If you live in Nebraska and are eligible for Medicare – or are nearing eligibility – you may be wondering about your options. Medicare is a national health insurance program for adults age 65 or older or people of any age who have certain disabilities.
Over the years, the program has expanded to include options you can purchase from private insurance companies to enhance or replace the coverage you get from the government.
Medicare is made up of different parts. Original Medicare, the coverage you get directly from the government, includes parts A and B.
- Part A helps pay some of the costs of inpatient healthcare services you receive in a hospital, provides limited coverage for skilled nursing facility care and home health services, and covers hospice care.
- Part B helps pay for general outpatient care and medical supplies you get when you see a doctor or specialist.
If you or spouse has worked for at least 10 years, you likely qualify to get Part A without having to pay any premiums. This is because you’ve probably already paid for it through a payroll tax. You do need to pay a premium for Part B. The premium amount varies based on factors, such as your income.
Original Medicare isn’t 100-percent coverage. You still pay out of pocket when you see a doctor in the form of copays, coinsurance, and deductibles. And there’s no coverage at all for prescription drugs, long-term care, or dental or vision services.
Fortunately, there are Medicare plans you can purchase from private insurance companies that can add to or replace original Medicare:
- Medicare supplement plans, sometimes called Medigap plans, add to your original Medicare. They may help relieve some of the costs of copays and coinsurance. They might also add dental, vision, long-term care, or other coverage.
- Part D plans are prescription drug plans. They specifically help pay the costs for prescription medications.
- Medicare Advantage (Part C) plans offer an “all-in-one” alternative to getting both original Medicare and supplemental coverage. Medicare Advantage plans cover all the same benefits as original Medicare, plus the types of additional coverage you might get from adding a Medicare supplement plan, including prescription drug, dental, and other benefits. Medicare Advantage plans typically come with lots of extras, too, including health and wellness programs, member discounts, and more.
If Medicare Advantage sounds like a good option for you, there are a number of private insurance companies offering plans in the state of Nebraska. They include:
- Aetna Medicare
- Blue Cross and Blue Shield of Nebraska
- Bright Health
- Medical Associates Health Plan, Inc.
Medicare Advantage plan offerings vary by county, so enter your specific ZIP code when searching for plans where you live.
We often think of Medicare as insurance for people age 65 or older, but you can enroll in Medicare if you are:
If your Medicare eligibility is based on age, your initial enrollment period begins 3 months before your 65th birthday and continues for 3 months after. It usually makes sense to enroll at least in Part A at this time, since you likely won’t need to pay anything for it, and Part A benefits will coordinate with any existing insurance coverage you have.
If you or your spouse continue working, and you still qualify for coverage through an employer-sponsored group health plan, you may elect to put off enrolling in Part B or any supplemental coverage at this time. In these circumstances, you’ll qualify for a special enrollment period later.
Additionally, there’s an open enrollment period each year during which you can apply for Medicare for the first time or switch plans. The general enrollment period for Medicare Advantage plans runs from January 1 through March 31 each year.
When you’re ready to enroll, it’s important to do your homework on Medicare plans in Nebraska, especially if you’re considering a Medicare Advantage plan. While federal law requires that Medicare Advantage plans cover the same benefits as original Medicare, there’s flexibility in how the plans are structured. Some are Health Maintenance Organization (HMO) plans, while others are Preferred Provider Organization (PPO) plans, for instance.
Which type of plan works best for you depends on your situation and preferences. It can be helpful to keep in mind questions such as the following:
- What is the provider network like?
- Does the network include physicians and hospitals that I might need that are convenient to me?
- Will I need referrals if I need to see specialists?
- How much will this plan cost me, both in premiums and at the point of service when I seek care?
- Does the plan include coverage and programs that make sense for me?
These resources can be useful to help you learn more about Medicare Nebraska coverage options:
When you’re ready to enroll in a Medicare Nebraska plan, consider the following actions:
- Do some research into your individual plan options. The list above can be a great starting point to learning more about Medicare Advantage plans in Nebraska.
- It can also be helpful to reach out to an agent who has expertise with Medicare and can help you understand how your options more precisely fit your situation.
- If you’re in the midst of your initial or an open enrollment period, fill out the online Medicare application on the Social Security Administration website. The application takes minutes and doesn’t require any initial documentation.
This article was updated on November 13, 2020, to reflect 2021 Medicare information.
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