Medicare Advantage Plans in Nevada

Medicare Advantage plans are an alternative to Original Medicare, offered by Medicare-approved private insurance companies. These plans include Part A (hospital) and Part B (medical), and most also include Part D (prescription drug coverage). Many plans offer added benefits like routine dental, vision, hearing, fitness programs, and telehealth.

Medicare Eligibility

To enroll in a Medicare Advantage plan, you must first sign up for Original Medicare (Parts A and B). Most people become eligible for Medicare enrollment at age 65, though those with qualifying disabilities or conditions like ALS or ESRD may be eligible earlier.

Key enrollment periods include:

• Initial Enrollment Period (IEP)
• General Enrollment Period (GEP)
• Special Enrollment Periods (SEP)

Missing these periods may result in penalties or delayed coverage.

What Types of Medicare Advantage Plans Are Available in Nevada?

Nevada offers the following MA plan types:

• Health Maintenance Organizations (HMOs): Require you to use in-network providers and designate a primary care physician (PCP). Referrals are usually needed for specialists.
• Preferred Provider Organizations (PPOs): Let you visit both in- and out-of-network providers (with higher costs out-of-network). No PCP or referrals are typically required.
• Private Fee-for-Service (PFFS) Plans: Allow you to see any provider who accepts the plan’s terms. No PCP is required; some plans have networks.
• Special Needs Plans (SNPs):
  • C-SNPs: Designed for chronic conditions like diabetes or cancer.
  • I-SNPs: For those needing long-term care in a facility or at home.
  • Dual Eligible Special Needs Plans (D-SNPs): For people eligible for both Medicare and Medicaid. These plans often include extra benefits like drug coverage and coordinated care with minimal cost.
• Medical Savings Accounts (MSAs): Combine a high-deductible MA plan with a savings account funded by your insurer to pay for qualified medical expenses.

What Are Your Prescription Drug Options with Medicare Advantage?

Most MA plans in Nevada include Part D drug coverage. However:

• MSAs and some PFFS plans do not include drug coverage.
• If your MA plan lacks drug coverage, you may be eligible to enroll in a standalone Part D plan.
• Delaying enrollment without creditable drug coverage may result in penalties.

Always check your plan’s drug formulary to confirm your medications are covered.

How Do You Choose a Medicare Advantage Plan?

Before choosing a plan, understand your Medicare Advantage costs:

• Premiums: Nevada has many $0-premium options, but you’ll still pay your Medicare Part B premium.
• Deductibles, Coinsurance & Copays: These vary by plan. Review how much you’ll pay before coverage kicks in, and what you owe per visit or service.
• Out-of-Pocket Maximums: Caps how much you’ll pay annually. After this cap is reached, the plan covers all in-network services.
• Extra Benefits: Many plans offer coverage for dental, vision, hearing, telehealth, gym memberships, and transportation services.

When and How Do You Enroll in a Medicare Advantage Plan?

You can enroll in Medicare during these specific enrollment periods:

• Initial Enrollment: Begins 3 months before and ends 3 months after your 65th birthday month.
• Annual Open Enrollment (Oct 15–Dec 7): Change, join, or drop a Medicare Advantage plan. Coverage begins January 1.
• General Enrollment (Jan 1–Mar 31): For people who enroll in Medicare Part B during this period. MA plan coverage starts July 1.
• Medicare Advantage Open Enrollment (Jan 1–Mar 31): For switching MA plans or returning to Original Medicare.
• Special Enrollment Periods: Available if you:
  • Move out of your plan’s service area
  • Lose or gain employer/union or Medicaid coverage
  • Have your plan terminated
  • Are diagnosed with a qualifying chronic condition

What If You Want to Change Your Medicare Advantage Plan?

You can switch your MA plan during:

• Open Enrollment (Oct 15–Dec 7)
• Medicare Advantage Open Enrollment (Jan 1–Mar 31)

Your old plan will be automatically canceled when your new plan begins.

What Are Medicare Resources in Nevada?

Nevada offers several free programs to help Medicare beneficiaries:

• Nevada SHIP (State Health Insurance Assistance Program): Offers free Medicare counseling and plan comparisons.
• Nevada SMP (Senior Medicare Patrol): Teaches beneficiaries how to detect and prevent Medicare fraud.
• Nevada Division of Insurance: Provides assistance and handles Medicare-related complaints.
• Nevada Medicaid (DWSS): Helps low-income residents with healthcare costs. Call 1-800-992-0900.

Learn more about the differences between Medicare and Medicaid.

Understanding Medicare Advantage Star Ratings

The CMS star ratings system is how the Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage (MA) plans using a 5-star quality scale. These ratings help consumers compare the performance of different plans based on a standardized set of measures.

CMS Star Ratings Overview

• 1 star: Poor performance
• 2 stars: Below average
• 3 stars: Average
• 4 stars: Above average
• 5 stars: Excellent

These ratings are updated annually and reflect data collected from Medicare Advantage (Part C) and Medicare Advantage Prescription Drug Plans (Part D).

Other Medicare Plan Options to Help with Out-of-Pocket Costs

Medicare Supplement Plans, also called Medigap, help cover costs not paid by Original Medicare—like deductibles, copayments, and coinsurance.

• You must be enrolled in Parts A and B to qualify.
• The best time to buy a plan is during your six-month Medigap Open Enrollment Period, which begins when you enroll in Part B.
• After this window, you may need to pass medical underwriting.
• Medigap plans don’t include drug coverage. You’ll need a separate Part D plan.

Medicare Supplement Plan G had the highest enrollment in 2023, and Plans G and N are among the fastest-growing. Plan F is not available to those newly eligible after 2020.

Learn more about Medicare Supplement plans in Nevada.

Next Steps

If a Medicare Advantage plan in Nevada aligns with your healthcare needs, compare plans in your ZIP code. Review costs, coverage, provider networks, drug formularies, and extra benefits. Be ready to enroll during your applicable enrollment window.