The federal Medicare program is designed to provide affordable health care coverage for senior citizens 65 years of age and older. If you are approaching the age of 65, you should be preparing to enroll in the Medicare program as soon as possible. Once you are enrolled, you will start by receiving benefits from Medicare Part A and Medicare Part B – also known as Traditional Medicare. The chart below will explain which parts cover what benefits.
The program is designed to be as affordable as possible for retired persons living on a fixed income. For this reason, Part B has monthly premiums and an annual deductible (which you can learn more about by clicking here). Every Medicare beneficiary must pay these costs. However, if you have a long enough employment history, you may get a break on Part A. If you have been employed for more than ten years, or forty quarters, you won’t have to pay the annual deductible associated with Part A. Anything less than that, however, and you will be required to pay the additional expense before receiving hospital benefits from Part A.
|Medicare Part A (Hospital Coverage)
||Medicare Part B (Medical Insurance)
|Medicare Part C (Medicare Advantage)
||Medicare Part D (Drug Coverage)
Nevada has a significant population of 379,860 seniors who are currently receiving Medicare benefits. Of those, one third (125,353 people) have replaced their Traditional Medicare plan with a Medicare Advantage policy. An additional 46,390 seniors (or 12%) are supplementing their Medicare with a Medigap policy. As for the other 55%, well, it’s hard to say. They could either be enjoying additional coverage and benefits through an employer, or they may be relying on Traditional Medicare alone to help cover their medical expenses.
Are you unsure of your Medicare status? If you have any questions about your status or your enrollment period, you can click here for more information about Medicare benefits.
Even if you are newly retired and aren’t in poor health right now, supplemental coverage can be invaluable in the future when your health care needs increase. You see, Traditional Medicare can only provide you with a certain amount of coverage. The coverage which it does not provide you with, often referred to as “coverage gaps”, will likely be your responsibility to pay out of pocket. And when that happens, you could get slammed with thousands of dollars in medical bills.
|Medicare Part A Costs||Medicare Part B Costs|
Fortunately, it is possible to protect yourself from these potentially expensive coverage gaps. The top two methods most seniors choose are Medigap supplement insurance, and Medicare Advantage policies. We’ll go into detail about each option now.
Nevada Medigap insurance is the same as it is in any other state – the only thing that changes from one location to the other is the price, and the insurance provider. This is because the government works in tandem with private insurance companies to make sure that all ten of the available Medigap plans give you a cost-effective and comprehensive form of coverage. You have the option to choose between plans A, B, C, D, F, G, K, L, M, and N. Each plan was crafted with known Medicare coverage gaps in mind to precisely reduce potential out-of-pocket medical expenses.
[chart category=”supplement” name=”planTypes” state=”NV” zipcode=”89108″]
Medicare Advantage is another way of saying “Medicare Replacement Insurance”, because that is exactly what such policies do. They are underwritten by private insurance companies, and are legally required to provide you with the exact same (or better) benefits that you are currently getting from Traditional Medicare. With any luck, you may be able to add additional coverages and benefits to your policy – such as dental or vision – for a relatively affordable additional expense.
However, make sure you do some research into your Medicare Advantage provider network before you finalize a policy. While Advantage plans offer reasonably priced options, they do so at the expense of restricting their networks. For some seniors, this might mean having to choose between affordable health care, and a doctor they trust.
Medicare Advantage networks offer care to their members through either HMO (Health Maintenance Organization) or PPO (Preferred Provider Organization) networks. Your location, as well as the company which underwrites your policy, will determine which doctors and facilities you can visit.
[chart category=”advantage” name=”topHMOPlans” zipcode=”89108″ state=”NV”]
[chart category=”advantage” name=”topPPOPlans” zipcode=”89108″ state=”NV”]
As confusing as it may be to sort out the differences between Medicare Advantage and Medigap, there are some significant nuances of which you should be aware:
|Questions||Medicare Advantage||Medicare Supplement|
|How are the plans funded?||Medicare will pay your insurance company a fixed amount based on average healthcare costs for your region. You may also be required to pay a premium based on your location and insurance company.||Your monthly premium takes care of the majority of your expenses.|
|Do I continue paying for Part B?||Yes||Yes|
|What does it cost me?||Some plans offer a zero-dollar premium (because the government subsidy covers the full cost). Other plans may cost up to 0-0 monthly.||While each plan does require a monthly premium, many of them are affordably priced.|
|What does the plan cover?||Depending on your plan, it will cover at least the same benefits offered by Medicare parts A & B. Possibly other benefits; but the more benefits you sign up for, the higher your out-of-pocket expenses may be.||All eligible expenses are split between Medicare, and your Medicare Supplement plan. If you have a comprehensive plan, such as Plan F, 100% of eligible expenses not covered by Medicare will be covered by your supplement insurance.|
|Can I budget my health care expenses?||It’s challenging; the more often you require medical care, the more often you may be required to pay out-of-pocket.||Budgeting is much easier with a Medicare supplement. You have fewer out-of-pocket expenses, and one simple monthly premium.|
|Can my plan be cancelled?||Yes. Unfortunately, your health insurance company has the legal right to review their Medicare Advantage services annually and decide whether or not they wish to continue providing coverage.||No – not unless you fail to pay your monthly premium, or your insurance company goes bankrupt. Only under such extenuating circumstances could your plan be cancelled.|
|Are pre-approvals or pre-certifications required?||Unfortunately, yes. These Plans usually require pre-certification or other qualification for some specific types of care.||No pre-approvals are required. If you qualify for Medicare, you will qualify for a Medicare supplement plan.|
|Can I use any doctor or hospital?||Usually, you choose from a network of pre-approved providers. These networks can fluctuate over time.||Yes. You are free to choose any doctor and/or hospital in the U.S. which accepts Medicare.|
|Can drug, vision, or dental coverage be included in the policy?||Yes.||No. These forms of coverage must be purchased separately.|
|Who is this plan type generally best suited for?||If you are relatively young, healthy, live in an urban area, and have a limited income, a Medicare Advantage plan could work for you.||If you live in a rural area without easy access to provider networks, if you like to budget your finances, or if you want comprehensive coverage, you might prefer a Medicare supplement plan.|
If you still have questions, that is perfectly understandable. Below is a directory filled with contact information you can use to ask Medicare insurance experts near you for all the answers you need. After all, your health is important – you should be as well informed as possible before making any serious decisions.
[chart category=”general” name=”usefulContacts”]
Important Medicare Terms
Mon-Fri, 8am-8pm EST