If you live in Nevada and are over 65, you may be eligible for Medicare. Medicare is health insurance through the federal government. You may also be eligible if you are under 65 and meet certain 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 prescription drug plans. Often called Part D, these private insurance plans cover prescription drug costs.
- Medicare supplement insurance (Medigap). These private insurance plans offer coverage to help pay for deductibles, copays, coinsurance, and other Medicare out-of-pocket costs.
Part A (hospital inpatient)
Part A covers care in a hospital, critical access hospital, or limited time in a skilled nursing facility (SNF).
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 (outpatient)
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 are set by CMS, and usually go up each year as healthcare costs increase. The premium for 2020 is $144.60 per month.
Part C (Medicare Advantage)
Private insurers also offer Medicare Advantage plans (Part C). 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, hearing
- 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.
Part D (prescription drug coverage)
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 and Medicare Part D prescription drug plans are subject to change every year. Updated plan information for 2021 should become available on October 1, in advance of Medicare’s Annual Election Period beginning October 15. Healthline.com will provide updated 2021 plan information once it is announced by the Centers for Medicare & Medicaid Services (CMS).
Medicare Advantage plans in Nevada fall into four categories:
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.
PPO. These plans have networks of doctors and facilities that provide services covered under your plan. You don’t need referrals to see a specialist, but it’s still good to have a PCP to coordinate your care. Care outside the network costs 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 everyone accepts these plans, so check if your healthcare provider accepts your PFFS plan before you choose this option.
Special needs plan (SNP). These plans are available to people who need a high level of care management and coordination. You may be eligible if you:
- have certain health conditions, such as kidney 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 11 insurance carriers:
- Aetna Life Insurance Company
- Anthem Insurance Companies
- Hometown Health Plan
- Humana Insurance Company
- Kaiser Foundation HP
- Port Holdings
- Prominence HealthFirst
- Sierra Health and Life Insurance Company
- SilverSummit Healthplan
- Union Pacific Railroad Employees Health Systems
Not every carrier offers plans in all Nevada counties, so your choices will vary.
You’re eligible for Medicare if you’re 65 or older and a citizen or legal resident of the United State for the past 5 or more years.
People under age 65 may be eligible if you:
- receive Railroad Retirement or Social Security Disability (SSDI) insurance
- have permanent kidney failure (ESRD) or are the recipient of a kidney transplant
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 65. You can enroll anytime in the three months before, the month of, or the three 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 two or three months before coverage starts.
During your IEP you are able to sign up for parts A, B, and D.
General enrollment period: January 1 – March 31
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: January 1 – March 31
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: October 1 – December 31
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 1 and December 31.
Special enrollment periods (SEP)
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. 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.
The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.