If you are a Medicare beneficiary living in Nevada, you have a variety of choices available if you choose to receive your Medicare benefits through Medicare Advantage (Part C), an alternative way of receiving Original Medicare Part A and Part B benefits. Since not all Medicare Advantage plans are available in every county, the specific benefits and costs available will depend on where you reside.
How Medicare Advantage works in Nevada
Medicare Advantage (Part C) is another way to receive your Original Medicare coverage. Private insurers contract with the federal government to provide Medicare Part A and Part B coverage to Medicare beneficiaries who live where these companies offer Medicare Advantage plans. (Hospice benefits are still covered by Part A and not by Medicare Advantage plans.) If you are enrolled in a Medicare Advantage plan, you’re covered under the Medicare program, but you will receive your benefits through the insurance company that handles your Medicare Advantage plan. You’ll need to continue paying your Part B premium and the Medicare Advantage plan’s premium, if any.
All Medicare Advantage plans are required to offer at least the same level of coverage as Original Medicare (except hospice care, which is still covered under Medicare Part A). However, many plans also cover benefits not included in Original Medicare, such as routine vision, dental, or prescription drug coverage.
Medicare Advantage plan costs in Nevada will vary, depending on the insurance company and the type of benefits covered. Some plans may cost less than Original Medicare, but not every plan is offered in every county of Nevada.
Medicare beneficiaries are eligible to enroll in a Medicare Advantage plan in Nevada if they:
- Have Medicare Part A and Part B;
- Live in the service area of the Medicare Advantage plan they’re considering; and
- In most cases, do not have end-stage renal disease (kidney failure), which is covered by Original Medicare.
Eligible individuals can enroll in a Medicare Advantage plan or make changes to their coverage during the following periods:
- Initial Coverage Election Period (ICEP):This is the period when a person is first eligible to enroll in a Medicare Advantage plan. If you enroll in Original Medicare (Part A and Part B) the first time you’re eligible, you can enroll in a Medicare Advantage plan during the same time period. In this case, the ICEP is a seven-month period that starts three months before the month you turn 65. The ICEP then runs through your birth month, and for the three months after your birth month.
- Annual Election Period:This is the Fall Open Enrollment period that occurs each year from October 15 to December 7. During this period, you can switch from Original Medicare to a Medicare Advantage plan (and vice versa). You may also add, drop or change your prescription drug coverage provided by a stand-alone Medicare Part D Prescription Drug plan or a Medicare Advantage Prescription Drug plan.
- Medicare Advantage Open Enrollment Period:This period occurs from January 1 to March 31 every year. During this period, individuals can disenroll from Medicare Advantage and return to Original Medicare, and if they choose, add a stand-alone Medicare Part D Prescription Drug plan to work alongside their Part A and Part B coverage. You also can switch Medicare Advantage plans during this period.
- Special Election Period:Individuals may be able to enroll in a Medicare Advantage plan or change Medicare Advantage plans outside of the Annual Election Period if they have experienced certain life or insurance coverage changes that make them eligible for a Special Election Period because if they did not have the opportunity of a Special Election Period, they might not be able to receive the Medicare benefits to which they were entitled. As an example, if you were enrolled in a Medicare Advantage plan, and then you moved permanently outside the service area of the plan, you would be eligible for a Special Election Period so that you could either enroll in another Medicare Advantage plan where you moved or opt to return to Original Medicare (Part A and Part B) coverage. If you had Part D prescription drug coverage before you moved, you could use this Special Election Period to sign up for a stand-alone Medicare Part D Prescription Drug plan available in the area where you recently moved.
Types of Medicare Advantage plans in Nevada
Nevada beneficiaries have several options when it comes to Medicare Advantage plans. Here are some of the most common types of Medicare Advantage plans:
- Health Maintenance Organization(HMO):These plans typically require members to use providers in the plan’s network in order to receive benefits. There are exceptions to this rule: if you require emergency care or if the plan pre-approves out-of-network care, your care will be covered by the plan. In an HMO Medicare Advantage Plan, you’ll select a primary care physician who coordinates your health care, and you generally need a referral to see a specialist.
- Preferred Provider Organization(PPO)*:In a PPO Medicare Advantage plan members have different levels of coverage, depending upon whether they use providers who participate in the plan’s network. Generally, your out-of-pocket expenses are lower when you use providers who participate in the plan’s network. You won’t usually have a primary care doctor and don’t need referrals to see specialists in a PPO Medicare Advantage plan.
- Health Maintenance Organization Point-of-Service (HMO-POS):This plan combines elements of HMO and PPO plans. Members have the option of seeing out-of-network providers and paying a higher out-of-pocket cost for services but they still have health coverage for services they receive from providers who do not participate in the plan’s network. Typically you will still select a primary care doctor, but you might not need a referral to see a specialist and have coverage for the specialist’s services.
- Private Fee-for-Service (PFFS): This type of plan (not Medicare) sets payment terms. Usually, members can use any provider that agrees to the plan’s payment terms and conditions. PFFS members are only responsible for the plan’s cost-sharing expenses, but some providers may charge up to 15% above the Medicare-approved amount.
- Special Needs Plan (SNP):These plans restrict membership to individuals who meet specific eligibility requirements. Each Special Needs Plan identifies a specific group of Medicare beneficiaries within their plan service area. These individuals may be persons who have a particular chronic health condition, such as congestive heart failure or diabetes, or individual whose health status requires they live in institutions such as nursing homes, or it may be individuals who receive Medicare and Medicaid benefits. Special Needs Plans often provide certain benefits, programs, and services that are designed to assist people who have these specific circumstances and conditions. All Special Needs Plans include prescription drug coverage.
- Medical Savings Account (MSA):This type of plan combines a high-deductible Medicare Advantage plan with a medical savings account. You direct the MSA plan to deposit a certain amount of money into a savings account each year, which can be used to pay for medical expenses with pre-tax dollars. You’ll pay the full cost for all health care until you reach the plan deductible. Medical Savings Account plans don’t include prescription drug coverage, so if you desire prescription drug coverage and a Medical Savings Account plan, you might consider enrolling in a stand-alone Medicare Part D Prescription Drug Plan, also.
- Medicare Advantage Prescription Drug Plan: Instead of enrolling in a stand-alone Medicare Part D Prescription Drug Plan, you receive your Part D prescription drug coverage and your health benefits from a single plan. Medicare Advantage Prescription Drug plans may be any of the above types of Medicare Advantage plans, except the Medical Savings Account plans.
Many Medicare Advantage plans include prescription drug coverage. If your Medicare Advantage plan doesn’t include prescription drug coverage and you desire this benefit, you can do one of the following during the Annual Election Period:
- Change to a Medicare Advantage Prescription Drug plan or
- Enroll in a stand-alone Medicare Part D Prescription Drug Plan.
Comparing Medicare Advantage plans available in Nevada
As you can tell, Nevada beneficiaries may have many options when it comes to Medicare Advantage. Because plans and costs can vary, you may find it worthwhile to compare the Medicare Advantage plans that are available in your county. Keep in mind that plan benefits, provider networks, and costs may change every year, so even if you’re currently happy with your coverage, it’s wise to review your options every year to be sure your plan is still meeting your needs.
Some Medicare Advantage plans in Nevada may have premiums as low as $0. Remember that even with $0 premium Medicare Advantage plans, you must continue paying your Part B premium.
When researching plans, remember to narrow your search to the county and zip code in which the Medicare beneficiary permanently resides.
* 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 we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.