What You Need to Know
Medicare Advantage Plans must include Medicare Part A and B coverage.
Most plans cover prescription drugs.
While some plans have a monthly cost, others are zero-premium plans.
What Are Medicare Advantage Plans in Nebraska?
After you enroll in Medicare Part A and B, or Original Medicare, you can switch to a private health insurance plan. These plans are known as Medicare Advantage or Medicare Part C. They offer the same coverage as Original Medicare. Many of them come with additional benefits that you won’t find in Original Medicare. They also usually include Part D prescription drug coverage.
What Types of Medicare Advantage Plans Are Available?
There are 18 Medicare Advantage plans in Nebraska.1 Plan types include:
- Health maintenance organization (HMO): Premiums for HMOs are typically the lowest among plans. However, you’ll be limited to seeing providers within your HMO’s network, except for in emergency situations. Also, you must get referrals to see specialists.
- Preferred provider organization (PPO): Your premium will be higher compared to an HMO plan, but you can go to out-of-network providers. However, you will pay more when you do so. You don’t need referrals to see specialists.
- Special needs plan (SNP): These plans limit membership to people who have certain conditions or characteristics. Your care must come from your SNP network, except for in emergencies. In addition, you’ll need a PCP or care coordinator who refers you to specialists.2 The three types of SNPs are:
- Chronic condition special need plan (C-SNP): A C-SNAP is designed for people who have an ongoing medical condition like diabetes or cancer.
- Dual eligible special need plan (D-SNP): If you qualify for both Medicare and Medicaid, a D-SNP can be an option.
- Institutional special need plan (I-SNP): An I-SNP is designed for people who need care in a nursing home or another type of long-term facility.
- Private fee-for-service (PFFS): A PFFS plan will decide how much to pay doctors and medical facilities. It will also determine your cost for care. You don’t have to choose a PCP or get referrals to see specialists.3
- Medicare savings account (MSA): You can think of an MSA as a mix between a medical savings account and a high-deductible plan.4
What Are Prescription Drug Options with Medicare Advantage?
Original Medicare doesn’t include prescription drug coverage. That’s why many Nebraskans who choose this option buy standalone Part D drug plans. All Medicare Advantage SNPs as well as most HMOs and PPOs cover prescription drugs.
Note that if the Medicare Advantage HMO or PPO plan you choose doesn’t include prescription drug coverage, you can’t buy a Part D prescription plan. If you choose a PFFS plan that doesn’t offer prescription drug coverage, you can buy Part D coverage.
How Do You Choose Medicare Advantage Plans?
When you shop for Medicare Advantage Plans, be sure to keep the following in mind.
- Premiums: Your premium is how much you pay for the plan each month. Even with a zero-premium plan, you may still have to cover the Medicare Part B premium. In 2021, the premium is $148.50.5
- Other Costs: In addition to your premium, you’ll want to look into other costs including:
- Coinsurance: The out-of-pocket percentage you pay for services after you meet your deductible.
- Copays: The amount you pay for a doctor visit or other medical service.
- Deductibles: The yearly amount you pay before your coverage begins.
- Maximum: The annual out-of-pocket amount you’re responsible for. In 2021, this amount is $7,550 for in-network services.6
- Plan Benefits
Consider all costs
You can get a zero-premium plan with Medicare Advantage, but you pay more out of pocket when you need care.
When and How to Enroll in Medicare Advantage?
To be eligible for a Medicare Advantage Plan, you must sign up for Medicare Part A and B. Once you enroll in Original Medicare, you can look for Medicare Advantage plans near you and fill out an application. You may join a Medicare Advantage plan during these defined enrollment periods.7
- Initial Enrollment Period (IEP): This is a seven-month period that begins before your 65th birthday month and ends three months after. You may enroll in a Medicare Advantage plan during this time.
- Annual Election Period (AEP): Also known as Open Enrollment, the AEP runs from October 15 through December 7 each year. You can enroll in a Medicare Advantage plan for the first time or switch to a different plan.
- Medicare Advantage Open Enrollment Period: This period lasts from January 1 to March 31. You can drop your Medicare Advantage plan or switch plans. The changes will take effect the month after you make them.
- General Enrollment Period: If you enroll in Medicare Part B for the first time during the Open Enrollment Period, you can join a Medicare Advantage plan anytime between April 1 and June 30 of that same year.
- Special Enrollment Period: There are certain situations in which you can make changes to your Medicare Advantage plan outside of regular enrollment periods.8 These include:
- Moving to a new address that’s outside of your plan’s service area
- Losing employer coverage or Medicaid
- Gaining coverage through an employer, union, or Medicaid
- Losing your plan due to Medicare terminating its contract
- Being diagnosed with a chronic health condition that would be a better fit for a C-SNAP
Who Has Signed up For Medicare Advantage in Nebraska?
Approximately 71,000 residents have enrolled in a Medicare Advantage in Nebraska. That number, which is known as a penetration rate, is about 19% among all people who are eligible for Medicare.
Medicare Advantage plans usually include benefits not included in Original Medicare like gym memberships.
How Much Do Medicare Advantage Plans Cost in Nebraska?
In 2021, the average cost for a Medicare Advantage plan in Nebraska is $12.76, which is significantly lower than the national average of $21.9 Your location and the benefits you want will determine the cost of your Medicare Advantage plan in Nebraska. Remember to consider the monthly premium, deductible, and other costs when you compare plans.
What If You Want to Change Your Medicare Advantage Plan?
There are two times you can change your Medicare Advantage plan each year. You may switch or drop your plan during open enrollment, which is between October 15 and December 7. Or you can disenroll from your current plan or enroll in a different one from January 1 to March 31.10
What Are Alternatives to Medicare Advantage?
If you decide that Medicare Advantage isn’t right for you, consider these alternatives.
- Programs of All-Inclusive Care for the Elderly (PACE): You may want to look into PACE if you’re 55 or older, live in an area where PACE has services, and qualify for nursing home care.11 Immanuel Pathways in Omaha is the approved PACE provider in Nebraska and serves all of Douglas and Sarpy counties as well as parts of Cass, Dodge, Saunders, and Washington counties.12
- Original Medicare: You can stay with Original Medicare over Medicare Advantage. If you do so, you may want to opt for a private Medicare supplement policy to cover out-of-pocket expenses that Original Medicare doesn’t cover. You might also want a Medicare Part D standalone prescription drug plan.
What Are Medicare Resources in Nebraska?
- Nebraska Department of Insurance: Explains the difference between Medicare and Medicaid in Nebraska.13
- Nebraska SHIP: Offers education to people with Medicare. You can call 1.800.234.7119 or at 402.471.2841 to schedule a phone call or video conference. You may also send an email to DOI.SHIP@nebraska.gov.14
If you believe Medicare Advantage is a good option for you, contact Medicare to find an insurance company or reach out to an enrollment agency. Be sure to choose the plan that works best for your budget and healthcare needs.