Medicare Advantage Plans in Nevada
Fact checked Contributing expert: Roseann Birch; Reviewed by: Leron Moore - Published: Jun 04, 2021
As they approach their 65th birthdays, most Nevada seniors start to think about signing up for Medicare. Original Medicare, however, is not the only option that seniors have for healthcare in their later years. There is also Medicare Advantage, which is also known as Medicare Part C.
Private healthcare companies manage Medicare Advantage plans. These plans must provide the same benefits the recipient would receive under Medicare Part A and Part B. But they can also come with additional advantages, like hearing, vision, or dental coverage, for an added cost.
- 1 In 2019, there were 34 Medicare Advantage plans available in Nevada.
- 2 35% of the total Medicare population in Nevada is enrolled in Medicare Advantage plans as of 2018.
- 3 In 2018, Original Medicare spent an average of $9,969 per beneficiary in Nevada, which is 1% lower than the national average.
- 4 Available Medicare Advantage plans range from one to 36 across Nevada’s 16 counties.
In Nevada, Medicare-eligible recipients who decide to use a Medicare Advantage plan have four different kinds of plans from which they can choose. Some of these plans may be familiar to people who obtained their healthcare from their employer in the past. Some of the plans require that you only use in-network healthcare providers, while others allow greater flexibility but at an added cost. It’s also important to note that not all of these plans cover prescription drugs. Plan availability is also based on location, so seniors can only enroll in their county’s plan offerings.
Medicare Advantage Plans in Nevada
Types of Medicare Advantage Plans
When looking at the plans in Nevada’s Medicare Advantage program: HMOs, PPOs, PFFS, and SNPs, seniors should consider the following questions.
- Do I want the option of being able to see healthcare providers outside of my plan’s network?
- Do I plan to travel or spend the winter away from my primary care physician?
- How much of a premium do I want to pay?
- Is it necessary for me to have a plan that includes Medicare Plan D prescription drug coverage?
Health Maintenance Organizations (HMOs)
If you select a Medicare Advantage HMO plan, you’ll need to name a primary care physician and get referrals to see a specialist. For all practical purposes, you’re limited to using healthcare providers in the HMO’s network (with exceptions for emergencies or out-of-network dialysis). Additional benefits like vision, dental, and hearing are available but at an extra cost. Most Medicare Advantage HMO plans include prescription drug coverage but not all do. So, before you select an HMO, look carefully at the policy documents. Nevada residents who desire an HMO plan must still pay Medicare’s Part B premium and, if applicable, the Part A premium.
Preferred Provider Organizations (PPO)
Nevada residents who have a Medicare Advantage PPO plan don’t need to pick a primary care physician or need a referral to see most specialists. They can also use providers outside of their PPO plan’s network, but there are usually additional fees. Extra benefits like health, vision, and dental are also available, but again, at an added cost. PPO plan members should understand that remaining within the PPO’s network typically results in a lower fee. Most PPO plans offer medication coverage but not all do.
Private Fee-For-Service Plans (PFFS)
These Medicare Advantage plans offer members additional flexibility when selecting a healthcare provider but are usually more expensive. Most PFFS plans contract with a network of healthcare providers, which treat all members of the plan. However, the member may seek treatment from out-of-network healthcare suppliers. Keep in mind that these individuals or companies may refuse to serve you if they don’t like the payment terms of the PFFS plan. (Exceptions are made for emergencies and out-of-network dialysis.) Many PFFS plans offer prescription drug coverage but not all do.
Special Needs Plans (SNP)
The average Nevada resident seldom chooses SNPs. These plans exist to provide coverage for Medicare beneficiaries who have special conditions or healthcare problems. SNPs offer members access to specialized healthcare providers who can treat their medical condition or provide service in a skilled nursing facility. Members must choose in-network healthcare providers, pick a primary care physician, and seek referrals to see a specialist. (Exceptions are made for out-of-network urgent care and dialysis for ESRD.) All SNPs are legally required to provide Medicare Part D coverage.
Enrollment and Eligibility for Medicare Advantage Plans in Nevada
Nevada recipients who wish to either remain in Original Medicare or select a Medicare Advantage plan must meet certain eligibility criteria:
- They are at least 65 years old, have been receiving Social Security disability benefits or suffer from ALS or ESRD
- Be a U.S. citizen or permanent resident of the United States for at least five years
- Nevada residents need to have worked long enough to be eligible for Social Security
- They must enroll in Original Medicare Part A and Part B first to be able to select a Medicare Advantage plan
- Eligible applicants need to select a Medicare Advantage plan that is available in the county where they live
Nevada residents who wish to become a member of a Medicare Advantage plan must enroll during specific periods:
- Initial enrollment transpires during the three months preceding an individual’s 65th birthday, the month of their birthday, and the three months following their birthday.
- The yearly Medicare enrollment takes place during October 15-December 7. An eligible Nevada resident can move from Original Medicare to a Medicare Advantage plan or return to Original Medicare. They may also transfer between different Medicare Advantage plans.
- During Medicare Advantage open enrollment, which takes place from January 1-March 31, a member of a Medicare Advantage plan can switch to a different Medicare Advantage plan or return to Original Medicare.
- Finally, a special general enrollment happens from April 1-June 30 when anyone who has recently signed up for Medicare Part B can instead select a Medicare Advantage plan.
Prescription Drug Coverage
As noted above, it’s important to pay attention to how each Medicare Advantage plan treats prescription drug coverage. Some plans carry it, and some don’t. You need to be aware of the rules that deal with selecting a Medicare Part D plan.
- Many HMOs and PPOs provide prescription drug coverage. They may bundle these plans into a Medicare Advantage Prescription Drug Plan (MA-PD). Some plans include this in the premium, while others require a separate premium. Not all HMOs or PPOs, however, provide prescription drug coverage.
- HMOs and PPOs that don’t provide prescription drug coverage don’t allow their members to select a stand-alone prescription drug coverage plan. If they do, they lose their Medicare Advantage plan membership and revert to Original Medicare.
- PFFS plans may provide prescription drug coverage, but their members can enroll in a separate Medicare Part D plan if they don’t.
- SNPs are required by law to include prescription drug coverage in every state.
Medicare Advantage Resources In Nevada
It can be confusing for seniors trying to decide between Original Medicare or purchasing a Medicare Advantage plan. Original Medicare is one plan, but there are several different types of Medicare Advantage plans. And even if you decide you want a Medicare Advantage HMO plan, there are several different types of HMO plans. Friends and family members may offer some guidance, but even they may not know all the answers. Fortunately, resources exist in Nevada to help seniors when it comes to selecting between Original Medicare and a Medicare Advantage plan.
Aging Services – State Health Insurance Assistance Program (SHIP)
This program, run by the Nevada Department of Health and Human Services, Aging And Disabilities Section, provides free assistance and counseling to Nevada residents who qualify to receive Medicare. The volunteers who run the program offer unbiased personal assistance and counseling on issues like Medicare, Medicare Advantage, long-term care options, and supplemental health insurance
Contact Information: Website | 800-307-4444
Nevada Division of Insurance
Consumers looking for information on health insurance can browse the guides on the state’s insurance website. Topics include Medicare supplements, long-term care insurance, disability insurance and various health discount plans. In addition, seniors who are having disputes about payment can file a confidential complaint online.
Contact Information: Website | 888-872-3234
Nevada Senior RX
This prescription drug assistance program is available to low-income seniors in Nevada or those on Social Security disability benefits who do not qualify for other programs like Medicaid. The plan provides a monthly subsidy for Part D prescription drugs to eligible recipients on Medicare or a Medicare Advantage plan.
Contact Information: Website | 866-303-6323 option two
- Sources [-]
https://www.medicare.gov/sign-up-change-plans/types-of-medicare-health-plans/special-needs-plans-snp | Last accessed June 2021
https://www.medicare.gov/drug-coverage-part-d/how-to-get-prescription-drug-coverage | Last accessed June 2021
https://www.medicare.gov/blog/medicare-enrollment-period-2020 | Last accessed June 2021
http://adsd.nv.gov/Programs/Seniors/SHIP/SHIP_Prog/ | Last accessed June 2021
http://doi.nv.gov/Consumers/Health-Accident-Insurance/ | Last accessed June 2021
http://adsd.nv.gov/Programs/Seniors/SeniorRx/SrRxProg/ | 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.