Seniors and other individuals in Nebraska can access alternative Medicare coverage through Medicare Advantage plans. These plans, which are also commonly known as Medicare Part C, must provide coverage that matches what’s provided through Medicare Part A and Part B. Most also include additional services that aren’t covered by Original Medicare, such as dental, vision and hearing services. In many cases, Medicare Part C also includes prescription drug coverage. These plans are provided by private insurance companies that offer coverage in cooperation with Medicare. Beneficiaries pay premiums directly to the insurance provider.
According to the Kaiser Family Foundation, 39% of Medicare beneficiaries across the U.S. are enrolled in Medicare Advantage while in Nebraska, the enrollment rate is less than half of that at just 19%, likely due to the fact that Medicare Advantage plans are only available in some counties in the state. Just across the state’s western border in Wyoming, the enrollment rate is even lower at 3%. However, other surrounding states, including Colorado and Iowa, have much higher rates of enrollment at 43% and 24%, respectively.
Older adults in Nebraska have several options to choose from when selecting a Medicare Advantage Plan. These include HMOs, PFFPs, PPOs, and SNPs for individuals who are living with chronic health conditions and require specialized care and regular prescription medications. This comprehensive guide includes details about what each of these plan types include, as well as the enrollment requirements for each one. We’ve also provided resources that are available to seniors throughout Nebraska to help them choose a Medicare Advantage plan that suits their needs.
The type of Medicare Advantage plans that are available to seniors and other Nebraska residents vary depending on the county. In some counties, Medicare Advantage plans aren’t offered at all, while in others, numerous plan options are available. Plans that may be offered to seniors include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-For-Service (PFFS) and Special Needs Plans (SNPs).
Health Maintenance Organizations (HMOs)
HMOs are usually the least expensive option when it comes to Medicare Advantage plans. While this is ideal for many participants, it’s important to keep in mind that HMOs have strict rules regarding access to care. To ensure that services are covered, patients must seek care from a designated primary care physician within their plan’s network. If specialist care is required, the patient’s primary care physician can provide a referral to another in-network healthcare provider. In many cases, care that’s provided outside of this network must be paid for out-of-pocket. Exceptions may apply, such as when an in-network physician provides the patient with a referral to an out-of-network specialist when no alternative is available.
Preferred Provider Organizations (PPOs)
PPOs operate similarly to HMOs and have a preferred network of health care providers that enrollees should seek care from. By sticking to this network, patients can ensure that they’re not paying additional or higher costs for care services. In cases where the patient would prefer to visit a physician or another healthcare provider outside of their network, their PPO plan will typically cover a portion of the service. PPOs are usually a bit more expensive than HMOs but can provide greater flexibility.
Private Fee-for-Service Plans (PFFS)
PFFPs are the most flexible of Medicare Advantage plans. These plans allow enrollees to obtain care from any qualified healthcare provider without being restricted to a specific network. The insurance company then pays a set fee for each service while the patient pays the remainder of the charge out of their own pocket.
Special Needs Plans (SNPs)
SNPs exist to cater to groups of people with specific health conditions or similar care requirements. People in a group may require regular specialist care and laboratory testing, as well as more frequent visits to their primary care physician, and an SNP plan tailors the services it covers to meet these needs. In contrast to other Medicare Advantage plans such as HMOs and PPOs, Medicare requires that all SNPs include coverage for prescription drugs. To qualify for enrollment in an SNP, seniors must be in the group the plan serves, which may mean being eligible for both Medicare and Medicaid or having certain disabilities, a specific chronic condition or disease or living in an institutional setting such as a nursing home.
Prior to enrolling in Medicare Advantage, seniors must first be enrolled in Original Medicare. Anyone who is eligible for Medicare Parts A and B is also eligible to enroll in Medicare Advantage. However, certain Medicare Advantage plans, such as SNPs, may have additional eligibility requirements.
Medicare Advantage has specific enrollment periods. One can only join a Medicare Advantage plan during the following periods:
Additionally, Medicare Advantage plan participants can change their plan outside of these enrollment periods under certain qualifying circumstances, such as moving to a new state.
In Nebraska, many Medicare Advantage plans include prescription drug coverage. The exact coverage and premiums for medication coverage vary depending on the insurance company that administers the plan. Seniors who enroll in a Medicare Advantage plan in Nebraska and want to be insured against the cost of prescription medications must find a plan that includes drug coverage, as Medicare Advantage cannot be combined with Medicare Part D in the state. Medicare Advantage plan participants who enroll in Medicare Part D are disenrolled from their MA plan automatically.
Medicare Advantage plans provide seniors with an affordable way to access the health care services they need. There are numerous plan options available from different insurance providers, which can make it difficult for many seniors to determine which plan suits them best, and navigating the complicated enrollment process can be difficult. Below, we’ve listed several statewide and local resources that can help seniors understand how this Medicare program works and the best plan choice for their needs.
Nebraska SHIIP provides Medicare counseling services to seniors and individuals with disabilities. This program is funded by the federal government and operated by the Nebraska Department of Insurance. Its sole purpose is to help Medicare beneficiaries make sense of the different plans that are available to them, choose the plan that best suits their needs and assist with claims, appeals and other concerns.
Seniors can request assistance by calling the Nebraska SHIIP hotline at 1-800-234-7119.
Volunteers Assisting Seniors is a statewide program that provides Medicare classes and counseling and other services. This nonprofit organization provides comprehensive training to volunteers that allows them to provide expert assistance in issues pertaining to Medicare. Volunteers are available to help seniors navigate the different Medicare plans that are available to them and provide assistance with any concerns that may arise.
Seniors who require assistance with Medicare can call Volunteers Assisting Seniors at 1-800-234-7119 to receive advice or schedule an in-person counseling session.
Nebraska’s Aging and Disability Resource Center helps residents aged 60 and older by providing a variety of senior-specific services. This includes benefits counseling for seniors who receive Medicare or Medicaid benefits, as well as long-term care advice and referrals to local resources and community services.
The Nebraska Department of Insurance – Consumer Affairs Division provides assistance in all types of insurance matters throughout the state. Seniors who need help understanding Medicare Advantage policies or who wish to file a complaint about their provider can contact this department for assistance. While the department is not able to recommend specific products, its employees can assist seniors who require an advocate to contact their insurance company on their behalf.
Nebraska DHHS’s Medicaid Services offers assistance to Medicare beneficiaries who are dually eligible for Medicare and Medicaid. This includes help with benefits coordination, as well as assistance with determining eligibility for specific waivers and programs.
To contact Nebraska’s Medicaid Services department, seniors can call 402-471-3121.
The Eastern Nebraska Office on Aging acts as one of the state’s Area Agencies on Aging. It provides a broad range of services and supports that are specifically designed to enhance the quality of life for seniors aged 65 and older. This includes assistance with understanding their Medicare options and obtaining Medicaid benefits.
Aging Partners is an Area Agency on Aging that serves Butler, Filmore, Polk, Saline, Saunders, Seward and York Counties. It’s a senior advocacy and social support agency that provides a broad range of services to those aged 60 and older, including Medicare and Medicaid counseling.
Serving fourteen counties in South Central Nebraska, this Area Agency on Aging provides benefits counseling for Medicaid and Medicare beneficiaries, as well as an array of other services to assist seniors and adults with disabilities.
The Aging Office of Western Nebraska serves seniors in 11 counties throughout the Panhandle area. It works with individuals aged 60 and older, providing a wide range of beneficial services that includes insurance counseling for those enrolled in Medicare and Medicaid programs.