Medicare Advantage Plans in Nebraska
Fact checked Contributing expert: Roseann Birch; Reviewed by: Leron Moore - Updated: Jul 06, 2021
Medicare Advantage is a Medicare program available to Nebraska seniors who are eligible for Original Medicare Part A and Part B. This plan is also known as Medicare Part C. In addition to the hospital and medical coverage available with Parts A and B, Part C also includes coverage for prescription drugs, vision, dental, and hearing care. Unlike other Medicare plans that the federal government oversees, Medicare Part C is managed by private insurance companies that have been preapproved by Medicare.
- 1 In 2019, there were 18 Medicare Advantage plans available in Nebraska.
- 2 15% of the total Medicare population in Nebraska is enrolled in Medicare Advantage plans as of 2018.
- 3 In 2018, Original Medicare spent an average of $9,969 per beneficiary in Nebraska, which is 1% lower than the national average.
- 4 Available Medicare Advantage plans range from one to 23 across Nebraska’s 93 counties.
Nebraska’s Medicare Advantage plans all offer differing levels of coverage and costs. For this reason, it’s important that seniors take the time to compare and consider plans carefully before making a decision. By understanding what each plan has to offer, seniors can select the plan that best suits their budget and needs. The availability of Medicare plans is dependent on the applicant’s geographic location and individual healthcare providers in the region. All plans must comply with Medicare’s terms of coverage and provide the same benefits, rights, and protection as Original Medicare.
Medicare Advantage Plans in Nebraska
Types of Medicare Advantage Plans
The Medicare Advantage program in Nebraska offers a range of different plans to seniors. The availability of these plans may vary across the state. Standard Medicare plans include Health Maintenance Organizations (HMO), Planned Provider Organizations (PPO), and Private Fee for Service (PFFS). Medicare also offers a Special Needs Plan (SNP) that provides coverage to people with specific conditions and illnesses. Each of these plans comes with its own set of eligibility criteria and network rules. Seniors will need to have a good understanding of these rules to make the right choice to suit their individual circumstances and needs. The good news is that help is on hand from a number of free and unbiased resources throughout Nebraska. From website resources and free seminars to toll-free numbers and one-to-one virtual sessions, these resources are designed to help seniors understand the options available and help them make the right decision.
Health Maintenance Organization (HMO)
Seniors enrolled in an HMO plan must receive all medical treatment through a specific network of health care providers. The only exception to this rule is if the participant requires emergency treatment. If the participant receives any general medical treatment from a provider not affiliated with their HMO network, they will be liable for all costs. Members of an HMO plan also need to select a primary care provider who will be responsible for all medical decisions and making referrals to specialists as required. HMO plans may be one of the most restrictive Medicare Advantage plans, but they are also one of the most cost-effective and always have low or no deductibles.
Planned Provider Organizations (PPO)
PPO plans are typically more expensive than HMO plans and always come with deductibles. However, these plans provide enrollees with much more freedom when it comes to network rules. Like HMOs, PPO plans are tied to a network of preferred providers. However, this list is more comprehensive and offers more choice to members. PPO members will usually receive at least part of the cost of any health care services they receive from providers outside of their network. However, providers within the network offer reduced rates to PPO members and the lowest copay and coinsurance rates. Seniors enrolled on a PPO plan do not need to select a primary care provider or require a referral if specialist medical care is required.
Private Fee-For-Service Plans (PFFS)
For seniors looking for maximum flexibility when choosing a health care provider, a PFFS plan is the most suitable option. Private Fee-for-Service plans have a full or partial network of providers, and some don’t have a network at all. This means that participants are free to select out-of-network doctors, hospitals, and other health care providers as long as they accept the terms of the plan. However, members will typically pay lower costs if they choose an in-network provider. On a PFFS plan, health care providers receive payments on a fee-for-service basis. It is down to the health insurance company to determine how much enrollees pay for each service and how much the plan pays out. Due to their flexibility, PFFS plans usually charge higher premiums than other Medicare Advantage plans.
Special Needs Plans (SNP)
Special Needs Plans (SNP) are designed to offer tailored benefits to members with specific chronic or disabling conditions. As a result of their specialist nature, SNPs come with stricter eligibility criteria and rules than other Medicare Advantage plans. These plans also have their own network of carefully selected healthcare providers. Members of an SNP must receive all health care from within their network. SNPs are generally more expensive than other Medicare Advantage plans and are often limited in geographic coverage. For this reason, it may be difficult for seniors to find an SNP in their local area.
Enrollment & Eligibility for Medicare Advantage Plans in Nebraska
Participants in Medicare Parts A and B are also eligible to enroll in Nebraska’s Medicare Advantage program as long as they meet the eligibility criteria set out below:
- Are at least 65 years old or have a qualifying disability
- Aren’t enrolled in a Medigap insurance plan
- Live in an area where Medicare Advantage plans are available
- Are a U.S. citizen or permanent resident
- Don’t have End-Stage Renal Disease — although SNPs may still be an option
The enrollment periods for Medicare Advantage depend on a number of criteria. Some enrollment periods may only be available to first-time applicants. Others require applicants to be already enrolled in a Medicare plan. The current enrollment periods for Medicare Advantage are as follows:
- Initial coverage election periods are accessible to first-time applicants. This period runs for seven months, starting three months before an applicant’s 65th birthday and ending three months after.
- Annual election periods are only available to existing members of a Medicare plan who wish to change to Medicare Advantage for the first time or Medicare Advantage members looking to switch plans. This period runs from October 15 and ends on December 7.
- Open enrollment periods are only available to existing Medicare Advantage members changing plans or changing back to Original Medicare. This enrollment period runs from January 1 to March 31.
- Special enrollment periods include a period that starts on April 1 and ends on June 30. This enrollment period is only valid for Medicare Part A members who enrolled in Part B during an open enrollment period and who want to switch to Medicare Advantage. Seniors who experience life-altering events may have additional enrollment options available to them.
Prescription Drug Coverage
Medicare prescription drug coverage, also known as Medicare Part D, comes as an optional benefit with Original Medicare and some Medicare Advantage plans. Prescription drug coverage is also often included as part of a package known as Medicare Advantage Prescription Drug or MA-PD plan. Medicare Part D is not available as a stand-alone plan to members of a Medicare Advantage HMO or PPO plan that does not include drug coverage. PFFS plan members may have prescription drug coverage included as part of their plan or be allowed to enroll in a stand-alone Medicare Part D plan. It is a legal requirement for Special Needs Plans to include prescription drug coverage.
Medicare Advantage Resources in Nebraska
All Nebraska seniors should have access to quality health care services. To ensure that seniors have a wide range of health care options to choose from, Medicare Advantage offers a selection of plans to suit individual needs and budgets. Nebraska’s Medicare Advantage program is comprehensive, giving seniors flexibility and freedom when choosing the right plan. However, such a wide choice of plans and coverage can lead to confusion. This could make it a little daunting for some seniors to select the most suitable plan. Fortunately, Nebraska is home to a number of free and unbiased resources designed to make the decision easier.
Nebraska State Health Insurance Assistance Program
Nebraska SHIP is a division of the Nebraska Department of Insurance and assists seniors and people with disabilities to make informed decisions regarding their health insurance. A toll-free hotline is available to Nebraska residents to call with any questions about Medicare. Seniors can also arrange a face-to-face meeting with an experienced SHIP counselor if they prefer. Nebraska SHIP offers completely unbiased advice and support and will never endorse any agent, insurance company, or product.
Contact Information: Website | 1-800 234 7119.
Nebraska Senior Medicare Patrol (SMP)
The Nebraska Senior Medicare Patrol (SMP) oversees a voluntary support service, helping seniors avoid Medicare billing mistakes, abuse, and fraud. The program is free and available throughout the state. Highly trained senior volunteers are on hand to assist fellow seniors on a number of topics from recognizing potential Medicare scams to understanding their latest Medicare Summary Notice.
Contact Information: Website | 800-234-7119
Volunteers Assisting Seniors (VAS)
Volunteers Assisting Seniors (VAS) offers Medicare presentations and private counseling sessions to Nebraska seniors. These presentations and sessions are designed to help seniors understand the Medicare program and make educated decisions about their options and benefits. All counseling sessions are free, confidential and unbiased.
Contact Information: Website | 1-800 234 7119
- Sources [-]
https://www.cms.gov/Medicare/Health-Plans/SpecialNeedsPlans | Last accessed June 2021
https://www.medicare.gov/blog/medicare-enrollment-period-2020 | Last accessed June 2021
https://www.medicare.gov/drug-coverage-part-d | Last accessed June 2021
https://doi.nebraska.gov/consumer/senior-health | Last accessed June 2021
https://doi.nebraska.gov/consumer/stop-medicare-fraud | Last accessed June 2021
http://vas-nebraska.org/services/medicare-2/ | Last accessed June 2021
Roseann Birch, Medicare Consultant
With experience in the insurance field since 1986, Roseann Birch is a seasoned Medicare consultant who is passionate in educating and guiding seniors through their Medicare and Medicare Advantage journey.
Leron Moore, Medicare Consultant
With over 10 years of experience in the Medicare industry, Leron Moore has dedicated his career to effecting change, educating, informing, and resolving issues for Medicare patients and their families.