Medicare offers healthcare coverage to Nevada residents age 65 or older, or to those Nevada residents that suffer from certain medical disabilities. In 2016, 456,000 people are enrolled in Medicare in Nevada, accounting for 16.4% of the population in Nevada. In 2009 about $9,692 was spent on each Medicare enrollee in Nevada, approximately 6.49% lower than the national average of $10,365. From 2015 to 2030 the number of seniors in Nevada is projected to rise by an estimated 89.03% according to calculations based off of the 2000 Census. Therefore the number of Medicare enrollees in the state is also expected to substantially grow.
Seniors that reside in Nevada, their family, and their caregivers can receive free personalized and unbiased health insurance counseling through the State Health Insurance Assistance Program (SHIP). Another program called Senior Medicare Patrol (SMP) assists Medicare beneficiaries in detecting, avoiding, and reporting cases of Medicare fraud, waste, and/or abuse.
When you are eligible for Medicare you may sign up for Original Medicare (Part A & Part B), which cover hospital services and medical services, respectively, or you may enroll in a Medicare Advantage Plan (Medicare Part C). If you sign up for Original Medicare you also have the option to purchase a separate or stand alone prescription drug plan (Part D). Medicare Advantage and Medicare Part D insurance plans are sold by private insurance companies that have a contract with Medicare. Original Medicare offers its beneficiaries flexibility in choosing their providers and you are not limited to a network. However, there is no limit on out-of-pocket medical expenses and you must always pay 20% coinsurance for medical service costs. For most Medicare beneficiaries, Part A is already paid through paycheck deductions during their working years (or their spouse's) but most Medicare beneficiaries pay premiums for Part B unless they qualify for financial assistance. Medicare Advantage plans require you to stay in network but some plans will also cover out-of-network care at a higher cost. Many Medicare Advantage plans also include additional health benefits such as vision, dental, or hearing coverage and you have the option to purchase a Medicare Advantage plan with prescription drug coverage (MAPD) in almost all states.
Using CMS data HealthPocket found that:
- The average total monthly premium for a 2017 Medicare Advantage plan in Nevada is $47.98, 23.21% less than the national average of $62.48. 47.27% of 2017 Medicare Part C insurance plans in Nevada have a $0 monthly premium.
- The maximum possible annual drug deductible in any 2017 Medicare Advantage plan with a drug component is $400, but in Nevada the average annual drug deductible for Medicare Part C insurance plans with drug components is $71.25. 75% of 2017 Medicare Part C insurance plans with a drug component in Nevada have a $0 annual drug deductible.
- 100.0% of 2017 Medicare Part C insurance plans without a drug component in Nevada have a $0 monthly premium.
- The average medical out-of-pocket limit for 2017 Medicare Part C insurance plans in Nevada is $3,820. 72.73% of 2017 Medicare Advantage plans in Nevada had a medical out-of-pocket limit of $3,400 or less.
To assist seniors in choosing Medicare plans, CMS assigns star ratings to Medicare Part C and Part D plans each year based on preventive care, chronic condition management, customer service, member satisfaction, and drug pricing. Ratings range from 1 star (a poor plan) to 5 stars (an excellent plan).
- The average overall CMS star rating assigned to Medicare Part C insurance plans in Nevada was 3.6 stars in 2017.
- Among Nevada's 2017 Medicare Advantage plans with CMS star ratings:
- 34.55% earned a score of 4 or 4.5 stars
- 65.45% earned a score of 3 or 3.5 stars
Data on Medicare eligibility, enrollment, and spending by state from Kaiser Family Foundation