Medicare in Nevada

Medicare is a program funded by the United States government that provides health insurance for adults aged 65 and older as well as people who are younger who have certain disabilities and end-stage renal disease. As of 2022, there are 558,698 individuals enrolled in Medicare. Almost 90% of these enrollees qualified for coverage because of their age. The latest data shows that the average Medicare spending in Nevada was $10,796 per year, which is about average for the United States. 

Medicare coverage is divided into four parts: A, B, C and D. 

Part A is hospital insurance, which pays for inpatient care, short-term skilled nursing, hospice care and limited home health care. It also includes some inpatient and rehabilitation therapies and some other home health care services. Medicare users don’t pay a monthly premium for Medicare Part A coverage if they or their spouse paid Medicare taxes for a certain amount of time while working. Part B is for outpatient services and more general care seniors get from their primary physicians. As of 2022, the standard premium for Part B was $170.10.

Medicare Part C is commonly known as Medicare Advantage. These privately run health insurance plans must pay for all the services covered by Original Medicare Parts A and B. They can also include specialized options for groups with specific care needs, such as seniors with diabetes or other chronic conditions. 

Medicare Part D is for prescription drugs. Everyone enrolled in Medicare is eligible for a Part D plan that pays for most prescription drugs. These plans usually include a premium.

Families can learn more about their Medicare coverage options in Nevada with this guide. It includes detailed information about all parts of Medicare as well as links to resources in the state that can provide assistance.

Options for Medicare Coverage in Nevada

Medicare Parts A and B provide the bulk of the health insurance most older adults need, but not everyone gets all the services, treatments and products they need from Original Medicaid. With Medicare Advantage, Part D, Medigap and other private options, families can ensure all their health care needs are covered. 

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 renal 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)

Seniors who need health insurance but who are not satisfied with Original Medicare Parts A and B may find a private Medicare Advantage plan that meets their needs. The companies that offer these plans are approved by Medicare and must follow rules regarding out-of-pocket expenses, premiums, copays and other costs. More than 240,000 enrollees in Nevada received their benefits through Part C or other private plans in 2021. Most Advantage Plans cover prescription drugs (Part D), and many plans offer dental, hearing or vision care. 

Medicare Advantage plans are similar to health insurance policies available to younger adults in the marketplace. They include health maintenance organization( HMOs), preferred provider organization (PPOs), Private Fee-for-Service Plans (PFFS) and Special Needs Plans (SNP). Each plan may have unique costs and benefits, including coverage for specific chronic conditions or diseases.

Who Should Consider Medicare Advantage

Seniors in Nevada may want to consider getting a Medicare Advantage plan if they:

• Prefer a managed care organization in their community
• Are generally healthy, so may qualify for lower premiums
• Want to include dental, vision and other specialized care services in their coverage
• Want more control over certain health care costs

The Top 10 Medicare Advantage Plans in Nevada

The 10 most popular Medicare Advantage companies in Nevada are listed in the following table. Because most of the companies offer multiple plans, monthly costs are listed in a range. Enrollment numbers represent all plans combined provided by a single company across the state. 

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.

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 Nevada

The more than half a million residents in Nevada who are eligible for Medicare have access to several resources that can help them with their benefits. These state and federal agencies, as well as some private organizations, can answer complicated questions about coverage and point families toward valuable cost savings. There may be eligibility requirements for some services offered.