Medicare in Nebraska
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Overview of Medicare in Nebraska
More than 333,600 residents of Nebraska received Medicare coverage in 2018, according to the Centers for Medicare & Medicaid Services (CMS). If you are eligible for Medicare, you can choose from several types of coverage for your Medicare coverage in Nebraska, as described below.
Original Medicare is the government health insurance program for eligible American citizens and legal residents aged 65 and older. Younger beneficiaries may also qualify by disability or through having certain conditions. In all states, you must be either a United States citizen or a legal permanent resident of at least five continuous years.
In Nebraska, as in all states, Original Medicare includes Part A and Part B.
- Medicare Part A covers inpatient hospital, skilled nursing facility, some home health visits, and hospice care.
- Medicare Part B helps pay for physician, outpatient, and some home health and preventive medical services.
While many people get Medicare Part A for free if they’ve worked at least 10 years (40 quarters) and paid Medicare taxes, most people pay a monthly premium for Part B coverage. Generally, you’ll also have cost-sharing expenses, such as deductibles, copayments, and coinsurance.
Original Medicare does not pay for some services that older people and younger beneficiaries with disabilities may need. For instance, Original Medicare does not pay for most prescription drugs; you’ll need to enroll in a stand-alone Medicare Prescription Drug Plan if you want this benefit. It also does not pay for custodial long-term services and supports, either at home or in a nursing home or assisted living facility. You’re also not covered for routine dental care, dentures, or routine vision care.
A Medicare Part D Prescription Drug Plan (PDP) can help pay your prescription drug costs. Designed to work alongside your Original Medicare coverage, Medicare Prescription Drug Plans are available from private insurance companies approved by Medicare and doing business in Nebraska.
Medigap (Medicare Supplement) insurance plans are also offered by private insurance companies and can help you pay your out-of-pocket costs for services covered under Original Medicare.
Instead of getting your Original Medicare coverage directly from the government, you may be eligible to enroll in a Medicare Advantage plan in Nebraska. Also known as Medicare Part C, Medicare Advantage plans are offered by private insurance companies that contract with CMS. Medicare Advantage plans must provide at least the same level of Medicare benefits as Original Medicare, with the exception of hospice care, which is paid by Medicare Part A.
Many Medicare Advantage plans also include extra benefits, such as routine dental and vision care. Some plans also include prescription drug coverage; these are called Medicare Advantage Prescription Drug (MA-PD) plans, and they deliver all your Medicare medical and prescription drug benefits through a single plan. Medicare Advantage plans are required to limit beneficiaries’ out-of-pocket spending for services covered under Medicare Parts A and B.
To enroll in a Medicare Advantage plan, you must meet all of the following criteria:
- Be entitled to Medicare Part A.
- Be enrolled in Medicare Part B.
- Live in the Medicare Advantage plan’s service area.
- Not have end-stage renal disease (with some exceptions).
Generally, Medicare Advantage plan members must continue to pay their Medicare Part B premium and may also pay an additional premium for their Medicare Part C coverage.
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Medicare resources in Nebraska
State Unit on Aging: This division of the Nebraska Department of Health and Human Services offers a broad range of programs and services for addressing the needs of seniors and allocates state and federal funds for specific local programs. The Department of Health and Human Services oversees the eight Area Agency Offices on Aging located in Beatrice, Hastings, Kearney, Lincoln, Norfolk, North Platte, Omaha, and Scottsbluff. The unit also offers its own statewide programs for Nebraska Medicare beneficiaries, including:
- Aging and Disability Resource Center – This center is funded by the State Unit on Aging and provides beneficiaries with a number of specific services, which are outlined in more detail below.
- Elder Rights – This office is responsible for protecting the rights of seniors through legal assistance and mediation. This office also helps to oversee Medicare fraud prevention in the state.
Nebraska Department of Insurance: The Nebraska Department of Insurance is home to the State Health Insurance Assistance Program (SHIP). This office provides information and counseling to Nebraska Medicare beneficiaries on all issues involving coverage benefits. The program is not linked directly to any insurance companies in the state and does not provide products or policies to Nebraska residents. The office does offer information about Medicare through their website, in-person presentations and private counseling sessions. The program is available to both seniors and those with disabilities who qualify for Medicare benefits.
Nebraska’s Aging and Disability Resource Center: This agency is a network of eight offices called Area Agencies on Aging. The local offices are designed to provide Nebraska Medicare beneficiaries in the immediate area with information about the specifics of their benefits. The network is funded through the Administration on Aging and the Center for Medicare & Medicaid Service. Benefit specialists are also on staff at each of the regional offices to provide personal counseling on Medicare services. The convenience of local offices scattered throughout the state provides easier access to many seniors who prefer face-to-face assistance with their Medicare questions.
Medicare statistical trends in Nebraska
- Approximately 283,865 Nebraskans had Original Medicare Part A and/or Part B. coverage; more than 49,740 enrolled in a Medicare Advantage plan and other health plans to provide their Medicare coverage.
- More than 242,250 people received Medicare Part D prescription drug coverage from either a stand-alone Medicare Prescription Drug Plan or from a Medicare Advantage plan that included prescription drug coverage.
Some noteworthy facts about Medicare in Nebraska for 2018 appear below:
- 92% of people with Medicare have access to a Medicare Advantage plan
- 19 Medicare Advantage plans are available in Nebraska.
- 23 Medicare Prescription Drug Plans are available in Nebraska.
- 74% of people with Medicare Part D have access to a plan with a lower premium than what they paid in 2017.
- 20% of people with Medicare Part D are eligible to receive Extra Help (also called the Low-Income Subsidy, or LIS).
- $20.40 is the lowest monthly premium for a Medicare Prescription Drug Plan (premiums may be lower for individuals who qualify for Extra Help or higher for individuals who pay a late-enrollment penalty).
Statistical data from the Centers for Medicare & Medicaid Services, Medicare Enrollment Dashboard ; and “2018 MA Part D Landscape State-by-State Fact Sheet”.
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This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply.
Benefits, premiums and/or copayments/co-insurance may change on January 1 of each year.