The Plan options For Most Nevadans

The facts about Nevada Medicare Advantage

The Ins and outs of a Nevada Medicare Advantage plan

If you are turning 65, already 65, losing employer coverage, or already have a Medicare Advantage Plan, we can help you find the best Nevada Medicare Advantage plan that suits your needs and answer any of your questions or concerns. We are licensed insurance agents and work with MOST, if not all, the Medicare Advantage carriers in Nevada and do all the research for FREE at no cost to you. Set up an appointment today. We have remote capabilities if we are not in the same area or quarantined, and you need HELP NOW! Call 702-277-4753 to speak with a licensed insurance agent.

Medicare Advantage Prescription Drug Plan (MAPD)

Medicare Advantage is a Medicare plan that is offered by private insurance companies in Nevada who are contracted with Medicare. These insurance plans are another way to get your Medicare coverage. The Medicare Advantage plans most of the time, combine health insurance and prescription drug benefits into one Plan called Medicare Advantage Prescription Drug plans (MAPD).

Medicare Advantage Plans and Medicare Advantage Prescription Drug plans are required to cover everything that Original Medicare (Part A and Part B) covers. However, there are exceptions like Hospice, and Hospice remains covered by Original Medicare Part A. Medicare Prescription Drug (Part D) coverage, when included, is named Medicare Advantage Prescription Drug plans. 

Different Types of Medicare Advantage Prescription Drug Plans

There are several types of Medicare Advantage Prescription Drug Plans Health Maintenance Organization (HMO), Preferred Provider Organization (PPO*), Medicare Savings Account (MSA), Private Fee-For-Service (PFFS), and Special Needs Plans (SNP). Each of these plans may have different rules regarding how you can receive care. For example, HMO plans require enrollees to stay within its network of providers when receiving medical care. Visiting an out-of-network provider may mean you pay the full costs for that care (except urgent and emergency care).

If you need prescription drug plans, you should consider enrolling in a Medicare Advantage Prescription Drug Plan is offered in your area. Medicare Part D, Prescription Drug plans work together with Original Medicare Parts A and B, not a Medicare Advantage Prescription Drug Plan. Remember enrolling in a Medicare Prescription Drug Plan (Part D), and Medicare will disenroll you from your current Medicare Advantage Drug Plan (Part C). Now you’ll have Original Medicare and a Prescription Drug Plan. It’s essential that you understand how your decisions affect your Medicare coverage.  

There is an exception when your current Medicare Advantage Plan without Prescription Drug coverage, Medicare Savings Accounts, and Individual Private Fee for Service plans. In these cases, you’re encouraged and allowed to apply and enroll in a stand-alone Medicare Prescription Drug Plan for your Part D coverage. If you don’t have a Prescription Drug Plan, you could incur penalties from Medicare.

Special Needs Plans (SNP) are another option of Medicare Advantage plans that you could have available. These SNP plans limit enrollment to beneficiaries who meet specific Chronic or Dual criteria, such as having a chronic condition or you have both Medicare and Medicaid coverage, or live in an institution like a nursing home. Special Needs Advantage Plans always include prescription drug plans and often cover medications for the Chronic health needs of the SNP members. For example, a Chronic-Special Needs Plan for diabetic patients may cover commonly prescribed diabetic drugs.

Medicare Advantage Prescription Drug Plan Formularies

All Medicare Advantage Prescription Drug plan has a documented Formulary that includes a list of prescription medications that is covered under the Medicare Advantage Prescription Drug Plan. Medicare Advantage Drug Plans must offer two or more medications within each category (e.g., antidepressant, antibiotic), and the prescription Tiers determine cost-sharing. An example using generic prescriptions are often in a lower-tier (and often come with lower copayment and coinsurance costs). In comparison, brand-name drugs are placed into a higher tier (and usually have increased copays). When considering enrollment in a Medicare Advantage Prescription Drug plan, it’s a good idea to make sure that all your current prescriptions are included in the Plan’s formulary since covered medications and costs can vary from Plan to Plan. Two Advantage plans may cover the same prescription drugs with vastly different out-of-pocket expenses; take your time to understand the plan options that could save money. Remember, formularies could change at any time. The Medicare plan carrier is supposed to notify you of any changes.

What does a Medicare Advantage Prescription Drug plan cost?

Medicare Advantage Prescription Drug plans are provided through private insurance companies approved by Medicare. Since they are private companies, the plan cost can vary. Medicare Medicare Advantage Prescription Drug plans could charge a monthly cost,. Don’t forget the government (Medicare) still requires you to pay the Part B premium. Also, you are responsible for any costs associated with copays, coinsurance, or deductibles.

How to Enroll in a Medicare Advantage Prescription Drug Plan

Having Medicare Part A and Part B, living within a service area and, not having End-Stage Renal Disease (ESRD), makes you eligible for Medicare Advantage Plans. There is an exception to ESRD if the city offers a Chronic ESRD – SNP, the person can enroll in that Plan only. The most common enrollment periods for Medicare Advantage is someone’s Initial Election Period, Initial Coverage Election Period, Annual Enrollment Period, Open Enrollment Period and, Special Enrollment Periods. I will describe them all below.

Your initially eligible to enroll in Medicare is during your Initial Election Period (IEP). IEP is determined by your birth month. You can enroll three months before the month you turn 65, till three months after your birth month, a total of seven months. If you qualified for Medicare early due to disability, your Initial Coverage Election Period starts three months before your 25th month of Social Security Disability or Railroad Retirement Board Disability benefits, and it continues for three months after your 25th month.

If you don’t enroll in a Medicare Advantage Drug Plan during your Initial Election Period or Initial Coverage Election Period, you must wait for the Annual Election Period. The annual election period happens every year from October 15–December 7.  The Annual Election period allows the most flexibility to change or alter your Medicare plan. There aren’t any restrictions during Annual Enrollment, and here are common changes you can make:

  • Enroll in a Medicare Advantage Plan
  • Enroll in a Medicare Advantage Prescription Drug Plan
  • Enroll in a Medicare Prescription Drug Plan
  • Disenroll from the Medicare Plans above and return to Original Medicare Part A and Part B
  • Switch Medicare Advantage Plans
  • Switch Medicare Prescription Drug Plans

Once Annual Enrollment is over, you have fewer opportunities to make changes to your Medicare coverage. In the spring, you can usually make one change to your Medicare Plan. You can use Medicare’s Open Enrollment Period (January 1-March 31) to do so. If you disenroll from your Medicare Advantage plan during this time, you can also use this period to enroll in a stand-alone Medicare Prescription Drug Plan, which works alongside Original Medicare to provide s prescription drug coverage.

In certain situations, you may be able to make changes outside of the regular election periods with a Special Election Period. Some examples of the most common qualifying conditions are: Moving out of your Plan’s service area, being eligible for the Extra Help/Low-Income Subsidy program, or being a dual-eligible. Dual eligibility means you have Medicare and State Medicaid benefits.

Remember, Medicare Advantage Prescription Drug plan coverage details and Plan costs can change annually. ECOS recommends that you review plan options every year.

Also, Out-of-network/non-contracted providers are under no obligation to treat Preferred Provider Organization (PPO) plan members, except in emergencies. If you are not sure you are covered, you can call the Carrier, your Provider, or ECOS Medicare Solutions.

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