Introduction to Medicare Advantage in Nevada (Medicare Part C)

Did you know about the potentially expensive coverage gaps inherent in Medicare Parts A & B? Were you aware that a Medicare Advantage policy could help protect you from these gaps? Medicare Advantage (Medicare Part C) is a “replacement” policy which replaces your federal Medicare benefits with a private insurance policy. It comes with many different options for adding additional coverage, many of which will help protect you from Medicare Coverage gaps.

Federal Regulations for Medicare Advantage

Because Medicare Advantage aims to replace your federal benefits with a private policy, there are laws in place to protect you (the consumer). The Advantage policy you subscribe to will have to offer you at least the same coverage you would get with Traditional Medicare. But the majority of plans will offer you more, including coverage for extended hospital stays and co-insurance fees, which Traditional Medicare alone will not pay for.

Medicare Advantage Enrollment In Nevada

Medicare Advantage is fairly popular in Nevada – a full third of all Medicare-qualified retirees (36%) have an Advantage plan. But not all Advantage plans are crafted in exactly the same way. There is a great deal of variance, and you can see with the chart below which ones are more popular than others:

Plan Type Enrollment Percentage
HMO Plans 59%
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 age, your city and/or county, and your current health status will all be factored together when your provider calculates your monthly rate for a Medicare Advantage plan. Below are estimated prices for seniors in your area. But remember that your personal circumstances may render you a higher or lower rate:

Most Popular Medicare Advantage Plans in Nevada

Which Medicare Advantage plan is the best performer in Nevada? To get an unbiased, third-party opinion. Check out Medicare’s Overall Star Rating program. Medicare collects data points and other information on every company offering Medicare related goods and services. For companies that provide Medicare Advantage plans, Medicare rates how well the company uses preventive measures like vaccinations, screenings, and lab tests, manages chronic conditions, member experiences and complaints, changes in performance ratings, and customer service. The more stars the better the performance.

Helpful Medicare Advantage Tips & Tricks

Doctor/Provider Network Restrictions

Provider networks (and their associated restrictions) can be difficult to deal with at times. Start by asking your doctor if they belong to any specific networks before you begin shopping around – unless you don’t mind changing doctors, that is. The cheaper plans, such as HMO plans, will be more difficult to manage than PPOs or PFFS plans. These more expensive plans have larger provider networks and fewer restrictions on where, when, and how you can receive your medical care.

Where you generally need to get your care and services from for:

  • HMO Plans – If you opt for a Medicare Advantage plan that is set up as a Health Maintenance Organization (HMO), the doctors and facilities you can use, including your primary care physician, specialists, hospital, surgery center, labs, etc., will be limited to those that are within the HMO network. The exceptions to that rule are emergency or urgent care and out-of-state dialysis. Some HMO plans will offer a Point of Service (POS) option that allows you to use a provider outside the network for a fee
  • PPO Plans – PPO Medicare Advantage plans also have extensive networks. However, unlike HMO, PPOs allow members to use any healthcare provider that accepts Medicare and the terms of the plan. If a member uses out-of-network resources, they can expect to be charged a higher copay than an in-network visit.
  • PFFS Plans – Some Private Fee For Services (PFFS) plans have networks but there is no restriction on who you can use. If the provider of your choice accepts Medicare and the insurance plan, the PFFS will cover you. However, not all providers accept PFFS plans. It is your responsibility to confirm acceptance when making an appointment. That applies even if you are using a “network” provider or a provider who has accepted your plan in the past.
  • Special Needs Plans – If you qualify for a Special Needs Plan (SNP) you will be assigned to a group that specializes in your condition. The doctors in that group will all be members of Medicare’s SNP Network and they will be the only physicians that you will be able to use. Emergencies and out-of-stse dialysis are the only exceptions to that rule.

Doctor/Providers List

Finding a doctor who accepts your Medicare Advantage plan:

  • HMO Plans – With a Medicare Advantage plan that offers an HMO, you don’t have to worry about finding a doctor who accepts your insurance. With an HMO, the doctors come to you. You may or may not be able to choose your primary doctor, but from that point on, the primary doctor decides who you will be referred to.
  • PPO Plans – PPO Medicare Advantage programs have online tools similar to Medicare’s. Typically, you will be able to search doctors and facilities in the network by location and specialty. The physicians name, contact info, and even patient reviews in some. It’s easy to find in-network providers but if you have a favorite who is outside the network, PPOs allow you to use them so long as they accept Medicare and the insurance plan.
  • PFFS Plans – While PFFS plans have no restrictions on who you select so long as they accept Medicare and the insurance plan, you always want to check with the provider to determine if they accept your plan before receiving services. Many won’t. PFFS plans tend to have lower payment terms than other types of Medicare Advantage programs. Consequently, many providers and facilities will not accept their insurance.
  • Special Needs Plans – Like an HMO, if you are in a Special Needs Plan you will be assigned to a special group. That group will have providers who are members of the Medicare SNP Network and they will be the ones you will use for your healthcare.

Medicare has made finding a physician who accepts Original Medicare pretty easy thanks to their Medicare’s physician search tool. Many Medicare Advantage plans have similar online tools but it’s important to remember there may be some conditions.

Drug, Vision and Dental Coverage

Medicare really doesn’t have any dental care benefits. Consequently, Medicare Advantage plans have no obligation to provide dental care, but many do. While benefits will vary from company to company, typical covered services include a routine exam, x-ray costs, cleaning, fillings, endodontics, and periodontics. Cosmetic procedures are typically not covered. Be sure to review each company’s dental care benefits in order to make a fair comparison.

Eye care is another service that Medicare overlooks. However, it is offered by many Medicare Advantage plans. Typically, Medicare Advantage plans provide for an annual eye exam, lenses, glasses, and contacts. Check your plan’s directory to find participating vendors. Many will offer discounts to plan members on frames and other services.

Enrollment Options & Best Time To Enroll

As long as you enroll during your IEP (Initial Enrollment Period), you shouldn’t have trouble finding affordable coverage under a Medicare Advantage plan. However, the longer you wait, the more difficult it may be to find coverage. Private insurance companies have the right to ask you about your health status and reject you based on pre-existing conditions, such as End Stage Renal Disease. For more information on getting coverage outside of your IEP, you can contact your local insurance agent or inquire at your state department of insurance. You can also look at our Medicare Advantage Enrollment Options page for more information.

  • Initial Enrollment Period: For best results, try to enroll in a Medicare Advantage plan within your first 6 months of Medicare enrollment.
  • Annual Enrollment Period (AEP): You have the option of changing or cancelling your Medicare Advantage and Part D drug plan between October 15th and December 7th every year.
  • Special Enrollment Period (SEP): If you lose your employer plan coverage, move out of your coverage area, or lose coverage from your provider, you could qualify for an SEP.

What Medicare Advantage Plan Is Best For Me?

We think the best Nevada Medicare Advantage plan for you is one that you have confidence in, has the medical staff and facilities that best serve you’re your needs in retirement, and fits your budget. It’s out there, you just need to find it. You have to take some time and seriously consider what your needs are likely to be. Consider the specialists you are likely to need and the convenience of location. If the plan offers Part D drug coverage, review the formulary to ensure the medicines you need are carried. Not all plans carry all drugs.

Premiums are important but with Medicare Advantage plans there are many zero-premium programs. Check copays for in and out of network services, deductibles, the company’s reputation and financial stability. If you do all that we are confident you’ll find your perfect plan. Just make sure you enroll during your enrollment period!

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