As a Medicare beneficiary in Nebraska, you have the option to receive your Medicare benefits through the Medicare Advantage (Medicare Part C) program rather than through Original Medicare, Part A and Part B. Several noteworthy differences distinguish Original Medicare and Medicare Advantage.
First, Original Medicare is administered by the federal government. Medicare Advantage plans are offered by private insurance companies approved by Medicare.
Second, Medicare Advantage plans may offer additional benefits beyond what Medicare Part A and Part B provides. While Medicare Advantage plans are required by law to provide at least the same coverage as Part A and Part B (except hospice care, which remains covered under Part A), many Medicare Advantage plans offer more coverage by benefit design, such as lower deductibles, copayments and coinsurance amounts that reduce plan members’ out-of-pocket costs, or added benefits for routine vision care, dental care or prescription drug coverage. In addition, Medicare Advantage plans are required to set annual limits on the amount their members pay out-of-pocket for covered services. Original Medicare does not have a limit on beneficiaries’ potential cost for covered health services.
Third, Medicare Advantage plans have broader ranges of monthly premiums than Original Medicare.
Finally, Original Medicare Part A and Part B is available throughout the U.S. and its territories. Medicare Advantage plans are available only within their defined service areas: you cannot select any Medicare Advantage plan; you can only choose a Medicare Advantage plan that provides coverage where you live.
Types of Medicare Advantage plans in Nebraska
Medicare Advantage plans in Nebraska vary. By familiarizing yourself with the basic types of Medicare Advantage plans, you can put yourself in a position to choose one suited to your personal preferences and your health care service and coverage needs. Listed below are the prevalent types of Medicare Advantage plans. Not all types may be available where you live.
- A Health Maintenance Organization (HMO) is a type of Medicare Advantage plan that uses a network of contracted health-care providers (i.e., physicians, hospitals and other health-care professionals) to deliver covered health-care services to plan members. Usually plan members are encouraged to choose a primary care physician who is responsible for coordinating the member’s care. You may have to get a referral from your primary care doctor to receive coverage for many health services he or she does not provide. To receive benefits for covered services, you normally have to use the plan’s providers, except in situations where you need emergency care or the plan authorizes medically necessary out-of-network care.
- An HMO Point-of-Service (HMO POS) plan provides a little bit more flexibility. This type of plan has a network of plan-participating providers and usually encourages plan members to select a primary care physician. However an HMO POS plan has a second, lower level of coverage that provides coverage for certain health care you receive from providers who are not participating in the plan’s network. Generally you pay more for health services from out-of-network providers than you would pay if you received the care from providers who participate in the plan’s network.
- A Preferred Provider Organization (PPO)* plan is structured similar to an HMO Point of Service plan. A PPO has two levels of benefit coverage, and the higher level of coverage is applied when you use plan-participating providers to provide covered services and when you go out-of-network there is a higher out-of-pocket cost.
- A Private Fee-for-Service (PFFS) plan reserves the right to decide how much it will pay for your doctor, health-care provider, and hospital visits, as well as your share of each expense.
- A Medical Savings Account (MSA) plan combines a high deductible with a savings account, which you may use to pay your health-care expenses.
- A Medicare Special Needs Plan (SNP) is designed for Medicare beneficiaries who have certain chronic diseases, those living in institutions (like nursing homes), and people who qualify for both Medicare and Medicaid.
If you’re seeking both health and prescription drug coverage, you may want to opt for a Medicare Advantage Prescription Drug (MAPD) plan, which combines health and Medicare prescription drug coverage in a single plan.
It’s important for you to understand that even if you decide to join a Medicare Advantage plan in Nebraska, you must remain enrolled in Original Medicare and continue paying your Medicare Part B premium, to keep your health coverage.
How Medicare Advantage works in Nebraska
You are eligible to sign up for a Medicare Advantage plan in Nebraska if you have Original Medicare Part A and Part B, do not have End Stage Renal Disease (ESRD or kidney failure), and you live in the Medicare Advantage plan’s service area.
You can enroll in a Medicare Advantage plan that is available where you live at one of several specific times:
- During the seven-month Initial Enrollment Period, which begins three months before you turn 65, includes your birthday month, and ends three months after your birthday month.
- During the Annual Election Period, which runs from October 15 to December 7. Your new coverage goes into effect on January 1 of the following year.
- During a Special Election Period, if you experience certain life-changing events including, but not limited to, losing your current coverage, moving to a new address where your existing plan is not available, or undergoing certain changes in your present plan that affect your health benefits.
If you enroll in a Medicare Advantage plan and decide you want to switch to Original Medicare Part A and Part B, you may do so during the annual Medicare Advantage Open Enrollment Period, which occurs from January 1 to March 31 each year. You also can add a stand-alone Part D Prescription Drug Plan during this period if you drop your Medicare Advantage plan or change to another Medicare Advantage plan with prescription drug coverage
Comparing Medicare Advantage plans available in Nebraska
As a Medicare beneficiary in Nebraska, you may find it useful to compare the Medicare Advantage plans available in your area.
The availability and cost of Medicare Advantage plans generally vary depending on your state and county of residence. It’s common for premiums of a Medicare Advantage plan with the same coverage and benefits to vary between different counties within the state of Nebraska. You may find that some Medicare Advantage plans in Nebraska offer premiums as low as $0; always keep in mind that you must continue paying your Medicare Part B premium, no matter which Medicare Advantage plan you choose, to keep your Medicare insurance coverage.
Medicare Advantage plans may offer benefits beyond what is included in Original Medicare, Part A and Part B, so you will need to determine exactly what kind of coverage you may require, plus whether or not you want prescription drug coverage through a Medicare Advantage Prescription Drug plan.
Medicare Advantage plans often utilize a network of health care providers to deliver services covered by the plan to plan members. If you are interested in a Medicare Advantage plan that has a network of participating providers, review the Medicare Advantage plan’s directory of participating providers to see if your doctors and preferred hospitals are participating in the network. If they are, you are likely to experience little, if any, disruption to your current care if you enroll in the Medicare Advantage plan and you receive the Medicare Advantage plan’s benefits for covered services. If your doctors and preferred hospitals are not participating in the Medicare Advantage plan’s network, you will need to evaluate your potential out-of-pocket costs and decide whether the plan offers value to you or whether you are willing to change health care providers to get the maximum benefits of the Medicare Advantage plan.
With all the Medicare Advantage plan options available in Nebraska, you can understand why it may be a good idea to compare each plan to determine which one offers affordable coverage that meet your personal health and budget needs.
To start comparing Medicare Advantage plans in Nebraska today, enter your zip code in the eHealth plan finder on this page for a customized list of plans available in your area. You can also enter your prescription drugs to refine your search and cost estimates.
See the following pages for additional information about Medicare in Nebraska:
*Out-of-network/non-contracted providers are under no obligation to treat Preferred Provider Organization (PPO) plan members, except in emergency situations. For a decision about whether the plan will cover an out-of-network service, you or your provider are encouraged to ask for a pre-service organization determination before you receive the service. Please call the plan’s customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.