Medicare in Nevada
Nevada is home to over 3 million residents, and as of 2015, there were 445,997 people enrolled in Medicare in the state. As with most other states, Nevada residents can choose from Original Medicare Parts A & B, as well as Medicare Advantage (Part C), prescription drug coverage (Part D), and Medicare Supplement Insurance (Medigap).
While that may sound like a lot of options to choose from, don’t worry: each year, the Nevada Department of Business and Industry publishes a Premium Comparison Guide to help you decide which plan is right for you.
In this article, we’ll look at some of the plans available to Nevada residents, as well as how to apply for Medicare in the state.
Who Uses Medicare in Nevada?
Of the 445,997 people enrolled in Medicare in Nevada, 296,171 were on Original Medicare, and 149, 826 had Medicare Advantage, which means they purchase their coverage from a private insurer who may offer additional benefits beyond what Original Medicare covers.
As in other states, there are certain requirements that residents must meet in order to be eligible for Medicare coverage. Who counts as a Medicare beneficiary in Nevada?
A Medicare beneficiary is someone who is eligible for Medicare and enrolled in Medicare Part A and/or B. Medicare beneficiaries are covered for some medical expenses, but not all, and may be required to pay coinsurance and copays for some services.
In general, a doctor who accepts Medicare will bill Medicare at the pre-approved rate and the beneficiary will not be charged for expenses that are covered by their plan.
To qualify as a beneficiary in Nevada, you must meet the following requirements:
- be a U.S. citizen or resident for five years or more
- be 65 years of age or older
You may also be eligible for Medicare if you are under 65 and have received Social Security Disability Insurance (SSDI) for 24 months or have End-Stage Renal Disease (ESRD).
Medicare Options in Nevada
Your Medicare options in Nevada depend on several factors, such as whether you want to stick with basic coverage or purchase supplemental insurance from a private insurer. You’ll also have to decide if you want separate prescription drug coverage since this isn’t covered by standard Medicare policies. Let’s look at the four major options, Parts A through D.
Medicare Part A and B
The core components of Original Medicare are Parts A and B. Part A covers care at a hospital, nursing home, or hospice, and Part B covers doctor’s visits and preventive medicine.
For most people, Part A does not have a premium, as long as you’ve worked and paid taxes into Medicare for at least 40 quarters. You may have to pay a premium if you’ve worked for less than 30 quarters, in which case the premium is $437 per month, or between 30-39 quarters, in which case the premium is $240.
Part A has a deductible of $1,364 per year, so you’ll have to pay that amount out-of-pocket before Medicare kicks in. After that, you’ll be covered for up to 60 days of care, but if you’re in the hospital for longer 60 days, you’ll pay $341 in coinsurance for days 61-90, and all costs beyond that once you’ve used up your “lifetime reserve days.”
Part B has a standard premium of $135.50 per month, although that can vary based on your income. The deductible is $185 per year, and after that, you pay 20% of the costs for doctor’s visits and other outpatient care; Medicare covers the other 80 percent.
If you want more coverage than Original Medicare, then you can choose a Medicare Advantage plan from a private insurer, which is referred to as Medicare Part C. These plans are required to offer the same minimum benefits as Original Medicare, but may also include additional benefits, such as dental or vision care, or prescription drug coverage.
Since these plans vary from insurer to insurer, you’ll want to do a cost comparison and research the best plan for you. You’ll still be responsible for your monthly Part B premium in addition to the premium for your Medicare Advantage plan. Some Advantage plans have $0 premiums, but you may end up with higher deductibles and copays. You may also pay more to see a doctor outside your network, so if you want to keep seeing your current doctor, make sure that they’re in your Medicare Advantage plan’s network.
You can use online tools like this one to search for Medicare Advantage plans in Nevada with or without prescription drug coverage.
Medicare Supplement Insurance
An alternative to Medicare Advantage is Medicare Supplement Insurance, or Medigap. Instead of paying a private insurer to manage your Medicare package, you’ll purchase a plan to cover the “gaps” in your Medicare costs. For example, you can choose a plan that covers all of the copays and coinsurance costs you would incur on Original Medicare.
These plans are standardized from state to state, so they’ll be the same regardless of which insurer you choose, and you won’t be restricted to seeing in-network doctors.
However, coverage can vary widely. You can choose a comprehensive plan with high premiums and few out-of-pocket costs, or a plan with a low monthly premium that covers fewer expenses. The best plan for you will depend on how often you expect to see a doctor and whether your doctor charges “excess charges” beyond the approved rates.
You can use this guide to compare Medigap premiums in Nevada for 2019.
Medicare Part D
Finally, there’s Medicare Part D, which offers prescription drug coverage. This plan is optional, and you’ll have to get it from a private insurer. As of 2019, there are 10 insurers in Nevada that offer 26 different Part D plans. Premiums range from $16.20 to $97.40 per month.
As with Part C and Medigap, you’ll have to do some research to find out which plan is the best fit for your prescription drug needs. Not all plans cover all prescriptions, so make sure the plan you choose covers from the drugs that you take or offers comparable alternatives.
You can purchase prescription drug coverage as part of a Medicare Advantage plan, or you can buy standalone coverage to supplement your Original Medicare plan. You can sign up when you first enroll in Medicare, or during the Annual Enrollment Period from October 15 – December 7.
You have more opportunities to switch prescription drug plans than you do other Medicare plans, and your insurer must notify you if they stop covering your prescribed drugs.
Applying for Medicare in Nevada
There are several ways to get Medicare coverage in Nevada. Regardless of which plan you’re applying for, it’s important to apply during your initial enrollment period to get the best coverage and most affordable premium.
You can apply for Original Medicare online via Social Security, or compare quotes from private insurers if you’re applying for Medicare Advantage.
For most people, the best time to enroll in Medicare is just before or after your 65th birthday. If you’re already receiving Social Security retirement benefits when you turn 65, then you should automatically be enrolled in Medicare Part A.
If not, you’ll have 7 months to apply for Parts A and B, beginning 3 months before your birthday and ending three months after it. If you don’t apply during this window, you can apply during the open enrollment period from January 1st to March 31st, but your Part B premium will increase by 10% for each year you delay.
The only exception is if you or your spouse are still working and have insurance through your employer or your spouse’s employer. If that’s the case, you can still choose to enroll in Part A (since there’s no premium, it will provide you additional insurance at no extra cost) and you’ll have an 8-month window during which to enroll in Parts A and B once you stop working or no longer receive coverage through your employer.
Once you are 65 years old and have signed up for Medicare Part B, you have six months to purchase Medicare Supplement Insurance (Medigap) if you choose to. It’s important to sign up during your initial enrollment period – otherwise, you’ll be subject to medical underwriting: your insurance can decline you or charge you a higher premium based on your health status. The initial enrollment period is the only time they are required by law to insure you.
We can help you.
We do this stuff for a living, and we help people with Medicare plans every day, so please feel free to reach out to us here.
Also, if this sounds like a lot, remember that the Department of Business and Industry publishes a guide to supplement insurance each year to help you compare premiums. The Department of Health and Human Services also runs a State Health Insurance Assistance Program (SHIP), that connects seniors with free assistance from volunteers.
If you’re a low-income resident, then you may also be eligible for a Medicare Savings Program through the state of Nevada to help you pay your premium.
Start during your research now so you’ll be well informed of your options, and can choose the Medicare plan that’s right for you. Be sure to apply as soon as you become eligible (three months before you turn 65) to avoid any gaps in your coverage.