Medicare in Nevada

In most areas of the United States, private Medicare Advantage plans are available as an alternative to Original Medicare.

In 2019, some of Nevada’s counties had no Medicare Advantage plans available for purchase (Nevada has 16 counties plus Carson City, and only nine of them had Medicare Advantage plans available in 2019). But all areas of Nevada had Medicare Advantage plans available by 2020, with the addition of Lasso Healthcare, which entered the market in Nevada with an MSA plan.

Medicare Advantage plan availability in 2023 in Nevada ranges from two plans in several rural counties, to 46 plans in Clark County.

The counties that didn’t have Advantage plans available prior to 2020 tended to have very low populations. Despite the fact that nearly half of Nevada’s counties had no Medicare Advantage plans for sale pre-2020, 35% of the state’s Medicare beneficiaries were enrolled in Medicare Advantage plans as of 2018 — compared with 34% nationwide.

By early 2023 the number of people enrolled in private Medicare plans in Nevada stood at 284,445 people, which was 49% of the state’s total Medicare coverage enrollment; the other 294,073 beneficiaries had Original Medicare. Between July 2020 and early 2023, Medicare Advantage enrollment in Nevada increased by more than 64,000 people, whereas Original Medicare enrollment decreased by more than 30,000 people. There’s been a similar trend nationwide, with Medicare Advantage enrollment increasing faster than overall Medicare enrollment.

People who enroll in Original Medicare get their coverage directly from the federal government, and have access to a nationwide network of providers. But Original Medicare enrollees need supplemental coverage (from an employer-sponsored plan, Medicaid, or privately purchased Medigap plans) for things like prescription drugs and out-of-pocket costs.

Original Medicare includes Medicare Part A (hospital inpatient services) and Part B (outpatient services). Medicare Advantage includes all of the benefits of Medicare Parts A and B, and the plans usually also have additional benefits, such as integrated Part D prescription drug coverage, dental and vision coverage, and extra programs like gym memberships and a 24-hour nurse hotline. But provider networks and service areas are limited with Medicare Advantage, and out-of-pocket costs (deductible, copays, and coinsurance) are often higher than they would be under Original Medicare plus a Medigap plan. There are pros and cons to either option, and no single solution that works for everyone.

Medicare’s annual election period (October 15 to December 7 each year) allows Medicare beneficiaries opportunities to switch between Medicare Advantage enrollment and Original Medicare (and add, drop, or change to a different Medicare Part D prescription plan). Medicare Advantage enrollees also have the option to switch to a different Advantage plan or to Original Medicare during the Medicare Advantage open enrollment period, which runs from January 1 to March 31 (only one plan change may be made during this window).

Original Medicare does not limit out-of-pocket costs, so most enrollees maintain some form of supplemental coverage. More than half of Original Medicare beneficiaries get their supplemental coverage through an employer-sponsored plan or Medicaid. But for those who don’t, Medigap plans (also known as Medicare supplement plans) will pay some or all of the out-of-pocket costs (deductible and coinsurance) they would otherwise have to pay if they had only Original Medicare.

According to the Nevada Division of Insurance, there were 104,457 Nevada residents with Medigap coverage as of 2021.

Medigap plans are sold by private insurance companies, but the plans are standardized under federal rules. There are ten different plan designs (differentiated by letters, A through N), and the benefits covered by a particular plan (Plan G, Plan K, etc.) are the same regardless of which insurer sells the plan. This makes it easier for consumers to compare plans and make their choice based on factors such as price and customer service, knowing that the coverage will be the same regardless of which insurance company will provide the plan.

21 insurance companies offer Medigap plans in Nevada as of 2023 (down from 31 in 2022). Nearly all of them use attained age rating, which means that individual enrollees’ monthly premiums increase as they get older, regardless of how old they were when they purchased the policy.

Unlike other private Medicare coverage (Medicare Advantage and Medicare Part D plans), federal law does not provide an annual open enrollment window for Medigap plans. Instead, federal rules provide a one-time six-month window when Medigap coverage is guaranteed-issue. This window starts when a person is at least 65 and enrolled in Medicare Part B (you must be enrolled in both Part A and Part B to buy a Medigap plan). It’s essential to purchase coverage in a timely fashion during this window; if you apply for a Medigap plan after it ends, the insurance companies are allowed to use medical underwriting to determine your eligibility for coverage and your monthly premium.

But Nevada enacted legislation (AB250) in 2021 that provides Medigap enrollees with an annual opportunity to switch to a different plan. This provision took effect in 2022. It ensures that Medigap enrollees in Nevada have a 60-day window, starting the first day of their birthday month, during which they can switch to any other available Medigap plan that has equal or lesser benefits. Medigap plan change applications submitted during this window are guaranteed-issue, which means the application cannot be rejected and the insurer cannot increase the premium due to medical history (equal or lesser value means the plan can be at the same letter level as the one they have, or any of the lower levels, but not a higher level).

Several other states already had similar “birthday rule” annual plan change windows for Medigap enrollees, but the majority of the states do not. To be clear, anyone with Original Medicare can apply for any available Medigap plan at any time. But after the initial enrollment window has passed, insurers can use medical underwriting to determine whether the applicant is eligible for coverage. Nevada’s new law ensures that people with medical conditions aren’t stuck with their current Medigap plan forever. But it does not allow a person to upgrade to a more robust Medigap plan. And it also does not allow a Medicare beneficiary who doesn’t already have Medigap to enroll in a Medigap plan (after their initial enrollment window) on a guaranteed-issue basis.

People who aren’t yet 65 can enroll in Medicare if they’re disabled and have been receiving disability benefits for at least two years, or if they have ALS or end-stage renal disease; nearly 11% of Nevada Medicare beneficiaries are under age 65. But federal rules do not guarantee access to Medigap plans for people who are under 65. The majority of the states have implemented rules to ensure that disabled Medicare beneficiaries have at least some access to Medigap plans, but Nevada is not one of them.

Nevada does not require Medigap insurers to offer coverage to people under age 65. As of 2023, Nevada’s Medigap guide and Medicare.gov’s plan finder tool both indicate that there are no insurers that offers Medigap coverage to beneficiaries under the age of 65.

As of 2022, there had been one company that did — State Farm Mutual Automobile Insurance Company — but their plans are no longer available as of 2023. And in previous years, Transamerica Life Insurance Company offered Medigap Plan A to enrollees under 65 in Nevada—albeit at a higher premium—but that appears to no longer be the case.

The Nevada Division of Insurance confirmed that there are no other supplemental coverage options for under-65 Medicare enrollees (ie, no state-run high-risk pool or similar program). But Medicare beneficiaries who are under age 65 do have the option to enroll in any available Medicare Advantage plan offered in their area. Medicare Advantage plans do have a cap on out-of-pocket costs, which Original Medicare does not, although beneficiaries may find that their access to medical providers is limited to a smaller network of doctors and hospitals if they use Medicare Advantage (note that the out-of-pocket cap does not include prescription drug costs, which do not have a maximum out-of-pocket cap regardless of whether the Part D coverage is purchased on its own or as part of a Medicare Advantage plan).

People who enroll in Medicare prior to 65 (due to a disability) do gain access to all of the available Medigap plans when they turn 65. At that point, they have the normal six-month open enrollment period for Medigap, with all plans guaranteed issue.

Although the Affordable Care Act eliminated pre-existing condition exclusions in most of the private health insurance market, those rules don’t apply to Medigap plans. Medigap insurers can impose a pre-existing condition waiting period of up to six months if you didn’t have at least six months of continuous coverage prior to your enrollment. And if you apply for a Medigap plan after your initial enrollment window closes (assuming you aren’t eligible for one of the limited guaranteed-issue rights), the Medigap insurer can consider your medical history in determining whether to accept your application, and at what premium.

Original Medicare does not provide coverage for outpatient prescription drugs. More than half of Original Medicare beneficiaries have supplemental medical coverage via an employer-sponsored plan (from a current or former employer or spouse’s employer) and these plans often include prescription coverage.

But Medicare beneficiaries who do not have drug coverage through an employer’s insurance plan need to obtain Medicare Part D prescription coverage (Medicare beneficiaries who are dually-eligible for Medicaid will also have Part D coverage for their drugs). It can be purchased as a stand-alone plan, or as part of a Medicare Advantage plan with integrated Medicare Part D enrollment.

In 2023, there are 23 stand-alone Medicare Part D plans for sale in Nevada, with monthly premiums that range from about $8 to $118.

As of early 2023, there were 159,845 Medicare beneficiaries in Nevada (a little more than a quarter of the state’s Medicare population) who were covered under stand-alone Medicare Part D plans. Another 272,006 had Part D prescription coverage integrated with their Medicare Advantage plans (this number has been increasing sharply as enrollment in Medicare Advantage plans has grown faster than overall Medicare enrollment in Nevada).

Medicare Part D enrollment is available during the annual election period from October 15 to December 7. You may change your mind more than once during this window; the last plan you pick will take effect January 1 of the coming year.

Need help with your Medicare application in Nevada? Got questions about Medicare eligibility in Nevada? You can contact the Nevada State Health Insurance Assistance Program with questions related to Medicare enrollment in Nevada.

The Nevada Aging and Disability Services Division offers a variety of resources for Nevada Medicare beneficiaries.

The Governor’s Office for Consumer Health Assistance (OCHA) is part of the Nevada Department of Health and Human Services, and can provide advice, guidance, and information on a variety of health-related issues.

The Nevada Department of Health and Human Services website also has a resource page with information on programs available to help lower-income Medicare beneficiaries afford their coverage and healthcare.

The Medicare Rights Center is a national resource that includes a website and a call center where consumers throughout the United States can get answers to a wide range of questions about Medicare.