Medicare in Nevada

Medicare is a federally funded and regulated program that provides health insurance for seniors 65 and older and those who are younger with certain disabilities or diseases. It’s divided into four parts: A, B, C and D. Parts A and B are called Original Medicare. Part A covers hospital and inpatient stays without a monthly premium for those who have paid enough Medicare taxes and their spouses. Part B covers outpatient services and general care for a standard premium and copay. Medicare Part C is called Medicare Advantage and consists of private health insurance plans following regulations created by the Centers for Medicare & Medicaid Services (CMS). Medicare Part D covers prescription drugs based on a premium.

As of 2023, 567,509 individuals have enrolled in Medicare, which is around 17.8% of the total Nevada state population. On average, Medicare in Nevada costs about $11,121 per person based on the most up-to-date information, totaling around $3.525 billion in 2021. These numbers are projected to increase annually by 5.4% as the aging population grows.

Approximately 583,000 Nevada residents are eligible for Medicare Advantage, with 288,345 individuals actively enrolled in the program. This 49% increase from 2022 to 2023 is slightly over the national average of 48% during the same time. Compared to 2022 data, the number of eligible enrollees increased by 2.96%, just over the national norm of 2.66%. Overall, the growth rate of enrollees in Nevada increased by 9.09%, while the percentage of enrollment growth was 5.96%. Both of these figures are lower than national averages, which reflect that the national population eligible for Medicare Advantage increased by 9.75% and that the percentage of enrollment growth nationwide was 6.90%.

This guide explores Medicare coverage options in Nevada as well as several resources that can help seniors make informed decisions about their insurance choices.

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 overseen by the Centers for Medicare & Medicaid Services (CMS) in two parts. Part A provides coverage for inpatient services, such as hospital care, nursing home and skilled nursing care, hospice and home health care. Outpatient services are covered by Part B, and these include medically necessary appointments, preventative care, mental health services and durable medical equipment. Original Medicare isn’t limited by geographic region, allowing seniors to seek care across the U.S. Annual deductibles are $1,600 for Part A and $226, plus an income-based premium starting at $164.90 for Part B in 2023

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)

Medicare Advantage Plans are an alternative to Original Medicare. These plans are similar to policies available in the Health Insurance Marketplace but are still subject to some oversight. Coverage must be offered for Part A and Part B services, with the exception of hospice care. While they may have their own fees, deductibles and in-network rules, private insurance providers offering these plans must be approved by Medicare and follow regulations set by CMS. Plans available include Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Private Fee-for-Service (PFFS) plans and Special Needs Plans (SNP).

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 Medicare Advantage Plans in Nevada

The 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 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 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.