- In 2019, there were 34 Medicare Advantage Plans available in Nevada.
- 35% of the total Medicare population in Nevada is enrolled in Medicare Advantage Plans as of 2018.
- In 2018, Original Medicare spent an average of $9,969 per beneficiary in Nevada, which is 1% lower than the national average.
- Available Medicare Advantage Plans range from one to 36 across Nevada’s 16 counties.
Whether you choose Original Medicare or Medicare Advantage, you pay the standard monthly premium for Part B coverage. Some Medicare Advantage Plans have additional monthly premiums on top of this base premium, depending on the scope of coverage and additional benefits. The plan you choose also affects whether you have to receive services from in-network providers or get a referral to see a specialist.
Medicare Advantage Plans in Nevada
Type of Medicare Advantage Plans
If you had private health insurance through your employer or from Nevada Health Link, the different types of Medicare Advantage Plans may already be familiar to you. Taking your budget and expected health care needs into account can help you determine whether one of these plans is right for you.
Health Maintenance Organizations (HMO)
HMOs are one of the most popular types of Medicare Advantage Plans. HMO plans are typically budget-friendly because these plans have in-network providers that agree to certain payment terms, helping insurance providers to control costs. In most cases, your HMO plan only covers services from in-network providers. With this plan, you have a fixed monthly premium, copayments, and coinsurance, although out-of-pocket expenses vary widely depending on your plan. You’re generally required to choose a primary doctor and get referrals to see specialists.
Preferred Provider Organizations (PPO)
Medicare PPO Plans are similar to HMOs in that these plans also have network providers. However, these plans offer greater flexibility because out-of-network care is covered, although you pay a higher portion of the bill. You don’t need to choose a primary care doctor, and you can usually schedule an appointment with a specialist without first getting a referral.
Private Fee-for-Service Plans (PFFS)
PFFS Plans have rules about how much the insurance company pays for a given service and how much you pay. If you have this type of plan, you can get health care services from any doctor, specialist, or hospital that agrees to the plan’s payment terms. Some plans have networks of doctors who agree to always treat you, even if they’ve never provided care to you before. Out-of-network providers may at any point decline the plan’s payment terms, even if they’re your primary provider.
Special Needs Plans (SNP)
SNPs are tailored to meet the needs of specific populations, such as those dually eligible for Medicare and Medicaid, who have certain medical conditions, or who live in a nursing home. Depending on the type of plan you’re enrolled in, your plan may cover more skilled nursing services or additional social services to help coordinate payments. In addition to meeting Medicare’s enrollment qualifications, you must meet the plan’s specific eligibility criteria to enroll.
Enrollment and eligibility for Medicare Advantage Plans in Nevada
To enroll in Medicare Advantage, you must be eligible for Parts A and B of Original Medicare. This program is open to those who are at least 65 years old or who are younger and have certain disabilities. Because Medicare Advantage Plans are offered by private insurance companies and often have provider networks, you must live within the service area of the plan you’re applying for. If you’re enrolled in a Medigap plan when you switch from Original Medicare to Medicare Advantage, you have to cancel your Medigap plan.
There are certain times of the year when you can sign up for Medicare Advantage, switch plans, or drop your coverage. Outside of these times, you can sign up for a Medicare Advantage Plan or switch to a different one if you experience a qualifying event, such as moving outside of your current plan’s service area or becoming eligible for an SNP.
- The Initial Enrollment Period opens up when you first become eligible for Medicare.
- The Open Enrollment Period runs from October 15-December 7.
- The Medicare Advantage Open Enrollment Period goes from January 1-March 31 and is for those enrolled in a Medicare Advantage Plan. During this time, you can switch to another Medicare Advantage Plan or back to Original Medicare once.
Prescription drug coverage
Most Medicare Advantage Plans include prescription drug coverage, and SNPs always have this coverage. Whether or not you rely on prescription drugs when you first become eligible for Medicare, it’s a good idea to make sure you sign up for a plan that has this coverage or add Part D to avoid late enrollment penalties down the road. While you can’t add Part D to HMO or PPO Plans, you can purchase this coverage alongside some PFFS Plans.
Medicare Advantage Resources in Nevada
Nevada has several agencies and programs that can help you get the most from your Medicare benefits. Through these resources, you can find out what Medicare Advantage Plans are available to you, compare benefits and out-of-pocket costs, and protect yourself from identity theft. These agencies can also advocate on your behalf in the event of billing errors, discrepancies, or denied claims.
Nevada Division of Insurance
The Nevada Division of Insurance provides up-to-date information regarding health insurance policies sold in the state. The division provides up-to-date information on health insurance rates, available Medicare plans, and details on how to apply for coverage. The division also advocates on behalf of seniors if their claims aren’t handled fairly by their insurance provider.
Contact Information: Website | 888-872-3234
State Health Insurance Assistance Program
The State Health Insurance Assistance Program assists Medicare-eligible individuals in Nevada. The program is staffed primarily by trained volunteers who can help you research the Medicare Advantage Plans available in your area and compare benefits and out-of-pocket costs. Advisors can also help you dispute medical billing errors or denied claims.
Contact Information: Website | 800-307-4444
Senior Medicare Patrol
Senior Medicare Patrol is a volunteer-driven program that educates Medicare beneficiaries on how to protect themselves from fraud and waste. Volunteers provide one-on-one assistance with reviewing billing statements to identify fees for services not ordered or rendered, double charges, and errors. SMP volunteers can also file reports with the proper authorities if you are a victim of Medicare fraud.
Contact Information: Website | 888-838-7305
City of Las Vegas Senior Services
City of Las Vegas Senior Services is the Area Agency on Aging for Las Vegas, the most populous city in the state. Through this local agency, you can get in touch with a local SHIP advisor. These advisors aren’t affiliated with an insurance company or licensed to sell policies, but they provide free, unbiased guidance regarding Medicare options. They can also help you determine whether you qualify for any Medicare Savings Programs.
Contact Information: Website | 702-229-6690
Legal Aid Center of Southern Nevada
Legal Aid Center of Southern Nevada is a free nonprofit legal organization that provides free advice and representation to older adults in Nevada. Its legal professionals can help you apply for Medicare Advantage or resolve issues, such as billing errors and denied claims.
Contact Information: Website | 702-386-1070
Learn More From Our Sources
- Medicare | Costs for Medicare Advantage Plans | Last accessed June 2021
- Medicare | Preferred Provider Organization | Last accessed June 2021
- Medicare | Private Fee-for-Service (PFFS) Plans | Last accessed June 2021
- Medicare | Who can join a Medicare Advantage Plan? | Last accessed June 2021
- Medicare | Joining a health or drug plan | Last accessed June 2021
- Medicare | Drug coverage (Part D) | Last accessed June 2021
- Medicare | Part D late enrollment penalty | Last accessed June 2021
- Department of Business and Industry | Nevada Division of Insurance | Last accessed June 2021
- Aging Services | State Health Insurance Assistance Program | Last accessed June 2021
- Aging Services | Senior Medicare Patrol (SMP) | Last accessed June 2021
- Las Vegas | Senior Services | Last accessed June 2021
- Legal Aid Center of Southern Nevada | Last accessed June 2021