who is trying to pressure you into buying a policy because the rate is only good for a short time. Remember: if the offer sounds too good to be true, it probably is.

  • The salesperson says you could go to jail for not having health insurance.
    • Starting in 2014, all Americans will be required to have health insurance. You will not face jail time if you do not purchase health insurance. However, those who remain uninsured and do not qualify for any exemptions will face a penalty of $95 (for each adult) or 1% of family income, whichever is greater. In 2015, the penalty will increase to $325 per adult or 2% of family income, and in 2016 and beyond, the penalty will be $695 per adult or 2.5% of family income. For more information on the individual shared responsibility provision of the ACA, click here.

  • You receive an unsolicited phone call or email from someone trying to sell insurance.
    • Neither the federal government nor the Louisiana Department of Insurance will contact individual consumers to sell them insurance. Do not give any sensitive information to anyone who claims to be with the federal government, the LDI or a navigator for your state’s exchange.  

For more information on the ACA, check out the LDI’s Health Care Reform Resource Center or visit the U.S. Department of Health & Human Services (HHS) website here.

Quick Facts about Medicare and the Health Insurance Marketplace

The Open Enrollment Period for Medicare is just around the corner. But before open enrollment begins, here are some quick facts you need to know about Medicare and the Health Insurance Marketplace.

1. Medicare is not part of the Health Insurance Marketplace. The Health Insurance Marketplace is designed to help consumers who don’t have health insurance. If you are a Medicare beneficiary, you are considered covered and do not need to do anything during the Marketplace open enrolment period that begins on October 1.

2. The Marketplace won’t affect your Medicare choices. No matter how you get Medicare, whether through Original Medicare or a Medicare Advantage Plan, you will still have the same benefits and security you have now.

3. The Medicare Open Enrollment Period WILL NOT be affected by the Health Insurance Marketplace Open Enrollment Period.
The Medicare Open Enrollment Period will be October 15 – December 7. If you want to change your coverage for next year, this is the time to do it. However, if you are satisfied with your current coverage level, you don’t need to do anything.  

4. It is against the law for someone who knows that you have a Medicare policy to issue or sell you a Marketplace policy.
However, you can choose to purchase a Marketplace policy if you’re eligible for Medicare but haven’t enrolled in it. Also, if you are not yet eligible for Medicare but will become eligible within the year, you can purchase a Marketplace policy to cover you and then cancel that coverage once your Medicare plan starts.

For more information on Medicare and Health Insurance Marketplace, feel free to contact the Louisiana Department of Insurance Office of Consumer Advocacy or the Senior Health Insurance Information Program (SHIIP).


The Subsidy Calculator

Some individuals who choose to purchase health insurance through the individual Marketplace may qualify for tax credit subsidies. Middle-income people who are under age 65 and are not eligble for health care coverage through their employer, Medicare or Medicaid can apply for these subsidies.

The Kaiser Family Foundation website www.kff.org offers a tool that allows consumers purchasing insurance in the Marketplace to calculate insurance premiums and subsidies available to them. With the subsidy calculator, users can enter different variables such as income level, age, and family size to get an estimate of their eligibility for tax credits and how much they would spend on health insurance.

To see if you qualify for any tax credit subsidies, simply enter information about yourself into the subsidy calculator below.


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Office of Consumer AdvocacyP.O. Box 94214Baton Rouge, LA 70804-9214
(225) 219-0619 or (800)259-5300www.ldi.la.govconsumeradvocacy@ldi.la.gov