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Medicare in Nevada

Nevada does not require Medigap insurers to offer plans to people under 65, and no insurers do so

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Key takeaways

Medicare enrollment in Nevada

As of mid-2020, there were 545,535 people enrolled in Medicare in Nevada, amounting to about 17 percent of the state’s population.

Most Americans become eligible for Medicare enrollment when they turn 65. But Medicare eligibility is also triggered for younger people if they’re disabled and have been receiving disability benefits for 24 months (people with ALS or end-stage renal disease do not have to wait 24 months for their Medicare coverage to begin). In Nevada, 13 percent of Medicare beneficiaries are under the age of 65 and eligible for Medicare due to a disability rather than age. Nationwide, 15 percent of all Medicare beneficiaries — nearly 10 million people — are eligible due to disability.

Medicare Advantage in Nevada

In most areas of the United States, private Medicare Advantage plans are available as an alternative to Original Medicare.

In 2019, some of Nevada’s counties had no Medicare Advantage plans available for purchase (Nevada has 16 counties plus Carson City, and only nine of them had Medicare Advantage plans available in 2019). But all areas of Nevada have Medicare Advantage plans available in 2020, with the addition of Lasso Healthcare, which entered the market in Nevada with an MSA plan. Plan availability in 2020 ranges from just one plan (from Lasso Healthcare) in several counties, to 36 plans in Clark County.

But the counties that didn’t have Advantage plans available prior to 2020 tend to have very low populations. Despite the fact that nearly half of Nevada’s counties had no Medicare Advantage plans for sale, 35 percent of the state’s Medicare beneficiaries were enrolled in Medicare Advantage plans as of 2018 — compared with 34 percent nationwide. And by July 2020, the number of people enrolled in private Medicare plans in Nevada stood at 219,979 people, which was 40 percent of the state’s total Medicare coverage enrollment; the other 325,556 beneficiaries had Original Medicare. Between August 2019 and July 2020, Medicare Advantage enrollment in Nevada increased by 19,000 people, whereas Original Medicare enrollment decreased by nearly 7,000 people.

People who enroll in Original Medicare get their coverage directly from the federal government, and have access to a nationwide network of providers. But Original Medicare enrollees need supplemental coverage (from an employer-sponsored plan, Medicaid, or privately purchased plans) for things like prescription drugs and out-of-pocket costs.

Original Medicare includes Medicare Part A (hospital inpatient services) and Part B (outpatient services). Medicare Advantage includes all of the benefits of Medicare Parts A and B, and the plans usually also have additional benefits, such as integrated Part D prescription drug coverage, dental and vision coverage, and extra programs like gym memberships and a 24-hour nurse hotline. But provider networks and service areas are limited with Medicare Advantage, and out-of-pocket costs (deductible, copays, and coinsurance) are often higher than they would be under Original Medicare plus a Medigap plan. There are pros and cons to either option, and no single solution that works for everyone.

Medicare’s annual election period (October 15 to December 7 each year) allows Medicare beneficiaries opportunities to switch between Medicare Advantage enrollment and Original Medicare (and add, drop, or change to a different Medicare Part D prescription plan). Medicare Advantage enrollees also have the option to switch to a different Advantage plan or to Original Medicare during the Medicare Advantage open enrollment period, which runs from January 1 to March 31 (only one plan change may be made during this window).

Medigap in Nevada

Original Medicare does not limit out-of-pocket costs, so most enrollees maintain some form of supplemental coverage. More than half of Original Medicare beneficiaries get their supplemental coverage through an employer-sponsored plan or Medicaid. But for those who don’t, Medigap plans (also known as Medicare supplement plans) will pay some or all of the out-of-pocket costs (deductible and coinsurance) they would otherwise have to pay if they had only Original Medicare.

Medigap plans are sold by private insurance companies, but the plans are standardized under federal rules. There are ten different plan designs (differentiated by letters, A through N), and the benefits covered by a particular plan (Plan G, Plan K, etc.) are the same regardless of which insurer sells the plan. This makes it easier for consumers to compare plans and make their choice based on factors such as price and customer service, knowing that the coverage will be the same regardless of which insurance company will provide the plan.

32 insurance companies offer Medigap plans in Nevada as of 2020. Nearly all of them use attained age rating, which means that individual enrollees’ monthly premiums increase as they get older, regardless of how old they were when they purchased the policy. According to an AHIP analysis, 95,795 Nevada residents were enrolled in Medigap coverage as of 2018.

Unlike other private Medicare coverage (Medicare Advantage and Medicare Part D plans), there is no annual open enrollment window for Medigap plans. Instead, federal rules provide a one-time six-month window when Medigap coverage is guaranteed-issue. This window starts when a person is at least 65 and enrolled in Medicare Part B (you must be enrolled in both Part A and Part B to buy a Medigap plan). It’s essential to purchase coverage in a timely fashion during this window; if you apply for a Medigap plan after it ends, the insurance companies are allowed to use medical underwriting to determine your eligibility for coverage and your monthly premium.

People who aren’t yet 65 can enroll in Medicare if they’re disabled and have been receiving disability benefits for at least two years, or if they have ALS or end-stage renal disease; 13 percent of Nevada Medicare beneficiaries are under age 65. But federal rules do not guarantee access to Medigap plans for people who are under 65. The majority of the states have implemented rules to ensure that disabled Medicare beneficiaries have at least some access to Medigap plans, but Nevada is not one of them.

Nevada does not require Medigap insurers to offer coverage to people under age 65. As of 2020, Nevada’s Medigap guide indicates that there is one insurer that offers Medigap Plan A to beneficiaries under the age of 65, but Medicare’s plan finder tool indicates that no insurers actually do so (in previous years, Transamerica Life Insurance Company offered Medigap Plan A to enrollees under 65 in Nevada—albeit at a higher premium—but that appears to no longer be the case). The Nevada Division of Insurance confirmed in 2018 that there are no other supplemental coverage options for under-65 Medicare enrollees (ie, no state-run high-risk pool or similar program). But Medicare beneficiaries who are under age 65 do have the option to enroll in any available Medicare Advantage plan offered in their area, unless they have end-stage renal disease (as of 2021, people will be able to enroll in Medicare Advantage plans even if they have end-stage renal disease).

Although there do not appear to be any Medigap plans available to people under 65 in Nevada, those individuals gain access to all of the available Medigap plans when they turn 65. At that point, they have the normal six-month open enrollment period for Medigap.

Although the Affordable Care Act eliminated pre-existing condition exclusions in most of the private health insurance market, those rules don’t apply to Medigap plans. Medigap insurers can impose a pre-existing condition waiting period of up to six months if you didn’t have at least six months of continuous coverage prior to your enrollment. And if you apply for a Medigap plan after your initial enrollment window closes (assuming you aren’t eligible for one of the limited guaranteed-issue rights), the Medigap insurer can consider your medical history in determining whether to accept your application, and at what premium.

Nevada Medicare Part D

Original Medicare does not provide coverage for outpatient prescription drugs. More than half of Original Medicare beneficiaries have supplemental medical coverage via an employer-sponsored plan (from a current or former employer or spouse’s employer) or Medicaid, and these plans often include prescription coverage.

But Medicare beneficiaries who do not have drug coverage through Medicaid or an employer’s insurance plan need to obtain Medicare Part D prescription coverage. It can be purchased as a stand-alone plan, or as part of a Medicare Advantage plan with integrated Medicare Part D enrollment.

In 2020, there are 28 stand-alone Medicare Part D plans for sale in Nevada, with monthly premiums that range from about $13 to $84.

As of mid-2020, there were 178,998 Medicare beneficiaries in Nevada (about a third of the state’s Medicare population) who were covered under stand-alone Medicare Part D plans. Another 210,606 had Part D prescription coverage integrated with their Medicare Advantage plans (this number has been increasing sharply as enrollment in Medicare Advantage plans has grown faster than overall Medicare enrollment in Nevada).

Medicare Part D enrollment is available during the annual election period from October 15 to December 7. You may change your mind more than once during this window; the last plan you pick will take effect January 1 of the coming year.

Medicare spending in Nevada

Average per-beneficiary spending for Medicare in Nevada was $9,969 in 2018, based on data that were standardized to eliminate regional differences in payment rates, and did not include costs for Medicare Advantage. Per-beneficiary Medicare spending in Nevada was slightly lower than the national average of $10,096 per enrollee. Spending was highest in Louisiana, at $11,932, and lowest in Hawaii, at just $6,971.

How does Medicaid provide financial assistance to Medicare beneficiaries in Nevada?

Many Medicare beneficiaries receive financial assistance through Medicaid with the cost of Medicare premiums and services Medicare doesn’t cover – such as long-term care.

Our guide to financial assistance for Medicare enrollees in Nevada includes overviews of these benefits, including long-term care coverage, Medicare Savings Programs, and eligibility guidelines for assistance.

Medicare in Nevada: Resources and information for Medicare beneficiaries and their caregivers

Need help with your Medicare application in Nevada? Got questions about Medicare eligibility in Nevada? You can contact the Nevada State Health Insurance Assistance Program with questions related to Medicare enrollment in Nevada.

The Nevada Aging and Disability Services Division offers a variety of resources for Nevada Medicare beneficiaries.

The Governor’s Office for Consumer Health Assistance (OCHA) is part of the Nevada Department of Health and Human Services, and can provide advice, guidance, and information on a variety of health-related issues.

The Nevada Department of Health and Human Services website also has a resource page with information on programs available to help lower-income Medicare beneficiaries afford their coverage and healthcare.

The Medicare Rights Center is a national resource that includes a website and a call center where consumers throughout the United States can get answers to a wide range of questions about Medicare.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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