Medicare Parts A and B (sometimes referred to as Original Medicare) are fairly comprehensive – but they aren’t fully comprehensive. There are some coverage gaps which, if you don’t find a way to cover them, could become very expensive later on. There are different supplemental insurance policies which can help you with this. Medicare Advantage is one of them. We’ll discuss some of the finer details of Medicare Advantage (Medicare Part C) here in this article.
Federal Regulations for Medicare Advantage
Medicare Advantage is also sometimes referred to as a “Medicare replacement” policy. This is because an active Medicare Advantage plan effectively replaces your Original Medicare benefits. But don’t worry – federal law dictates that your Advantage plan must provide at least the same or better coverage than what you would get from Original Medicare. And it is highly likely that your Advantage plan will include even more than just that basic coverage.
Medicare Advantage Enrollment In Nebraska
Medicare Advantage plans aren’t very popular in Nebraska. Only about 12% of seniors in the state are currently enrolled in a Medicare Advantage plan. Of those, not all are members of the same plan; the plans vary widely by popularity, as you can see in the chart below.
|Plan Type||Enrollment Percentage|
|Local PPO Plans||13%|
|Special Needs Plans||11%|
|Regional PPO Plans||9%|
|Private Fee-For-Service Plans||5%|
|Other (Cost Plans, MSA’s, etc.)||3%|
Plan Coverage & Cost
Your rates will vary based on personal factors such as location, age, when you enrolled, and how healthy you are. Based on aggregated data, we’ve come up with some estimated rates for seniors in your area. Remember, though, that your specific rate will vary.
Most Popular Medicare Advantage Plans in Nebraska
If you are looking for an unbiased evaluation of the Medicare Advantage plans offered in Nebraska, have a look at Medicare’s Overall Star Rating program. Medicare reviews data it has collected on all companies providing Medicare related products and services, and issues an Overall Star Rating report. For companies that provide healthcare services, like Medicare Advantage programs, Medicare evaluates how well each company performs. These evaluations are based on the company’s use of preventive medicine like screenings and vaccinations, managing chronic diseases, member experiences with the company and changes in company performance, and customer service. These ratings can be useful in evaluating a plan that you are interested in.
Helpful Medicare Advantage Tips & Tricks
Doctor/Provider Network Restrictions
Medicare Advantage is different from other supplement insurance plans in that it comes with specific networks of doctors and hospitals which are approved by your insurance provider. If you try to go outside of your network, it could prove difficult or costly to get the medical care that you need. Also, your list of approved doctors and facilities could change at any time. So be prepared for sudden changes.
Where you generally need to get your care and services from for:
- HMO Plans – If your Medicare Advantage plan is set up as a Health Maintenance Organization (HMO) your choice of healthcare providers including primary doctor, specialists, hospitals, labs, etc. will be restricted to those that are part of the HMO’s network. There are exceptions to that rule. Emergency care or urgent care or out-of-state dialysis are all covered under the HMO model. Some will also have an option called Point of Service that allows you to use a provider or facility outside the HMO network.
- PPO Plans – Like an HMO, Medicare Advantage programs established as PPOs have extensive networks. Unlike HMOs, a PPO plan will allow you to choose any provider you like providing they accept Medicare and the terms of your PPO coverage. If you select a provider outside the PPO network, expect to be charged a higher copay than you would pay for an in-network provider.
- PFFS Plans – Private Fee For Services (PFFS) plans have only two requirements for your choice of healthcare providers. They have to accept Medicare, but many find the terms of PFFS too low to be worthwhile. PFFS plans normally have a list of providers who will accept the plan available to members. However, it’s important you reconfirm the plan is accepted when you make an appointment.
- Special Needs Plans – If you qualify for a Special Needs Plan, your choice of healthcare providers will be limited to those that are in the group you belong to. These groups are made up of specialists that have experience in treating your specific condition. The exception is for emergency care due to a sudden onset of illness or out-of-state dialysis.
Finding a doctor who accepts your Medicare Advantage plan
- HMO Plans – If you are looking at an HMO, you don’t have to worry about finding healthcare providers who will accept your plan. HMOs operate extensive networks of physicians, and facilities. Because they have made that investment, they require their members to use only network providers and facilities. You may or may not be able to choose your primary physician, but from that point forward, he or she is responsible for referring you to other network resources.
- PPO Plans – PPOs are a good pick if you already have healthcare providers you like. While the PPO has a network, and using in-network resources is less expensive than using out-of-network providers, you can choose whoever you like providing they accept Medicare and the terms of the plan. If you don’t have a preferred provider, most PPOs have comprehensive directories listing contact info, specialty, location, and even patient reviews.
- PFFS Plans – Private-Fee-For-Services (PFFS) plans have no restrictions on which healthcare provider or facility you use. Their only requirement is a provider must accept Medicare and the terms of the PFFS. Not all providers will. A good practice is to ensure that the provider accepts your plan when making an appointment. In fact, you should follow this practice even if the provider has accepted your coverage in the past.
- Special Needs Plans – If you have a chronic disease, live in a nursing home, or qualify for both Medicare and Medicaid, you may qualify for a Special Needs Plan or SNP. Like an HMO, your selection of providers will be limited to Medicare’s SNP Network. These networks are comprehensively staffed with specialists and facilities focused on your specific condition. Emergencies and out-of-state dialysis are the two exceptions to the rule.
Medicare’s physician search tool makes finding a doctor who accepts original Medicare pretty easy. The good news is that most Medicare Advantage programs have similar directories allowing you to ensure a plan has the kind of specialists and facilities that you need and that they are conveniently located.
Drug, Vision and Dental Coverage
Dental care for seniors is an area of health that Medicare does not address. However, many Medicare Advantage programs do offer a basic dental care benefit for its members. This benefit typically is limited to a paid annual examination that includes x-rays, cleaning, and fillings. There may be a limited number of participating dental offices so scheduling may take longer than other provider appointments.
Eye care is another health issue that is pretty much ignored by original Medicare. Vision health is addressed by many Medicare Advantage plans. Participating optical shops offer annual eye exams, lenses, glasses, and contacts to plan members. Additional optical products and services are often offered at a discount to plan subscribers.
Enrollment Options & Best Time To Enroll
Enrolling in Medicare Advantage is as simple as enrolling in Medicare – provided you enroll within your Initial Enrollment Period. If you try to enroll outside of your IEP, and do not qualify for a Special Enrollment Period, you may have difficulty getting covered. This is especially true for people with serious health conditions, such as ESRD (or End Stage Renal Disease). But your insurance agent can give you more information on getting covered under unusual circumstances. You can also take a look at our Medicare Advantage Enrollment Options page for more info.
- Initial Enrollment Period: 6-month timeframe when you first enroll in Medicare to purchase a Medicare Advantage plan.
- Annual Enrollment Period (AEP): This timeframe runs from October 15th through December 7th every year, and during this time you can change or cancel your Medicare Advantage and part D drug plan.
- Special Enrollment Period (SEP): During special circumstances, you may be eligible to purchase/change a plan outside of the Annual Enrollment Period. Things such as moving out of the plans’ service area, losing group health or employer coverage, a company no longer offering plans in the area, etc. are all events that could trigger a SEP.
What Medicare Advantage Plan Is Best For Me?
To find the best Medicare Advantage plan for you, it’s important that you think about what your medical needs are likely to be during your retirement. If you can determine that, choosing the best fit will be much easier. Of course, premiums are important, but comparing premiums can get tricky because some plans have zero-premium programs. Keep in mind the company’s financial stability, customer service, reputation, and how long it has been serving your community.
You want to make a good decision the first time because changing plans can be problematic. Enrollment period rules control when you can change plans. The perfect plan is out there, you just have to decide why it’s perfect for you.