Wading through the many intricacies of Louisiana Medicaid waivers can be a literal headache. But what if you have private insurance too? Can you use both coverages? If so, in which order should they be billed? Knowing how coordination of benefits works with a waiver and private insurance is essential for any beneficiary who wants to make the most of their coverage.
And luckily, we have all the answers you need. Read on to learn if you’re permitted to have a Louisiana Medicaid waiver along with your own private insurance plan. We’ll cover everything you need to know as a waiver recipient.
You Can Have a Medicaid Waiver and Private Insurance
Yes, it’s 100% possible and okay to have both Medicaid waiver coverage and a private insurance plan in the state of Louisiana. Just because you enroll in Medicaid programs (including waiver programs) doesn’t mean you have to give up your private insurance.
How are Benefits Coordinated When You Have Multiple Insurance Plans?
Here’s a little bit about how insurance works: when you are covered under multiple insurance plans, one is deemed primary, the other is deemed secondary, and so on. Your private insurance will be your primary coverage; it’ll be billed first.
That doesn’t mean your Medicaid waiver won’t get any use. Your waiver will be used after your private insurance has paid all they’re contracted to pay – see this ROW waiver resource for confirmation.
For example:
- If private insurance covers the entire bill, Medicaid won’t pay anything further.
- If private insurance only pays part of the cost, Medicaid can often cover the balance, as long as the service is included in your waiver plan of care.
- If private insurance denies the service, Medicaid may still cover it – again, depending on whether it’s an approved waiver service.
Having Multiple Health Coverage Plans Can Be Helpful
Having two insurance plans can bring several benefits to the table, including:
- Reduced out-of-pocket costs. With private insurance billed first, Medicaid can step in to cover remaining expenses such as co-pays, deductibles, or the portion of costs your private plan doesn’t cover.
- Enhanced access to the services you need. Private insurance may cover certain medical services, prescriptions, or therapies that Medicaid doesn’t, while Medicaid waivers may cover specialized supports like in-home care, personal attendants, or equipment.
- Peace of mind – one plan may cover something the other doesn’t. Insurance gaps are stressful, especially if you rely on regular care. Having both private insurance and Medicaid waiver coverage gives you reassurance that if one plan denies or limits coverage, the other may provide backup.
- The ability to support your state program by lowering your individual monetary burden. When your private insurance pays first, it reduces the financial strain on Louisiana’s Medicaid system, which in turn helps keep waiver programs sustainable for all participants.
Talk to Your Support Coordinator for More Information on Dual Coverage
For specific questions about dual coverage, think of your support coordinator as your #1 resource. They can answer questions about dual coverage, how the process goes, and what to expect as you obtain services with both insurance plans. It’s their goal to ensure you’re confident and informed throughout your Medicaid journey, so we urge you to use them as needed.
We hope you found all the information you were looking for, and we wish you the best as you work to obtain the services you need to live your best life.
