In 2018 around 333,600 Nebraska residents received Medicare coverage as per the Centers for Medicare & Medicaid Services. Legal American citizens of 65 years of age or older is eligible can avail Original Medicare, which is the government health insurance program designed for seniors. Some of the younger residents can also qualify for Medicare coverage if they have been receiving disability benefits from the Railroad Retirement Board or Social Security Administration for at least 25 continuous months, or if residents have end stage renal disease or permanent kidney failure or amyotrophic lateral sclerosis or Lou Gehrig’s disease . In order to qualify for Medicare, residents need to be a U.S. citizen or a legal permanent resident for at least five continuous years. Like any other states, Original Medicare in Nebraska also include Part A and Part B. Medicare Part A covers inpatient hospital care like skilled nursing facility, some home health visits and hospice care whereas Part B covers physician pay, outpatient services along with some health and preventive medical services. Medicare Part A coverage is free for residents who have worked at least 10 years and paid Medicare taxes. Though, residents need to pay a monthly premium for Part B coverage and they will also have cost-sharing expenses like deductibles, coinsurance and copayments.
Medicare Part C or Advantage Plan in Nebraska
The Nebraska state has 93 counties and the Medicare Advantage plans are available only in 67 counties. Moreover in Box Butte, Hamilton, and Kearney counties there is just one Medicare Advantage Plan. Medicare Advantage or Part C plan is an alternative way to receive Original Medicare coverage and the plan is offered by private insurance companies having contract with Medicare. Medicare Advantage plans in Nebraska cover the same hospitalization and medical benefits as Original Medicare except the hospice care, which is covered only under Part A. Some of the Medicare Advantage plans offer additional coverage like routine dental, vision and hearing benefits. Around 16% of Medicare beneficiaries in Nebraska are enrolled in a Medicare Advantage plan in 2019. Residents of Nebraska should keep in mind that if they enroll in Medicare Advantage or Medicare Advantage Prescription Drug plan then they have to stay enrolled in Original Medicare and they will have to continue paying their Medicare Part B premium in order to enjoy health insurance coverage. In Nebraska different types of Medicare Advantage plans are available, though not every plan is available in all of the county of Nebraska. Two most popular types of managed-care Medicare Advantage plans are Health Maintenance Organization (HMO) plans and Preferred Provider Organization (PPO) plans.
Medicare Advantage Prescription Drug Plans in Nebraska
Medicare Advantage plans that come along with prescription drug coverage is known as Medicare Advantage Prescription Drug plans and these plan combine both health and prescription dug coverage into a single plan for the beneficiaries of Medicare. The list of medications covered may vary from plan to plan so before enrolling in this plan people need to check the plan’s formulary, which shows the list of all the medications covered by the plan. The formulary of the plan may change at any time but the members of the plan are notified about the change by their insurance carrier.
Medicare Part D or Prescription Drug Plan in Nebraska
Residents of Nebraska who wish to obtain prescription drug coverage can enroll in Medicare Part D plans offered by private insurance companies having contract with Medicare. The stand-alone Medicare Part D Prescription Drug Plans assist beneficiaries cover the cost of prescription drugs, which is not covered under Original Medicare. In order to be eligible for a stand-alone Medicare Part D Prescription Drug Plan residents should have Part A and/or Part B coverage and they must be living in the Plan service area. These plans are designed to work alongside Original Medicare coverage and each plan has a list of covered prescription drugs called a formulary. Every Part D Prescription Drug Plan has a separate formulary including drugs into various categories. Each drug plan comes with a different cost, as the top-tier plan includes higher-priced medications whereas the bottom tier plan includes the least expensive prescription drugs. Though, if it medically necessary to treat a patient with a higher tier drug then the physician can ask the plan for an exception. Besides, Medicare Part D plans allow residents of Nebraska to choose between brand-name prescription drugs and generic prescription drugs.
Medicare Supplement or Medigap Plans in Nebraska
Since Original Medicare does not limit out-of-pocket costs so Medicare enrollees need to maintain some form of supplemental coverage. Medicare beneficiaries who do not receive their supplemental coverage through an employer sponsored plan can opt for Medicare Supplement or Medigap plans, which are designed to pay some or all of the out-of-pocket costs that beneficiaries would otherwise have to pay themselves. The out-of-pocket costs include deductibles, copayments, coinsurance and other expenses associated with Original Medicare. Sold by private insurance companies, Medigap plans are standardized under Federal rules and there are ten different plans, Plan A, B, C, D, F, G, K, L, M and N in this category. More than a quarter of Original Medicare beneficiaries have Medigap coverage and there is no annual open enrollment window for Medigap plans. Federal rules provide six month window when Medigap coverage can be availed. In order to buy a Medigap plan people need to be enrolled in both Medicare Part A and Part B.