Medicare is the federal health insurance program for seniors. Basic coverage, also called Original Medicare, includes Medicare Part A (hospital coverage) and Part B (outpatient coverage). Original Medicare doesn’t always cover all of your expenses. There’s no coverage for prescription drugs and there’s no cap on out-of-pocket expenses.
Another option to get coverage in Nevada is to enroll in Medicare Advantage (MA), or Medicare Part C. These private insurance plans provide the same level of coverage as Original Medicare. You’ll also get coverage for prescription drugs with most MA plans, and many plans limit out-of-pocket expenses for care.
What You Need to Know
Your Medicare Advantage plan provides the same coverage as Original Medicare.
Most MA plans have additional benefits, such as prescription drug coverage.
The best time to sign up for a Medicare Advantage plan is during your Initial Enrollment Period when you turn 65.
What Types of Medicare Advantage Plans Are Available in Nevada?
Medicare Advantage plans in Nevada usually work within a network of doctors and healthcare facilities that have contracted with your insurance provider. Different plan types include:
- Health Maintenance Organization (HMO): You’ll pay less out-of-pocket if you visit an in-network doctor. Except in certain emergencies, you may have to cover the full cost of out-of-network care. Most HMOs require you to designate a primary care physician (PCP).
- Preferred Provider Organization (PPO): You can visit any doctor or healthcare facility, but you’ll pay less out-of-pocket when you go to an in-network doctor. You’re not required to choose a PCP.
- Special Needs Plans (SNP): These plans cover special health conditions and characteristics.1
- Chronic Condition SNP (C-SNP): Provides coverage for chronic conditions, such as diabetes or cancer.
- Institutional SNP (I-SNP): Helps cover costs associated with living in an institution, such as a nursing home, or requiring in-home nursing care.
- Dual-Eligible SNP (D-SNP): Only available if you qualify for both Medicare and Medicaid.
- Private Fee-for-Service (PFFS): Your insurer will decide how much the plan pays doctors for services. The plan also determines what you’ll pay for care. You won’t need to pick a PCP.2
- Medicare Medical Savings Accounts (MSA): You use an MSA to help pay for out-of-pocket expenses from a high-deductible health insurance plan.
What Are Prescription Drug Options with Medicare Advantage?
Original Medicare doesn’t provide Medicare Part D, or coverage for prescription drugs. Most Medicare Advantage plans, however, do offer prescription drug coverage.
Be sure to look at a plan’s drug formulary, or list of covered prescription medications, to make sure your prescriptions are included before signing up.
A Word of Advice
You’ll save money with most Medical Advantage plans by staying in-network for services.
How Do You Choose Medicare Advantage Plans in Nevada?
Insurance companies in Nevada offer MA plans in geographical areas, known as service areas. Consider the costs and coverage options of plans available in your area, including:
- Premiums: The monthly cost of a plan, in addition to the Medicare Part B premium ($148.50 for most people in 2021). You might be able to choose a zero-premium plan. Zero-premium plans may cost more out-of-pocket in other areas, such as your deductible or coinsurance.
- Other Costs
- Deductible: The annual amount you’ll have to pay out-of-pocket for care before your insurance benefits kick in.
- Coinsurance: The portion of your care you’ll have to pay out-of-pocket. This is usually a percentage of the total cost.
- Copay: A fixed cost for specific medical services or procedures.
- Out-of-Pocket Maximum: The annual maximum amount you’ll have to pay out-of-pocket, not including premiums.
- Plan Benefits
- Vision: Provides coverage for eye exams and other vision services.
- Dental: Helps cover the cost of services such as checkups or teeth cleanings.
- Telehealth: Covers remote health services, including video office visits or phone consultations.
- Additional Perks: Many plans provide extra benefits for plan members, such as gym membership reimbursement or discounts on fitness classes.
When and How to Enroll in Medicare Advantage?
You become eligible to enroll in Medicare as you approach age 65. Your Initial Enrollment Period includes the three months before and three months after the month you turn 65. You can still enroll in Medicare if you miss your Initial Enrollment Period by joining during the General Enrollment Period from January 1 to March 31 annually. However, you could be required to pay late penalties on Medicare premiums if you miss your Initial Enrollment Period.
Medicare enrollment goes through the Social Security Administration. You can apply for Medicare online, over the phone, or by visiting your local Social Security office.
After signing up for Original Medicare, you’re ready to pick a Medicare Advantage plan. Enroll in your MA plan during one of the enrollment periods:
- Initial Enrollment Period: Choose your MA plan at the same time you enroll in Original Medicare.
- Medicare Annual Election Period: Sign up for Medicare Advantage during open enrollment from October 15 to December 7 each year.
- Medicare Advantage Open Enrollment Period: Switch from a Medicare Advantage plan back to Original Medicare or change MA plans each year from January 1 to March 31.
- Special Enrollment Period: You may be eligible to enroll in an MA plan outside of the normal enrollment periods if you meet certain criteria, such as:
- You’ve moved outside your plan’s service area.
- You are covered by an employer or union healthcare plan.
- You’re losing your existing coverage, such as becoming ineligible for Medicaid.
- Your current plan is leaving Medicare or being terminated.
- You’ve been diagnosed with a health condition and need to switch to an SNP.
How Much Do Medicare Advantage Plans Cost in Nevada?
The cost of a Medicare Advantage plan varies. Your location, as well as other factors, can change the cost of your plan. The average 2021 monthly premium for Medicare Advantage plans in Nevada is $3.93.3
The monthly premium for coverage in Reno ranges from $0 to $180, while monthly premiums in Las Vegas could be between $0 and $151.4 Monthly premiums are only part of the cost of an MA plan. You should also consider other costs, such as deductibles and coinsurance, when choosing a plan.
Check Your Prescriptions!
When comparing plans, make sure your prescriptions are on the list of covered medications.
What If You Want to Change Your Medicare Advantage Plan?
The best time to change your Medicare Advantage plan in Nevada is during one of the open enrollment periods each year. When you change plans, your old plan is automatically canceled when your new coverage takes effect.
What Are Alternatives to Medicare Advantage?
If you’re not sure whether Medicare Advantage is right for you, there are other options.
- Original Medicare: Stick with Medicare Part A and B if it provides enough coverage.
- Medicare Supplement: Also known as Medigap, these policies offer supplemental coverage for the gaps in Original Medicare.
- Medicare Supplement with Part D: Medigap policies don’t usually include prescription drug coverage. You’ll need to purchase a separate Medicare Part D plan.
What Are Medicare Resources in Nevada?
- State Health Insurance Assistance Program (SHIP): This statewide program provides free, unbiased counseling on your Medicare options, as well as resources to help you enroll.5
- Nevada Division of Insurance: Provides resources on health insurance options, including Medicare Advantage plans and Medicare Supplement policies.6
- Medicaid: This federal program helps low-income families and seniors get affordable health insurance and is run by the state of Nevada.7
Consider whether a Medicare Advantage plan in Nevada is right for you so you can start comparing plan options. This makes it easier to sign up for an MA plan when you’re eligible to enroll in Medicare.