With insurance companies expanding benefits and adding more plan options every year, it's no wonder Medicare Advantage enrollment keeps growing. In 2023, over 30 million people had an Advantage plan – that's over one-half of eligible Medicare beneficiaries. This page describes Medicare Advantage plans in Nevada and explains how the program works.
What is Medicare Advantage in Nevada?
Original Medicare includes Part A, hospital insurance and Part B, medical insurance. It does not cover prescription medications. For that, you need Medicare Part D.
Medicare Part C plans (more commonly known as Medicare Advantage) must provide the same coverage you'd get with Original Medicare. Most plans, however, offer additional benefits.
The most common of these is prescription drug coverage, found in around 90% of Medicare Advantage plans. Other popular add-ons include fitness programs and routine vision and dental care.
Nevada Medicare Advantage plans with prescription drug coverage
Medicare Advantage Prescription Drug plans (MA-PD) are often referred to as all-in-one plans, because they combine your Parts A, B, and D benefits.
If you choose an Advantage plan that does not include prescription drug coverage, you need to join a standalone Medicare Part D plan. You risk lifelong penalties if you do not have creditable drug coverage. To be considered creditable, your prescription drug plan must provide comparable coverage to what you'd have with Medicare Part D.
Who is eligible for Medicare Advantage in Nevada?
If you have Medicare Parts A and B, you are eligible for Medicare Part C in Nevada.
American citizens and permanent legal residents become eligible for Medicare once they turn 65. Please note that you will not be automatically enrolled in Parts A and B unless you began collecting Social Security benefits at least 4 months before your 65th birthday.
You may qualify for Medicare before turning 65 if you collect Social Security disability benefits for 24 months. In this instance, enrollment occurs automatically during month 25.
When can you sign up for a Medicare Advantage plan in Nevada?
Medicare limits enrollment in a Medicare Advantage plan to specific times of the year.
You may first join a Medicare Advantage plan any time during your Initial Enrollment Period (IEP). This begins 3 months before your Medicare eligibility month and ends 7 months later. So, if your birthday or 25th month of disability is in March, your IEP starts on December 1 and ends on June 30.
If you do not sign up for Medicare Part A and/or Part B during your IEP, you may do so during the General Enrollment Period, which runs from January 1 through March 31. Once General Enrollment ends, you may then sign up for a Part C plan from April 1 through June 30.
The Medicare Annual Enrollment Period (AEP) allows current Medicare beneficiaries to join an Advantage plan any time between October 15 and December 7.
If you already have a Part C plan, the Medicare Advantage Open Enrollment Period lets you switch to a different MA plan or return to Original Medicare. If you lose your prescription drug coverage due to making that change, you may then join a standalone Part D plan. Open Enrollment lasts from January 1 through March 31.
Finally, you may be able to join a Medicare Advantage period during a Special Enrollment Period if you experience certain life changes. The full list of qualifying special circumstances is on Medicare.gov.
Types of Medicare Advantage plans in Nevada
Types of Medicare Advantage plans in Nevada include:
- Health maintenance organizations, or HMO plans, require members to use a provider network, choose a primary care doctor, and get a referral to see a specialist. Non-emergency care received from an out-of-network is rarely covered by an HMO plan.
- Preferred provider organizations, or PPO plans, also use a provider network. However, members can go to an out-of-network provider for a higher copay. You also don't have to get a referral to see a specialist or choose a primary care physician with a PPO plan.
- Private fee-for-service (PFFS) plans determine how much they and their members will pay for services. There is usually a provider network, but plan members may go out-of-network for a higher copay. You also don't have to choose a primary doctor or get a referral for a specialist if you belong to a PFFS plan.
- Special needs plans (SNPs) only serve people who belong to one of the following groups: qualify for both Medicare and Medicaid (dual eligible), have a chronic condition, or require nursing home or at-home healthcare. All services covered by the plan are tailored to the specific population it serves.
How to choose a Medicare Advantage plan in Nevada
Private insurance companies provide Medicare Advantage plans, which means coverage and costs can vary widely from plan to plan. When comparing your options, consider the following:
- Costs: May include a yearly deductible, monthly premium, and copays or coinsurance payable at the time of service.
- Coverage: The benefits the plan offers help put the costs in perspective. Often, more robust plan offerings – that come with a higher premium – can actually save you money, so make sure you're comparing apples to apples. And if it's an MA-PD plan, don't forget to review the drug formulary.
- Network: If you have pre-existing conditions or complicated medical issues, you may want an MA plan whose network includes your providers.
- Ratings: Medicare rates all plans on a 5-point scale and releases their findings each fall, before Annual Enrollment.
Our Find a Plan tool makes it easy to compare Medicare Advantage plans in Nevada. Just enter your location information and estimated coverage start date to review Medicare plans in your area.
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