If you live in Nevada and are 65 years old or older, you may be eligible for Medicare. Medicare is health insurance through the federal government. You may also be eligible if you are under age 65 and meet certain medical requirements.
Read on to learn about your Medicare options in Nevada, when and how to enroll, and next steps.
- Original Medicare: covers hospital stays and outpatient care under parts A and B
- Medicare Advantage: private health insurance plans that bundle the same benefits as original Medicare and may also offer additional coverage options
- Medicare Part D: these private insurance plans cover prescription drug costs
- Medicare supplement insurance (Medigap): plans offer coverage to help pay for deductibles, copays, coinsurance, and other Medicare out-of-pocket costs
If you’re not eligible for part A without a premium, you can still get Part A but will have to pay a premium.
Part B covers other medical care outside a hospital, including:
- visits to your doctor
- preventive care
- lab tests, diagnostic screenings, and imaging
- durable medical equipment
The monthly premiums for part B plans change each year.
Part C (Medicare Advantage)
Private insurers also offer Medicare Advantage (Part C) plans. Medicare Advantage plans offer the same benefits as parts A and B of original Medicare but often have extra coverage (with an additional premium) that could include:
- dental, vision, and hearing care
- wheelchair ramps
- home meal delivery
- medically necessary transportation
You still need to enroll in parts A and Part B and pay the Part B premium when you enroll in a Medicare Advantage plan.
Everyone on Medicare is eligible for prescription drug coverage (Part D), but it’s only offered through a private insurer. It’s important to compare plans because costs and coverage vary.
Medicare supplemental insurance (Medigap)
Medicare supplemental insurance (Medigap) helps cover out-of-pocket costs for parts A and B. These plans are offered through private insurance providers.
Medigap plans may be a good fit if you have high healthcare costs since original Medicare does not have an annual out-of-pocket spending limit. Medigap plans can also help relieve anxiety around unknown healthcare expenses if you choose one with an out-of-pocket maximum.
Medicare Advantage plans in Nevada fall into four categories:
Health Maintenance Organization (HMO). With an HMO, your care is coordinated by a primary care physician (PCP) in the plan’s network who refers you to specialists as needed. If you go out of the network for anything except emergency care or dialysis, it probably won’t be covered. It’s important to read and follow all plan rules.
Preferred Provider Organizations (PPO). PPO plans have networks of doctors and facilities that provide services covered under your plan. You don’t need a referral to see a specialist, but you may still want to have a PCP to coordinate your care. Care outside the network will cost more.
Private Fee-For-Service (PFFS). With a PFFS, you can go to any Medicare-approved doctor or facility, but they negotiate their own rates. Not every provider accepts these plans, so check if your preferred doctors participate before you choose this option.
Special Needs Plan (SNP). SNPs are available to people who need a high level of care management and coordination. You may be eligible for an SNP if you:
- have certain health conditions, such as end stage renal disease (ESRD), diabetes, or chronic heart conditions
- qualify for both Medicare and Medicaid (dual eligible)
- live in a nursing home
Medicare Advantage plans in Nevada are offered by the following insurance carriers:
- Aetna Medicare
- Alignment Health Plan
- Anthem Blue Cross and Blue Shield
- Imperial Insurance Companies, Inc
- Lasso Healthcare
- Prominence Health Plan
- Senior Care Plus
Not every carrier offers plans in all Nevada counties, so your choices will vary based on your ZIP code.
You’re eligible for Medicare if you’re age 65 or older and a citizen or legal resident of the United States for the past 5 years or more.
If you’re under age 65, you may be eligible if you:
- receive disability benefits from the Railroad Retirement Board or Social Security
- have ESRD or are the recipient of a kidney transplant
- have amyotrophic lateral sclerosis (ALS)
To get Medicare Part A without a monthly premium, you or your spouse must meet the requirements by having worked in a job where you paid Medicare taxes for 10 or more years.
You can use Medicare’s online eligibility tool to determine your eligibility.
Original Medicare, Medicare Advantage, and Medigap plans have set times when you can enroll or change plans and coverage. If you miss an enrollment period, you may have to pay a penalty later.
Initial enrollment period (IEP)
The original window to enroll is when you turn age 65. You can enroll anytime in the 3 months before, the month of, or the 3 months after your 65th birthday.
If you enroll before your birthday month, your coverage will begin the month you turn 65. If you wait until your birthday month or later, there will be a delay of 2 or 3 months before coverage starts.
During your IEP you are able to sign up for parts A, B, and D.
General enrollment period
If you missed your IEP and need to sign up for original Medicare or switch plan options, you can do this during the general enrollment period. The general enrollment period occurs annually between January 1 and March 31, but your coverage will not begin until July 1.
You’re able to sign up for parts A and B or switch from original Medicare to Medicare Advantage during the general enrollment period.
Medicare Advantage open enrollment
You can switch from one Medicare Advantage plan to another or switch to original Medicare during the Medicare Advantage open enrollment. Medicare Advantage open enrollment occurs annually between January 1 and March 31.
Open enrollment period
During open enrollment, you can enroll in a Part C (Medicare Advantage) plan for the first time or sign up for Part D coverage if you didn’t do it during IEP.
Open enrollment occurs annually between October 15 and December 7.
Special enrollment periods (SEPs)
SEPs allow you to enroll outside normal enrollment periods for certain reasons, such as losing an employer-sponsored plan, or moving out of your plan’s service area. This way, you don’t have to wait for open enrollment.
With so many options available, it’s important to consider your healthcare costs and needs each year to determine the best plan for you.
If you expect high healthcare costs in the coming year, you may want a Medicare Advantage plan so costs are covered after you reach the out-of-pocket max. A Medigap plan may also help with high medical expenses.
Other things to consider are:
- monthly premium costs
- deductibles, copays, and coinsurance
- providers in a plan’s network
You can review the CMS star ratings to see how well certain plans score on quality and patient satisfaction.
For more information about Medicare plans in Nevada, reach out to any of the following resources:
To find and enroll in Medicare in Nevada:
- Determine your health needs and potential healthcare costs for each year so you can select the right plan, including supplemental or Part D coverage.
- Research plans available from carriers in your area.
- Mark your calendar for the correct enrollment period so you won’t miss signing up.
This article was updated on November 13, 2020, to reflect 2021 Medicare information.
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