Every senior citizen in the US is entitled to enroll in the Medicare program once they reach the age of 65. Once enrolled, many common medical services (hospital stays, doctor appointments, outpatient services, and more) will be covered by either Medicare Part A, or Medicare Part B. The chart below will help outline which part of your Original Medicare takes care of what expenses.
Coverage and Benefits
There are some basic costs and fees associated with Original Medicare. Part B has certain low-cost premiums you can learn about on this website. The monthly premium and yearly deductible are required of everyone who receives Medicare benefits. There may be additional costs for Part A, but that depends on your employment history. If you have been employed for fewer than 10 years in your life, or a total of 40 quarters, then you will be required to pay an annual deductible for Part A benefits as well.
If you’re a Nebraska resident that’s 65 or older you qualify to receive Medicare health coverage. If you’ve worked more than 40 quarters or 10 years in your lifetime your Part A coverage is free, otherwise you’ll be expected to pay a premium for it every month. If you enroll in Medicare, you’ll receive Part A coverage automatically. Medicare Part A includes inpatient coverage, hospice care, home health care and nursing facility care. For an added cost you can expand your coverage to Medicare Part B for added outpatient care, additional home health services, doctor and hospital services, and preventative care services.
Besides those base Medicare services, there are Medicare parts C and D as well. You need Medicare Part A and Medicare Part B to qualify for either C or D coverage. Medicare Part C is additional service coverage from a private insurance company, also known as Medicare Advantage, and the services you receive depend on the plan that you choose. Medicare Part D is a prescription drug plan and will help cover the cost of most medications.
|Medicare Part A (Hospital Coverage)
||Medicare Part B (Medical Insurance)
|Medicare Part C (Medicare Advantage)
||Medicare Part D (Drug Coverage)
Medicare Plans in Nebraska: The Breakdown
More than a quarter of a million (287,565) Nebraska seniors are currently enrolled in Medicare. Of those, around 13% (37,383 individuals) prefer the Medicare Advantage program over Original Medicare. Then there are the highly popular Medigap supplemental insurance policies – 129,723 Nebraska seniors (or 45% of all Medicare beneficiaries) are supplementing their Original Medicare benefits with a Medigap insurance policy. We’ll tell you why these are so popular later on in this article. Finally, the remaining 42% of seniors have either not yet decided to supplement their Medicare coverage, or they are receiving some alternative type of supplement (likely through an employer).
Please keep in mind that you must first be enrolled in Medicare and actively receiving benefits before you can look into supplementing your coverage gaps. To check your Medicare enrollment status, click here.
Why Should Seniors Supplement their Medicare Coverage?
Well, to make a long story short: because it could prove to be financially disastrous later on down the road if they do not. You see, although Original Medicare tries to be as comprehensive as possible, it isn’t perfect. There are certain “gaps” in coverage that you may end up footing the bill for if you rely on Medicare alone to cover all of your health care needs:
|Medicare Part A Costs||Medicare Part B Costs|
Granted, if you are newly retired and still in good health, you may feel like you don’t need to supplement your Medicare coverage. And you may be correct. But that status could very likely change in the future. You never know when a medical emergency will hit, and with health care costs on the rise, that emergency could cost you big if you aren’t prepared for it.
Many Nebraska residents today need to seek out additional healthcare coverage on top of Medicare because the cost of quality health care is higher than ever. Most seniors are expected to pay about $1,100 in added deductible costs for their Part A policy, and extended hospital stays can come with hefty added costs.
Approximately 45% of Nebraska residents with Medicare are relying on another form of supplemental health insurance as well to cover their costs. These people don’t want to get stuck with huge out-of-pocket costs after their Medicare coverage, so they are investing in another insurance to help reduce the risk of that happening.
A good Medicare supplement can help with filling your Medicare coverage gaps so you get the coverage that you need, and you aren’t paying huge costs outside of your insurance premiums. There are different supplement insurance policies available, but the best options all work with Medicare itself to help complement the services that you receive and to help lower your overall medical expenses even further.
If you want an additional Medicare insurance policy, you have two options to choose from; Medicare Advantage or Medicare Supplement (Medigap). Each option is effective for covering your added medical expenses, but they work in very different ways and can leave you with different medical costs depending on your health and your total medical expenses.
Supplementing your Benefits with a Medigap Policy
There are two main types of supplemental coverage available on the market for seniors who are receiving Original Medicare. One of them – by far, the most popular option in Nebraska – is Medigap supplemental insurance. These policies are the result of a collaboration between the federal government and private insurance companies to give you the most comprehensive protection against the gaps in Original Medicare coverage. The plans are named alphabetically, A-N, with the exception of plans E, H, I, and J (these were eliminated in 2010 with the Medicare Modernization Act). Each plan is universal across all 50 states, which means that only your provider and your premiums will vary by location.
This helpful chart details what each of the ten plans has to offer:
Top Medicare Supplement Plans in the Area
|Type||Starting From||Part A Deductible||Part B Deductible||Excess||Nursing||Travel|
|F||$96||$0||$0||100% Covered||100% Covered||100% Covered||Request Info|
|C||$95||$0||$0||Not Covered||100% Covered||100% Covered||Request Info|
|G||$81||$0||$147||100% Covered||100% Covered||100% Covered||Request Info|
|B||$81||$0||$147||Not Covered||Not Covered||Not Covered||Request Info|
|N||$68||$0||$147||Not Covered||100% Covered||100% Covered||Request Info|
|D||$85||$0||$147||Not Covered||100% Covered||100% Covered||Request Info|
|A||$68||$1||$147||Not Covered||Not Covered||Not Covered||Request Info|
|L||$73||$304||$147||Not Covered||75% Covered||Not Covered||Request Info|
|K||$48||$608||$147||Not Covered||50% Covered||Not Covered||Request Info|
|M||$76||$608||$147||Not Covered||100% Covered||100% Covered||Request Info|
Protecting Yourself with Medicare Advantage
Whether you call it Medicare Part C or Medicare Replacement, Medicare Advantage policies are designed to protect you from coverage gaps by replacing your Original Medicare with “equal or greater” coverage through a private health insurance company. This means that all of your current Medicare benefits, in addition to any additional coverage you purchase, is handled under a single policy through a single provider.
It is unclear as to why so few Nebraska residents have signed up with Medicare Advantage, but it might have something to do with the desire to keep their current doctors. In order to maintain competitive prices, many Advantage networks are highly restricted, forcing seniors to have to choose between more affordable health care, and losing their current doctor(s). Make sure you do some research first, especially if your current physician is important to you, before you decide to commit to a Medicare Advantage policy.
Most Medicare Advantage providers operate through Health Maintenance or Preferred Provider Organizations (HMOs and PPOs, respectively). There may be significant restrictions on your ability to receive medical care outside of your HMO or PPO.
A Side-by-Side Comparison of Medigap vs. Medicare Advantage
One basic distinction that separates Medicare Advantage and Medicare Supplement from one another is how medical claims are dealt with. With Medigap the claim comes in, Medicare pays some of it and Medigap pays some of it. In the end you must pay the remaining costs if there are any left. With a good enough Medigap policy you won’t have any costs left over at all.
Each of these insurance plans are issued by a private insurance company. Medigap is highly regulated though, and it doesn’t matter who you get the insurance from. No matter what company Medigap comes from, you get the same level of coverage from that company. That means you can shop from one company to another and only have to look at premium costs to decide if the policy is right for you or not.
Medicare Advantage isn’t regulated nearly as closely. Private insurance companies make key decisions about plan coverage options and costs. The insurance company takes over all the Medicare benefits from Medicare Part A and Part B, something Medigap doesn’t do. When you work with a Medicare Advantage provider you will often be given a chance to choose added coverage options like vision insurance that you can get as well as the Medicare coverage. These come at an added cost and there are often many different options to choose from.
Pricing is another area where the two policies are very different. Medigap is quite simple, while Advantage can be complicated. As a senior in Nebraska with Medigap you will pay a fixed monthly premium, and then you will pay leftover medical costs on procedures that you have done. With Medicare Advantage you will pay a premium, co-pays and additional coverage costs that vary from one procedure to another. There is a chance that your costs will change from year-to-year and you have more details to keep track of to understand what you are paying for.
We’ve covered the major differences between a Medigap and an Advantage plan, but below we outline more of the differences between the two. For more answers about Medicare policies and to get help figuring out exactly what option is better for your needs and one-on-one help choosing a policy, talk with our team of experts today.
|Questions||Medicare Advantage||Medicare Supplement|
|In what way are medical expenses covered?||Medicare Advantage covers all your medical expenses directly, takes some money from Medicare and then hands the remaining costs to you.||Medicare pays your costs first then Medicare Supplement pays some more of the remaining costs and you pay the final balance left over if there is one.|
|Do I still pay for Medicare Part B?||Yes||Yes|
|How much will I pay?||It’s impossible to say. You pay an adjusted amount that depends on how often you get sick and what services you need. Each plan has different premiums, co-pays and expected out-of-pocket costs.||With a full-coverage Supplement plan you only pay your monthly premium and nothing else. With a lower coverage plan you pay your monthly premium and any remaining costs that aren’t covered by your policy fully.|
|What does the policy cover?||Medicare Parts A and B services and added services that you choose to get added to the policy. Things like dental, vision, medication costs and other things can be covered with Medicare Advantage.||The Supplement plan covers Medicare services from Parts A and B solely. Any additional services must be paid out-of-pocket if you want them.|
|Can I budget for my health costs easily with this plan?||No, you will have to try and estimate costs based on how often you get sick, and this is very difficult to do with an Advantage plan.||With a full coverage plan you’ll only pay the monthly premium. With a lower coverage Supplement plan your costs vary based on how much care you need, but it’s still easier to estimate than an Advantage plan is.|
|Do I get guaranteed coverage?||Sadly, no. You can be taken off your policy during the renewal period from an Advantage plan.||Yes, this is one of the biggest benefits. You get to keep your plan if you pay your premiums and your company remains in business.|
|Am I guaranteed to get this policy to begin with?||No, there is no guarantee. You must go through a pre-approval policy to get the plan.||Yes, if you can get Medicare you are automatically qualified.|
|Can I see any doctor I like?||No, you must use a doctor within the Advantage network.||Yes, as long as your doctor accepts Medicare.|
|Is Medicare Advantage or Medicare Supplement best for me?||If you are a younger senior in excellent health and you live in a location with many hospitals, an Advantage plan might be more affordable for you.||If you are older, require more care or live in an area with fewer care options, a Supplement plan might be best for you.|
Informative Resources for Nebraska Seniors
Please take advantage of the directory we have included at the bottom of this page. With it, you can get helpful contact information for local offices and experts in Nebraska Medicare insurance supplements. Your health is important, which is why you should get as much information as possible before making a final decision about your Medicare benefits and coverage.
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Help with my Medicare options & issues
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Important Medicare-Related Healthcare Terms
- HMO: Health Maintenance Organization, this refers to a network of doctors and hospitals with a plans’ network.
- PPO: Preferred Provider Organization, this refers to a network of doctors and hospitals with a plans’ network.
- Co-Pay: Amount of money charged per visit to doctor, specialist, etc.
- Co-Insurance: A percentage required by the policyholder to pay out-of-pocket. For example, 80/20 coinsurance means the insurance company will cover 80% of the charges, and the policyholder pays the remaining 20% of the charges.
- Deductible: This is the amount of money required out-of-pocket by the policyholder before the insurance will kick-in and pay for any remaining charges. For example, a policy with a $1,000 deductible means that you must pay full healthcare costs out-of-pocket up to $1,000 before the plan will start coverage.