- In 2019, there were 18 Medicare Advantage Plans available in Nebraska.
- 15% of the total Medicare population in Nebraska is enrolled in Medicare Advantage Plans as of 2018.
- In 2018, Original Medicare spent an average of $9,610 per beneficiary in Nebraska, which is 5% lower than the national average.
- Available Medicare Advantage Plans range from one to 23 across Nebraska’s 93 counties.
Most counties in Nebraska offer multiple Medicare Advantage Plans to choose from, allowing you to shop around for the coverage that best meets your needs. Some plans have low or no monthly premiums, but may have higher deductibles, copays, and caps on out-of-pocket expenses. Before enrolling, be sure to consider how you’d use a plan to see if it’s cost-effective for your specific situation.
Medicare Advantage Plans in Nebraska
Types of Medicare Advantage Plans
Nebraska’s Medicare Advantage program offers four main types of plans: HMO, PPO, PFFS, and SNP. These plans have different rules on how you receive your health care, so make sure you understand how a particular policy works before enrolling. Insurance companies aren’t required to offer each type of plan, so you may have a choice of all, some, or none of the four types of plans, depending on the service area you live in.
Health Maintenance Organizations (HMO)
HMO plans have a network of providers that you must use to have your health care costs covered. If you receive services from doctors, hospitals, and health care facilities outside of the network, you usually have to pay more. Most HMO plans require you to choose a primary care doctor who’s your first point of contact and refers you to specialists if needed.
Preferred Provider Organizations (PPO)
PPOs offer flexibility in the health care providers you use. You can receive treatment and services from a network of preferred providers who’ve agreed to the plan’s payment terms. You can also use doctors and hospitals outside of the network, although usually at a higher cost. PPOs typically let you coordinate your own care, so you don’t need a primary care physician and can schedule consultations with specialists if you wish.
Private Fee-For-Service Plans (PFFS)
Health care providers are paid a set amount for each service under a PFFS. You pay the copayment or coinsurance directly to the provider, and the plan pays the provider for its share of cost. You may get treatment from any doctor, hospital, or health care facility that agrees to the plan’s terms. Not every provider accepts the plan, and some may accept it only for certain services, so you should confirm payment prior to treatment. If the PFFS plan has a network, it may cost you more to use out-of-network providers.
Special Needs Plans (SNP)
SNPs are customized for people with specific health conditions, such as diabetes mellitus, autoimmune disorders, neurologic disorders, and cancer. There are also SNPs for those living in a nursing home or needing nursing care at home. SNPs aren’t available in all areas, and you can only remain enrolled if you meet the plan’s conditions. These plans require you to have a primary care doctor, and in most cases, use providers within the plan’s network.
Enrollment and eligibility for Medicare Advantage Plans in Nebraska
To be eligible for a Medicare Advantage Plan, you must have Medicare Parts A and B and live in the plan’s service area. You’re usually enrolled automatically in Parts A and B if you’re age 65 and have been receiving Social Security benefits for at least four months. Otherwise, you must contact Social Security directly to sign up. As of 2021, individuals with end-stage renal disease may join a Medicare Advantage Plan.
Medicare has very specific rules about when you may join a Medicare Advantage Plan. It’s a good idea to begin researching your options well before these windows open.
- Initial enrollment period: Your first opportunity to enroll begins three months before the month of your 65th birthday. If you sign up at this time, your coverage begins the first day of the month you turn 65. You can also enroll during your birthday month and the three months after you turn 65, but your coverage will be delayed.
- Open enrollment period (October 15th to December 7th): During this window, you may change to Medicare Advantage from Original Medicare, switch between Medicare Advantage Plans, or drop a Medicare Advantage Plan and return to Original Medicare. Your new coverage begins January 1st.
- Medicare Advantage open enrollment period (January 1st to March 31st): If you’re already enrolled in a Medicare Advantage Plan, you can switch between plans during this time, or drop your Medicare Advantage Plan and return to Original Medicare.
Prescription drug coverage
If you want to receive Part A and B benefits through Medicare Advantage and have your prescription drugs paid for, you can choose a plan that includes prescription drug coverage. While there are stand-alone Part D prescription drug plans, these are designed to supplement Original Medicare. You can’t enroll in a Medicare Advantage Plan and a stand-alone drug plan at the same time, except with some PFFS plans that don’t include drug coverage. All SNPs and most PPOs and HMOs include drug plans.
Medicare Advantage Resources in Nebraska
Your Medicare Advantage Plan affects how you receive your health care — the providers you can use, your costs, and the services that are covered. To maximize your benefits, it’s important to understand your options and choose your plan carefully. There are several resources in the state that can assist with your Medicare Advantage questions.
Nebraska State Health Insurance Assistance Program (SHIP)
SHIP is a statewide service offered through the Nebraska Department of Insurance. Nebraska residents eligible for Medicare, along with family members and caregivers, can call the toll-free hotline for confidential support. While SHIP counselors don’t recommend specific insurance policies, they provide objective assistance to help you understand how plans work and make knowledgeable decisions. Counselors can answer your questions and assist you in comparing plans, applying for income assistance, and appealing Medicare decisions.
Contact Information: Website | 800-234-7119
Volunteers Assisting Seniors (VAS)
VAS is the regional SHIP office serving seniors in Omaha and surrounding communities in Cass, Dodge, Douglas, Sarpy, and Washington counties. This local nonprofit offers free Medicare information workshops and private counseling to help you understand Medicare rules, enrollment periods, and penalties. You can discuss your health needs and coverage options with trained counselors. VAS also has a New to Medicare video presentation that can be viewed on its website.
Contact Information: Website | 402-444-6617
Nebraska Department of Health and Human Services (DHHS)
Nebraska DHHS has information on its website about Medicare and other health insurance programs. It also provides programs to help low-income seniors pay for health care. If you’re finding it difficult to afford insurance, you may qualify for the state Medical Assistance Program, also known as Medicaid. You can apply online through the ACCESSNebraska system or speak to customer service staff with any questions. You can also contact your local DHHS office for assistance applying.
Contact Information: Website | 855-632-7633
Learn More From Our Sources
- Medicare | How Original Medicare works | Last accessed June 2021
- Medicare | Understanding Medicare Advantage Plans | Last accessed June 2021
- Medicare | Private Fee-for-Service (PFFS) Plans | Last accessed June 2021
- Medicare | How Medicare Special Needs Plans (SNPs) work | Last accessed June 2021
- Medicare | How do I get Parts A & B? | Last accessed June 2021
- Medicare | Understanding Medicare Advantage & Medicare Drug Plan Enrollment Periods | Last accessed June 2021
- Medicare | Drug coverage (Part D) | Last accessed June 2021