Medicare in Nebraska

Medicare is a federal health insurance program that helps seniors aged 65 and older and those with certain qualifying disabilities access a comprehensive health care policy. Eligible enrollees can select from Original Medicare or Medicare Advantage. Both cover similar services, but there are some differences. Original Medicare offers coverage for inpatient care (Part A) and outpatient services (Part B). Medicare Advantage bundles Part A and Part B while offering additional benefits, including prescription benefits (Medicare Part D), in one comprehensive plan. Medicare Advantage must follow regulations established by the Centers for Medicare & Medicaid Services (CMS), but each plan is offered by a private insurance provider and will have varying costs and copays.

Medicare expenses account for 21% of national health spending, totaling around $689 billion nationwide in 2021, and these figures grew an additional 4.3% in 2022. In Nebraska, total Medicare spending exceeded $2.9 billion in 2021. This significant figure is likely to increase by around 5.4% annually through 2031 as the population and individuals eligible to enroll continue to grow.

In 2023, CMS reported that 364,469 Nebraskans enrolled in Medicare, representing around 18.5% of the statewide population. As of July 2023, 372,967 individuals were eligible for enrollment in Medicare Advantage, with 107,829, or about 29%, actively enrolling in the program. While this is significantly lower than the percentage of national enrollment (48%), the state saw a 14.68% growth in enrollees. The statewide number of eligible enrollees increased by 2.62%, just under the national rate of 2.66%. However, the 11.75% growth in the percentage enrolled in Medicare Advantage in Nebraska is significantly higher than the respective 6.90% national figure. Overall, Nebraska has seen an 11.75% growth in the percentage enrolled from 2022 to 2023, higher than the national 6.90% rate.

This guide provides an overview of the Medicare options available to eligible residents in Nebraska as well as a list of resources that may help Nebraska seniors enroll and access 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 coverage is divided into two parts. Inpatient hospital care, skilled nursing and nursing homes, home health care and hospice are covered by Part A. Part B covers outpatient and preventative care, emergency medical transportation, durable medical equipment and mental health services. Beneficiaries of Original Medicare can obtain services from any physician who accepts Medicare in the country.

Under Original Medicare, seniors pay for services as needed. Part A has an annual deductible of $1,600 for the first 60 days of inpatient care and then a daily coinsurance. Part B premiums are based on income, starting at $164.90 monthly.

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)

Through Medicare Advantage, Nebraska seniors can access the same coverage as Original Medicare from private insurance providers. While having access to Parts A and B coverage, seniors may also receive additional benefits, such as dental and vision coverage. Most Medicare Advantage Plans offer drug coverage, which Original Medicare beneficiaries must enroll in separately through Medicare Part D. 

Medicare Advantage enrollment in Nebraska is lower than national norms but increasing, with 29% of eligible individuals enrolled in 2023 compared to 24% in 2021. While in 2021, five providers offered Medicare Advantage Plans, this number has increased to seven in 2023.

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 August of 2023. 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 2023 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.