Medicare Advantage Plans in Nebraska

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

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, although some may qualify earlier due to disability or certain conditions such as ALS or ESRD.

Key enrollment periods include:

• Initial Enrollment
• General Enrollment
• Special Enrollment

Late enrollment can lead to penalties or reduced access to premium-free coverage.

What Types of Medicare Advantage Plans Are Available in Nebraska?

Nebraska offers the following MA plan types:

• Health Maintenance Organizations (HMOs): Require in-network care and referrals to see specialists.
• Preferred Provider Organizations (PPOs): Allow out-of-network care at higher costs; referrals are generally not needed.
• Private Fee-for-Service (PFFS) Plans: Let you see any provider who accepts the plan’s terms; some plans have networks.
• Special Needs Plans (SNPs): Tailored for individuals with specific needs.
  • C-SNPs: For chronic conditions like diabetes or cancer.
  • I-SNPs: For individuals in long-term care or institutions.
  • Dual Eligible Special Needs Plans (D-SNPs): For people eligible for both Medicare and Medicaid; offer extra benefits and often low or no cost.
• Medical Savings Accounts (MSAs): Combine a high-deductible health plan with a savings account funded by your insurer.

What Are Your Prescription Drug Options with Medicare Advantage?

Most MA plans include Part D drug coverage. However, MSAs and some PFFS plans may not.

If your MA plan does not offer drug coverage, you may:

• Enroll in a standalone Part D plan (only allowed with certain plans).
• Face a penalty if you delay coverage and don’t have other creditable drug insurance.

How Do You Choose a Medicare Advantage Plan?

Understanding Medicare Advantage costs can help you select the right plan.

• Premiums: Many plans have $0 premiums; others require monthly payments.
• Deductibles, Coinsurance & Copays: These affect your out-of-pocket expenses for medical services.
• Out-of-Pocket Maximums: Caps your total yearly spending on covered services.
• Extra Benefits: Some plans include dental, vision, hearing, fitness programs, and OTC allowances.

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

You can enroll in Medicare during specific enrollment periods:

• Initial Enrollment: 3 months before through 3 months after your 65th birthday.
• Annual Open Enrollment (Oct 15–Dec 7): Join, switch, or drop MA plans.
• General Enrollment (Jan 1–Mar 31): For those signing up for Part B during this time.
• Medicare Advantage Open Enrollment (Jan 1–Mar 31): Switch MA plans or return to Original Medicare.
• Special Enrollment Periods: Triggered by life changes, such as:
  • Moving outside your plan’s service area
  • Losing employer/union coverage
  • Plan termination
  • Gaining a chronic condition

What If You Want to Change Your Medicare Advantage Plan?

You can switch or drop your plan during:

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

What Are Medicare Resources in Nebraska?

Nebraska offers helpful programs:

• Nebraska SHIP Program: Free Medicare counseling via phone or video; call 1-800-234-7119 or email DOI.SHIP@nebraska.gov.
• Nebraska SMP Program: Educates beneficiaries about avoiding healthcare fraud.
• Nebraska Department of Insurance: Handles Medicare-related complaints.

Low-income residents may receive help through Nebraska Medicaid. Visit ACCESSNebraska or call 1-855-632-7633. 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, or Medigap, are standardized policies from private insurers that help cover costs like deductibles, copays, and coinsurance from Original Medicare.

• You must be enrolled in Parts A and B to buy a plan.
• The best time to enroll is during your six-month Medigap Open Enrollment Period.
• Medigap plans do not include drug coverage—consider a separate Part D plan.
• There are 10 standardized Medigap plans. Medicare Supplement Plan G had the highest enrollment in 2023 and, along with Plan N, is among the fastest-growing.
• Plan F is unavailable to those newly eligible for Medicare as of 2020.

Learn more about Medicare Supplement plans in Nebraska.

Next Steps

If a Medicare Advantage plan in Nebraska is right for you, compare local plans to evaluate provider networks, out-of-pocket costs, and extra benefits—then enroll during your eligible window.