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Medicare in Nebraska

October 6, 2016

As a Nebraska resident, you’re eligible to receive health insurance coverage through Original Medicare once you turn age 65, including Part A, medical insurance, and Part B, hospital insurance. You may have other choices for how you receive your Medicare benefits. Through Part C, also known as Medicare Advantage, you may be able to enroll in a Medicare Advantage plan, offered by a Medicare-approved private insurance company. Through Medicare Part D, you may be able to enroll in a stand-alone Medicare Part D Prescription Drug Plan, offered by a Medicare-approved private insurance company. Your options for Medicare plans offered by private insurers  may vary depending on where in Nebraska you live.

Original Medicare for Nebraska beneficiaries

As a Nebraska Medicare beneficiary, it’s important for you to understand which benefits you’re eligible to receive under Original Medicare. Original Medicare consists of Medicare Part A (hospital insurance) and Medicare Part B (medical insurance).

Generally, to qualify for Original Medicare, you must be 65 years of age or older, a citizen of the United States or a legal permanent resident of at least five continuous years,  You may be eligible for Original Medicare under the age of 65, if you have been receiving disability benefits from the Social Security Administration or the Railroad Retirement Board for at least 25 continuous months, or have certain health conditions such as end stage renal disease (ESRD or permanent kidney failure) or amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease).

Enrollment periods

Most Americans are automatically enrolled in Original Medicare when they turn age 65. These beneficiaries are collecting Social Security Administration (SSA) or Railroad Retirement Board benefits (including disability benefits even if younger than 65). If you’re automatically enrolled, you’ll get a Medicare card and other materials from Medicare in the mail.

If you’re not automatically enrolled (for example, if you’re not collecting SSA benefits), you need to enroll in Original Medicare during your Medicare Initial Enrollment Period. This is the seven-month span that starts three months before you turn 65, your birthday month, and three months after your birthday month.

If you’re disabled, your Initial Enrollment Period is the seven-month period that starts three months before your 25th month of collecting disability benefits, the 25th month you receive disability benefits, and the three months following that month.

If you don’t enroll in Original Medicare during your Initial Enrollment Period, you can still sign up during the General Enrollment Period, which in Nebraska and in the rest of the U.S. runs from January 1 to March 31 each year. Be aware, however, that if you miss your Initial Enrollment Period, you might have to pay a late enrollment penalty.

Some people  may be eligible for a Special Enrollment Period and avoid a penalty for late enrollment. For example, a Special Enrollment Period provides you an opportunity to enroll in Part A and Part B if you didn’t sign up during your Initial Enrollment Period because you were covered under an employer or union sponsored group health plan. You can enroll in Part A and/or Part B during the eight-month timespan that begins the month after employment ends or the coverage ends, whichever happens first.

Most Medicare beneficiaries are eligible to enroll in premium-free Medicare Part A (hospital insurance). If you don’t qualify for premium-free  Medicare Part A because neither you nor your spouse have paid Medicare taxes, you may have to pay a monthly premium.

Medicare Part A benefits include the following types of care:

  • Hospital inpatient
  • Limited nursing home
  • Skilled nursing facility
  • Home health services (usually short-term)
  • Hospice

Medicare Part B is medical insurance. In Nebraska, you’ll pay a monthly Part B monthly premium. If your income is higher that a certain limit set by the government, you may also have to pay an income-related monthly adjustment. Part B offers the following benefits to Nebraska residents (this is not a complete list):

  • Durable medical equipment
  • Mental health services (inpatient, partial hospitalization, and outpatient)
  • Certain outpatient medications
  • Second medical opinion prior to surgery
  • Clinical research
  • Ambulance services

To apply for Medicare, contact the Social Security Administration (SSA). If you are applying for retirement benefits, you can enroll in Medicare at the same time. You can apply:

  • Online at the Social Security website. Individuals applying for Medicare only (as opposed to applying for SSA benefits as well) can use this application.
  • By calling Social Security at 1-800-772-1213.If you are a TTY user, you can call 1-800-325-0778. SSA representatives can be reached Monday through Friday, from 7AM to 7PM.
  • In person at a local Social Security office. To look up office locations in Kentucky, click here.

Medicare plan options in Nebraska

Medicare beneficiaries in Nebraska may have several plan options.

  • Medicare Part C, also known as Medicare Advantage affords you an alternative way to receive your Medicare Part A and Part B coverage. Medicare Advantage plans are offered by private insurance companies contracted with Medicare. In Nebraska (as elsewhere in the United States) Medicare Advantage plans are required to cover at least the same hospitalization and medical benefits as Original Medicare Part A and Part B (except hospice care, which continues to be covered under Part A). Many Medicare Advantage plans offer additional coverage as well, like routine dental, routine vision, and hearing benefits. Many of these plans offer prescription drug coverage. Known as Medicare Advantage Prescription Drug plans, they combine health and prescription drug coverage into a single plan.
  • It’s important for you to note that if you enroll in Medicare Advantage plan or Medicare Advantage Prescription Drug plan in Nebraska, you have to stay enrolled in Original Medicare and continue paying your Medicare Part B premium in order to keep your health insurance coverage.
  • If you decide to stay with Original Medicare (Part A and Part B), another option you may have is to sign up for a Medicare Supplement (Medigap) plan to help pay for Original Medicare’s out-of-pocket costs. Different Medigap plans pay for different amounts of those costs, such as copayments, coinsurance, and deductibles.
  • Medicare Part D provides the means for obtaining prescription drug coverage. Offered by private insurance companies contracted with Medicare, stand-alone Medicare Part D Prescription Drug Plans can assist beneficiaries cover the cost of prescription drugs.   Costs for stand-alone Medicare Part D Prescription Drug Plans vary, but they generally require beneficiaries to pay a monthly premium, an annual deductible, and a copayment or coinsurance. To be eligible to enroll in a stand-alone Medicare Part D Prescription Drug Plan you must have Part A and/or Part B coverage and live in the Plan service area.

Medicare health and prescription drug plan costs in Nebraska may differ, among insurance companies, and availability may vary. Therefore, it’s important for you to customize your search for Medicare plans based on both your individual health needs and your home zip code.

Nebraska resources for Medicare beneficiaries

There are a number of resources designed to help Nebraska Medicare beneficiaries with Medicare-related issues and concerns. Here are some of the resources from Medicare.gov that may be helpful to you:

Learn more about how Medicare plans work in Nebraska including:

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