Medicare Advantage Plans in Nevada

Medicare Advantage is an alternative to Original Medicare that allows you to choose a private insurance company to fulfill your Medicare benefits. Choosing a Medicare Advantage plan can enable you to obtain additional benefits that Original Medicare doesn’t offer. If you’re thinking of this option, here’s what you should know about Medicare Advantage in Nevada.

In Nevada, you can choose a Medicare Advantage plan from a private insurance company that will provide your Medicare benefits. In return, you will select from the company’s in-network providers the company has contracted to provide medical services. If you do wish to enroll in a Medicare Advantage plan, you must do so when you are first eligible or during the Medicare Open Enrollment Period, also called the Annual Enrollment Period, from October 15 to December 7 every year.

There are 94 Medicare Advantage plans available in Nevada in 2023. Among those plans, 15 offered benefits such as wellness services, healthcare planning and financial or reward incentive programs.

How is Medicare Advantage in Nevada different from Original Medicare?

When you enroll in a Medicare Advantage plan in Nevada, you choose a private insurance company to fulfill your Medicare benefits. Medicare Advantage companies are region-specific. This is why you will search for available plans by zip code — you can only choose from the plans available to you based on where you live in Nevada.

The following table can help you tell the difference between Original Medicare and Medicare Advantage in Nevada.

What is the Medicare Advantage medical loss ratio?

Medicare requires Medicare Advantage companies to report a medical loss ratio on an annual basis. The medical loss ratio is the ratio that shows how much an insurance company spent on its clients versus how much it made in profit or used for administrative costs. Medicare requires all Medicare Advantage companies to spend at least 85% on patient care costs.

If a company doesn’t meet this ratio, it must pay penalties. Sometimes, Medicare may not renew a company’s contract or allow the company to enroll new members if it cannot follow the spending rules. The medical loss ratio is a way that Medicare protects Medicare Advantage enrollees.

When you have Medicare Advantage, you still must pay your monthly premium for Medicare Part B and potentially a premium to your Medicare Advantage company. According to the Centers for Medicare & Medicaid Services (CMS), the average premium paid for Medicare Advantage in 2023 in Nevada is $3.58.

If you are hoping to find a Medicare Advantage plan that offers a $0 premium, you’re in luck: 100% of Nevadans have access to a $0 premium plan in 2023. However, it’s important to evaluate each plan carefully as a $0 premium plan may not save you as much money in the long run, depending on things like copayments, deductibles and other out-of-pocket expenses.

Most Nevada residents will qualify for Medicare Advantage based on age. You qualify for Medicare at age 65. Typically, you can enroll the three months before, the month during, or the three months after you turn 65. You will sign up via the Social Security Administration. At the same time, you can choose a Medicare Advantage plan if you wish.

Some people qualify for Medicare before age 65. You may qualify if you meet the following criteria:

• You have end-stage renal disease (ESRD).
• You have a disability that prevents you from working.
• Have amyotrophic lateral sclerosis (ALS).

Waiting periods exist for when you can qualify for Medicare because of ESRD or a disability. However, if a doctor has diagnosed you with ALS, you can qualify for Medicare benefits when you are diagnosed.

If you are already receiving Social Security benefits, you are usually automatically enrolled in Medicare. You can expect to receive your Medicare card in the mail in the three months before you turn 65.

However, if you aren’t getting Social Security benefits, you’ll need to sign up for Medicare. To enroll in Medicare in Nevada, you will need to contact your Social Security office. You can apply online at the Social Security Administration’s website, visit your local office or sign up by calling Social Security at 1-800-722-1213 (TTY: 1-800-325-0778).

Yes, there are many Medicare Advantage plans that offer prescription drug coverage. These bundled plans mean you can pay a single premium for your Medicare Advantage and prescription drug coverage (remember, you’ll still pay your Part B premium to Medicare).

The Medicare Advantage plans that offer prescription drug coverage will have a list called a formulary. This formulary is a list of medications the plan covers. The formulary will divide the medications into tiers — typically five — that can help estimate what you will pay out of pocket.