At a glance: Medicare health insurance in Nevada
- More than half a million Nevada residents are enrolled in Medicare.
- 36 percent of Nevada Medicare beneficiaries are enrolled in Medicare Advantage plans, but seven of the state’s 16 counties have no Advantage plans available.
- In the nine Nevada counties where Medicare Advantage plans are sold, availability ranges from one plan to 27 plans, depending on the county.
- 24 insurers offer Medigap plans in N
evada, and about 85,000 people are enrolled. Insurers are not required to offer Medigap plans to people under 65, and only one insurer does so.
- There are 26 stand-alone Part D prescription plans available in Nevada in 2019, with premiums that range from about $16 to $97 per month. A little more than a third of the state’s Medicare beneficiaries have stand-alone Part D coverage.
- Per-enrollee Original Medicare spending in Nevada is a little lower than the national average.
Medicare enrollment in Nevada
As of late 2018, there were 515,792 people in Nevada with Medicare coverage. That’s less than 17 percent of the state’s population, compared with more than 18 percent of the total US population enrolled in Medicare.
Most Americans become eligible for Medicare 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. In Nevada, 14 percent of Medicare beneficiaries are eligible due to a disability rather than age. Nationwide, 16 percent of all Medicare beneficiaries are eligible due to disability.
Medicare Advantage in Nevada
In most areas of the country, private Medicare Advantage plans are available as an alternative to Original Medicare. But Nevada is one of the states where some counties have no Medicare Advantage plans available for purchase. Nevada has 16 counties, and nine of them have Medicare Advantage plans available in 2019. Across those nine counties, Advantage plan availability ranges from just one plan in Mineral County, to 27 plans in Clark County.
But the counties without available Advantage plans tend to have very low populations. Despite the fact that nearly half of Nevada’s counties have no Medicare Advantage plans for sale, 36 percent of the state’s Medicare beneficiaries were enrolled in Advantage plans as of 2017 — compared with 33 percent nationwide. As of December 2018, private Medicare enrollment in Nevada stood at 187,071 people; the other 328,721 had Original Medicare.
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 Parts A and B. 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 and coverage for things like dental and vision care. But provider networks are limited with Medicare Advantage, and out-of-pocket costs 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 the chance to switch between Medicare Advantage and Original Medicare (and add, drop, or switch to a different Medicare Part D prescription plan). As of 2019, 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.
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 they would otherwise have to pay if they had only Original Medicare.
Medigap plans are sold by private insurers, but the plans are standardized under federal rules. There are ten different plan designs (differentiated by letters, A through N), and the benefits offered by a particular plan (Plan A, Plan F, etc.) are the same regardless of which insurer sells the plan.
24 insurers are offer Medigap plans in Nevada (all of the insurers are listed in the state’s guide to Medigap plans under the summary of Plan A rates; under federal rules, all Medigap insurers are required to offer at least Plan A). Nearly all of them use attained age rating, which means that enrollees’ premiums increase as they get older, regardless of how old they were when they purchased the policy. According to an AHIP analysis, 85,417 Nevada residents had Medigap coverage as of 2016.
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).
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; 14 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. Transamerica Life Insurance Company is the only Medigap insurer in the state that offers coverage to people under age 65, and they only offer Plan A to those enrollees (Plan A is the least comprehensive Medigap plan). The Nevada Division of Insurance confirmed that Transamerica can charge higher premiums to under-65 enrollees, although they did not have any specifics in terms of the premium details. The Division confirmed that there are no other options for people in that situation (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.
Although only Transamerica’s Plan A is available to people under 65, 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.
Medicare Part D in Nevada
Original Medicare does not provide coverage for outpatient prescription drugs. More than half of Original Medicare beneficiaries have supplemental 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-sponsored 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 Part D prescription drug coverage.
In 2019, there are 26 stand-alone Part D plans for sale in Nevada, with premiums that range from about $16 to $97/month.
As of late 2018, there were 177,896 Medicare beneficiaries in Nevada (about 34 of the state’s Medicare population) with stand-alone Part D plans. Another 180,079 had Part D prescription coverage integrated with their Medicare Advantage plans.
Medicare spending in Nevada
Original Medicare’s average per-beneficiary spending in Nevada was $9,347 in 2016, 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 $9,533 per enrollee. Spending was highest in Louisiana, at $11,399, and lowest in Hawaii, at just $6,441.
You can read more about Medicare in Nevada in our state Medicare guide. You can also contact the Nevada State Health Insurance Assistance Program with questions related to Medicare coverage in Nevada.
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 healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.