ACA Impact in LouisianaApril 11th, 2015

Addressing the Needs of HIV Providers & Health Professionals in Louisiana

LA Area Health Education Centers

AHEC’s Role in the Affordable Care Act Navigators play a vital role in helping

consumers prepare electronic and paper applications to establish eligibility and enroll in

coverage through the Marketplace.

In Louisiana, Navigators are certified by the Federal government, licensed by the LA Dept. of

Insurance and have undergone rigorous training, criminal background checks, and fingerprinting prior to assisting consumers.

Louisiana Federal Navigators

Certified Application CentersThe Federally-Facilitated Marketplace has

designated organizations to certify application counselors who perform many of the same

functions as Navigators, completely free at no cost to the consumer – including educating

consumers and helping them complete their application for coverage. These groups include community health centers or other health care

providers, hospitals, or social service organizations.

LA Federally Qualified Health Centers

Open Enrollment November 15th, 2014 marked the beginning of Open

Enrollment in the Health Insurance Marketplace under the Affordable Care Act, a period that

spanned from November 15th, 2014 to February 15th, 2015. During this time, Louisiana residents were

able to fill out or update a Health Insurance Marketplace application and enroll in a 2015 plan.

Penalty for not Having Health Insurance

5 Years Later: How the Affordable Care Act is Working in Louisiana In Louisiana, 186,277 individuals selected a

Marketplace plan between November 15, 2014 – February 15, 2015. (Nationwide 11.7Million)

89% of Louisiana consumers who signed up qualified for an average tax credit of $319 per month.

63% of LA enrollees obtained coverage for $100 or less after an applicable tax credits in 2015 and 95% had the option for doing so.

68,792 consumers in Louisiana under the age of 35 are signed up for Marketplace coverage (37% of the plan selections in the state).

Insurance Providers in Louisiana In Louisiana, consumers could choose from 5

issuers in the marketplace in 2015 – up from 4 in 2014.

Louisiana consumers could choose from an average of 44 health plans in their parish in 2015 – up from 33 in 2014

The ACA and HIV/AIDS The ACA is one of the most important pieces

of legislation in the fight against HIV/AIDS in our history. Its implications for people at risk for and living with HIV/AIDS.

Essential Health Benefits

Important Conversations Providers need to have with patients on prescription drugs. Plans offered in the Health Insurance Marketplace are

broken into meta-levels: Bronze, Silver, Gold, and Platinum. Cost-sharing reductions are an exception to this rule. Silver level plans Each of the plans offered by the providers in Louisiana will

generally vary in regards to how prescription drugs affect their overall deductible. Plans will fall into one of three categories: A single deductible comprised of both medical and prescription

expenses that must be met before co-insurance or copay takes effect.

A separate drug deductible that must be met before co-insurance or copay takes effect for prescription medication.

A zero dollar drug deductible with either a fixed copay or co-insurance for prescription medication.

Important Conversations Providers need to have with patients on prescription drugs. Out-of-pocket maximums will also vary

between plans and providers. Plans will fall into one of two categories. A single out-of-pocket maximum comprised of

both medical and prescription expenses. A separate out-of-pocket maximum for

prescription medication.

Prescription Drug Coverage For Louisiana each provider will cover at a

minimum two of the once-daily combination tablets approved to treat HIV.

In most cases the once-daily pills will count as “specialty drugs” for billing purposes for all plans. The cost to consumers for a thirty day supply per drug will range between forty five dollars to one hundred fifty dollars after the deductible is met (if there is one).

LA Plan Drug Formularies

United Healthcare

Atripla

Complera

Stribld

Triumeq

Blue Cross Blue

Shield of Louisiana

Atripla

Complera

Stribld

Triumeq

Louisiana Health

Cooperative

Atripla

Stribld

Vantage Health Plan

Atripla

Complera

Stribl

Brian Burton, MPHLouisiana State Director, Navigators for a Healthy Louisiana

Southwest Louisiana Area Health Education Center 103 Independence Blvd.

Lafayette, LA 70506 

196 Williamsburg St. Lake Charles, LA 70506

337.478.4822 ext. 15 interventions@swlahec.com

www.swlahec.com www.LAHealthcareNAV.com