Medicare in Nebraska

Medicare is a federal health insurance program designed to help seniors and some individuals with disabilities access comprehensive health coverage. Original Medicare consists of Medicare Part A, which covers inpatient care, and Medicare Part B, which covers outpatient care. Since Original Medicare doesn’t include prescription coverage, enrollees have the option of purchasing Medicare Part D, a drug supplement. Original Medicare may also be paired with Medicare Supplement Insurance, a supplemental plan that covers some of the out-of-pocket costs that come with using Medicare benefits.

In 2003, Medicare-eligible individuals gained access to Medicare Advantage, also known as Medicare Part C, a type of Medicare coverage that bundles Part A, Part B and often covering prescription benefits (Part D) as well, into a comprehensive plan. Although Medicare Advantage Plans must follow certain rules established by the Centers for Medicare & Medicaid Services (CMS), each plan is offered by one of the private health insurance companies operating in the United States. Allowing multiple insurers to sell Medicare Advantage Plans has given seniors in Nebraska access to additional benefits that aren’t covered by Original Medicare.

As of 2020, Nebraska had a total of 351,668 individuals enrolled in Medicare. About 81.5% were enrolled in Original Medicare, leaving the other 18.5% enrolled in Medicare Advantage. In 2019, Nebraska spent over $2.8 billion on Medicare costs, accounting for approximately 0.7% of total Medicare spending in the United States.

This guide provides an overview of the Medicare options available to residents of Nebraska. It also includes a list of resources to help Nebraska seniors access their Medicare benefits.

Options for Medicare Coverage in Nebraska

Nebraska residents have more than one way to get Medicare coverage, giving seniors extra flexibility when it comes to accessing health care and limiting their out-of-pocket expenses. Original Medicare is considered the basic option, while Medicare Advantage is typically for seniors who want more comprehensive coverage. Original Medicare enrollees also have access to supplemental plans.

Original Medicare (Parts A & B)

Original Medicare is administered by the Centers for Medicare & Medicaid Services (CMS) and is open to seniors aged 65 and over, along with those under 65 years old, but with certain disabilities or end-stage kidney disease. It includes two parts. Part A covers inpatient hospital care, nursing home and skilled nursing care, hospice and home health care. Part B, or medical coverage, pays for medically necessary goods and services such as durable medical equipment, mental health services and emergency medical transportation. 

Unlike most private Medicare plans, Original Medicare’s provider network isn’t limited to the beneficiary’s geographic region, making it easier to obtain services while traveling within the country. In most cases, Medicare doesn’t pay for health services the individual receives outside the United States. 

Under this program, seniors pay for services as they receive them. They must pay an annual deductible, which is $1,556 for Part A and $233 for Part B in 2022. After they’ve paid this amount, Medicare covers all eligible services at 80%. Beneficiaries pay the remaining 20% out of pocket.

Who Should Consider Original Medicare

Original Medicare may be a good option for those who:

• Travel frequently within the United States
• Don’t need extra benefits such as home-delivered meals and coverage for over-the-counter medication
• Want to choose their own prescription drug coverage

Medicare Advantage (Part C)

Medicare Advantage is another way for Nebraska seniors to access health coverage. It shares many features with Original Medicare, but one of the main differences is that Medicare Advantage plans are managed by private insurance companies, rather than the federal government. A significant advantage of enrolling in Medicare Part C is that many providers offer additional benefits. Original Medicare doesn’t cover vision exams for glasses or contact lenses, for example, but some Medicare Advantage Plans do. Most Advantage Plans include drug coverage (Part D). 

Although Medicare Advantage offers many benefits, enrollment is growing slowly in Nebraska. In 2020, only 65,094 Medicare-eligible Nebraskans were enrolled in Medicare Advantage, an enrollment rate of 18.5%. In 2021, five companies offered Medicare Advantage Plans in Nebraska, with each company offering multiple options. Out of 93 counties in Nebraska, only eight had no Medicare Advantage Plans available in 2021.

Who Should Consider Medicare Advantage

Medicare Advantage may be the right choice for seniors who:

• Want access to vision care, dentures and other benefits
• Don’t mind receiving coverage through a private insurer
• Want limits on their out-of-pocket expenses
• Are generally healthy, so may benefit from lower premiums

The Top 10 Medicare Advantage Plans in Nebraska

Below are the top 10 Medicare Advantage providers in Nebraska, ranked according to their total enrollment. Due to the availability of multiple plans, cost information is presented as a price range. Enrollment numbers represent the sum of all individuals enrolled in each plan offered by a provider. All data is current as of April 2022. More information about Medicare Advantage is available on the Medicare Advantage Plans in Nebraska page.

Medicare Prescription Drug Coverage (Part D)

Original Medicare doesn’t pay for most prescription drugs through Part A or B coverage. Instead, seniors purchase separate prescription drug policies, also called Part D coverage. Medicare contracts with private health insurance companies to provide this coverage. There are multiple plans to choose from with varying monthly premiums, which beneficiaries pay in addition to their Original Medicare premiums. While seniors don’t have to purchase prescription drug coverage when they’re first eligible for Medicare, not obtaining this coverage at this time may result in late enrollment penalties they pay for as long as they have Medicare if they enroll later.

Each prescription drug plan has its own formulary, or list of covered drugs. Formularies are typically split up into tiers. The tier a medication is in determines how much the insurance company pays and how much the beneficiary pays for it. Lower-level tiers are usually made up of generic and low-cost brand name drugs, while higher tiers are composed of more expensive brand name and specialty drugs. In most cases, the lower the tier, the lower the policyholder’s cost-sharing responsibility.

Who Should Consider Medicare Prescription Drug Coverage

Seniors who may benefit from prescription drug coverage include those who:

• Currently take prescription medication or expect to in the future
• Want to avoid late enrollment penalties
• Want to reduce out-of-pocket prescription drug expenses

Medicare Supplement Insurance (Medigap)

While Original Medicare provides coverage for many medical costs, seniors may still have significant out-of-pocket expenses. These may include copays, coinsurance and deductibles. Seniors may be able to reduce their cost-sharing obligations by purchasing a Medigap plan. These plans can only be used with Original Medicare. It’s illegal for private insurance companies to sell Medigap plans to those with Medicare Advantage plans.

In California, there are 10 types of Medigap plans, eight of which are available to new enrollees. Plans are standardized, meaning policyholders get the exact same coverage from a given plan regardless of the health insurance provider they buy it from. For more information on Medigap plans, seniors can refer to the Best Medicare Supplement Companies of 2022 page.

Who Should Consider Medicare Supplement Insurance

Good candidates for Medigap may be those who:

• Have ongoing health issues and expenses
• Travel overseas often
• Want to access an expanded network of health care providers
• Expect to need health services not covered by Original Medicare

Medicare Resources in Nebraska

Due to the number of Medicare options available, it can be difficult for seniors to choose the right plan and get enrolled at just the right time. Fortunately, Nebraska has several government agencies and nonprofit organizations available to help. The following resources can help Medicare-eligible residents of Nebraska understand their coverage options, sign up for the right plans for their needs and get more information about supplemental Medicare coverage.