Nebraska may be known for its abundant plains, but it’s also a solid source of great healthcare.
For those that live on the Great Plains, there’s no reason why you should go without a great healthcare plan. Hundreds of thousands of Nebraska residents are enrolled in Medicare, and a high percentage of them have access to Medicare Advantage plans. If you’re a Nebraskan looking for a guide on Medicare coverage in your state, you’ll find a treasure trove of information below.
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Nebraska Medicare at a Glance
|Number of Original Medicare Enrollees||298,774|
|Number of Medicare Advantage Enrollees||45,426|
|Total Number of Medicare Beneficiaries||344,200|
*Source: Kaiser Family Foundation
What Is Medicare?
Medicare is a federal health insurance program. Essentially, the U.S. government, through the Centers for Medicare & Medicaid Services, regulates the program with the purpose of providing healthcare to people older than 65, people with disabilities, and people with end-stage renal disease. More often than not, these groups struggle to afford health insurance on their own, and this assistance program seeks to alleviate their hardship and provide them with much needed extra help.
There are different types, or parts, of Medicare with each one focusing on a different aspect of coverage:
- Medicare Parts A and B: Better known as “Hospital Insurance,” Part A covers inpatient care, including hospital stays, skilled nursing facilities, and hospice care. Some aspects of Part A even cover some home healthcare costs. Medicare Part B is known as “Medical Insurance” and covers more routine healthcare services, such as doctor visits, outpatient care, medical supplies, and preventative medical services. Together, Parts A and B are commonly known as “Original Medicare.”
- Medicare Part C: Also known as “Medicare Advantage,” Part C offers an alternative to Original Medicare and provides all-in-one health plans. Part C plans are provided by pre-approved private insurance companies. They cover everything that Original Medicare plans cover but often come with additional benefits, such as dental, vision, and hearing coverage. What’s more, Part C plans can also provide prescription drug coverage as well.
- Medicare Part D: Part D provides prescription drug coverage. Part D plans should be available to you, whether you’re obtaining them through Original Medicare or Medicare Advantage plans.
- Medicare Supplement Insurance: Also known as “Medigap,” Medicare Supplement Insurance provides assistance with various Original Medicare costs, such as co-payments, coinsurance, and deductibles.
Who Qualifies for Medicare in Nebraska?
To qualify for Medicare in Nebraska, and in the rest of the United States, you must be 65 or older, as well as a citizen or legal permanent resident for at least continuous five years.
You may also have eligibility if you are under the age of 65, provided that you have been receiving disability benefits from the Social Security Administration or the Railroad Retirement Board for at least 25 continuous months.
Additionally, you can be eligible if you suffer from serious chronic health conditions, such as end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS).
How Much Does Medicare Cost in Nebraska?
The cost of Medicare in Nebraska varies depending on which plans you sign up for. The costs themselves come from a few places:
- Premium: This is the actual monthly cost of keeping your insurance policy.
- Deductible: This is the amount of money you must pay out of pocket for medical services before your insurance begins to cover and compensate you for costs.
- Coinsurance: Once you’ve met your deductible, your insurance policy will pay for a percentage of covered medical costs, leaving you to pay a much smaller percentage.
- Co-payment: Flat-rate payments for covered medical services and prescriptions.
- Out-of-pocket limits: The absolute maximum you can pay for medical services in a given year before your insurance policy pays for 100 percent of subsequent out-of-pocket costs.
As you look for insurance plans that best suit your needs, take note of what each plan will cost you. A plan that has a low premium may seem attractive, but you may end up paying more in the long run if it has a high deductible. In the same vein, plans with higher co-payments may not make sense for you if you require many regular doctor visits throughout the year.
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The Cost of Original Medicare in Nebraska
While the cost of Original Medicare is standardized in the United States, it’s still important to know how much you can expect to pay. There are different factors to consider, such as your work history and income, that can affect how much you will have to pay.
- Part A premiums cost $0, provided that you or your spouse has worked and paid taxes for at least 10 years. Part A plans have a $1,484 deductible (per hospitalization), covering the first 60 days in hospital. Part A can also cover an additional 90 days in the hospital per stay; however, there will be a co-pay for the additional days. Part A does not have an out-of-pocket maximum
- Part B premiums cost $145.50 per month; however, if your annual income exceeds $87,000 as an individual or $174,000 as a married couple, you can expect to pay higher premiums. The yearly deductible is $203. Once you meet that deductible, your Part B plan will cover 80 percent of the covered costs, leaving you to pay 20 percent of the covered costs.
The Cost of Medigap Plans in Nebraska
There are various factors at play when looking at how much Medicare Supplement Insurance plans may cost you. For example, the general range for a Medigap Plan G Premium is $92–$282 per month. Your age, where you live, your gender, your use of tobacco, and the insurance company/policy you choose can all have a bearing on how much your Medigap premium will cost.
The policy that you choose will determine how high your deductibles and co-payments will be. For example, Medigap Plan G requires you to pay the $198 Part B deductible and covers 100 percent of all other Part A and B deductibles/co-payments.
The Cost of Medicare Advantage in Nebraska
Nebraska Medicare Advantage plans at a glance:
|Total Number of Plans||584|
|Average Monthly Premium||$73.07|
|Average Drug Deductible||$172.47|
As mentioned previously, Medicare Advantage plans come from pre-approved private insurance companies and are the all-in-one alternative to Original Medicare. Medicare Advantage plans provide Part A, Part B, and Part D coverage, along with other Medicare benefits like dental, vision, and hearing coverage.
Those who have enrolled in a Medicare Advantage plan in Nebraska are still required to continue paying the $144.60 Part B monthly premium. Depending on the plan, Medicare Advantage plans may also require the payment of an additional monthly premium that can range from $0 to $145 per month.
In terms of deductibles, Medicare Advantage plans can have a deductible as high as $1,000 per year, though this again depends on which plan you choose. For co-payments, each individual plan has different co-payment amounts for each covered service. For example, a Medicare Advantage plan may have a $10 co-pay for regular doctor visits, a $40 co-pay for visits to a specialist, and a co-pay of $300 for outpatient surgeries. Be sure to look closely at the terms of your selected policy to determine how much each co-pay be.
The Cost of Prescription Drug Plans in Nebraska
Nebraska prescription drug plans at a glance:
|Total Number of Plans||470|
|Average Monthly Premium||$55.15|
|Average Annual Deductible||$315.83|
Medicare Part D, or prescription drug plans, provides coverage for the cost of medication that doctors prescribe to you. As with Medicare Advantage plans, the overall cost of a Part D plan will ultimately depend on which one you choose.
Medicare Part D premiums range from $13.20 to $89.60 per month, depending on the plan you choose.
Deductibles can range from $0 to $435 a year, again, depending on the plan you choose. Once you meet the deductible for your plan, you can make coinsurance payments or co-payments for your medication at a reduced cost. The cost of coinsurance payments or co-payments also depends on your selected plan.
It should be important to note that not all Part D plans cover all types of medication, so be sure to compare your needed medications against what medications your selected plan will cover. There’s also what’s known as the “donut-hole,” which is a temporary limit on what the plan will cover for prescription medication. This coverage gap typically occurs after spending a specific amount on medication.
Cost of Special Needs Plans in Nebraska
Nebraska Special Needs Plans at a glance:
|Total Number of Plans||121|
|Average Monthly Drug Premium||$70.96|
|Average Annual Deductible||$416.29|
Medicare Special Needs Plans are a type of Medicare Advantage plan that aims to assist individuals who might have an extremely difficult time paying for Medicare. Special Needs Plans limit enrollment to beneficiaries who fit a number of requirements, including:
- Chronic-Condition Special Needs Plans, which cover beneficiaries with certain severe or disabling chronic conditions, such as cancer, chronic health failure, or HIV/AIDS.
- Institutional Special Needs Plans, which cover individuals living in an institution, such as a nursing home.
- Dual-Eligible Special Needs Plans, which covers people who are “dual eligibles” for both Medicare and Medicaid benefits.
How Do I Choose Between Original Medicare and Medicare Advantage?
While making the decision between Original Medicare and Medicare Advantage may seem difficult, it’s best to go with the coverage that best helps you manage both your health and finances.
Below you’ll find a table that gives solid information on the benefits and drawbacks of each coverage format.
How Do I Apply for Original Medicare in Nebraska?
There are three different ways to apply for Original Medicare in Nebraska:
- Apply online at the Social Security Administration website (SSA.gov/myaccount/).
- Call Social Security at 1 (844) 928-0667. If you are a TTY user, you can call 1 (844) 928-0667. SSA representatives can be reached Monday through Friday, from 7 a.m. to 7 p.m.
- Apply in person at Social Security offices located in Lincoln, Omaha, and Grand Island.
Many Americans are automatically enrolled in Medicare when they turn 65, provided that they’re already collecting Social Security or Railroad Retirement Board benefits. For those who are not collecting such benefits, you can sign up for Original Medicare during the Initial Enrollment Period.
This enrollment period occurs during a seven-month window that begins three months prior to your 65th birth month and ends three months after your 65th birth month. If you are not automatically enrolled in Original Medicare, be sure to take advantage of the Initial Enrollment Period, as failure to enroll can incur a late enrollment penalty, causing you to pay more for Medicare than you otherwise would. For more information on how to enroll, please visit the Medicare website at www.medicare.gov.
How Do I Apply for Medicare Advantage in Nebraska?
In order to apply for Medicare Advantage, you’ll first need to enroll in Original Medicare Part A and Part B plans during the Initial Enrollment Period. After this, you can take advantage of the Medicare Open Enrollment Period, which occurs every year from October 15 to December 7. During this time, you can switch your coverage to a Medicare Advantage plan.
What’s the Best Medicare Advantage Plan in Nebraska?
While the best Medicare Advantage plan is out there for you, there is no one plan that is definitively the best. The differences between medical needs and budgetary constraints can vary widely from person to person. So the best plan is truly in the eye of the beholder.
With that in mind, make a list of your general medical needs over the course of the year. If you need to make regular specialist visits, it would be helpful to join a plan that offers low specialist co-pays. If you require specific medications on a regular basis, it would help to join a plan that covers those medications in an affordable way. If money is your main concern, look for plans with lower monthly premiums, lower deductibles, or lower coinsurance/co-payment costs.
Though Medicare Part A has no monthly premium, Part B Premiums cost $144.60 per month. This does not include things like deductibles or co-payments (Part A has a deductible of $1,408, while Part B has a deductible of $198). Please contact an insurance agent, or visit the Nebraska Department of Insurance website, which offers the Nebraska Senior Health Insurance Information programs (SHIIP), at doi.nebraska.gov. No, Medicare and Medicaid are not the same thing.
The federal government manages the federal Medicare program and offers health insurance to citizens based on their age. In special circumstances, individuals who are younger than 65 can apply for Medicare, provided that they meet certain requirements.
State governments, on the other hand, manage Medicaid and typically offer health insurance based on applicants’ income. For Nebraska, the Nebraska Department of Health and Human Services manages Medicaid through the Medicaid and Long-Term Care Program.
FAQ: Nebraska Medicare
How much is Medicare when I turn 65?
Where can I find more information on Medicare and Medicaid in Nebraska?
Are Medicare and Medicaid the same thing?
Though Medicare Part A has no monthly premium, Part B Premiums cost $144.60 per month. This does not include things like deductibles or co-payments (Part A has a deductible of $1,408, while Part B has a deductible of $198).
Please contact an insurance agent, or visit the Nebraska Department of Insurance website, which offers the Nebraska Senior Health Insurance Information programs (SHIIP), at doi.nebraska.gov.
No, Medicare and Medicaid are not the same thing. The federal government manages the federal Medicare program and offers health insurance to citizens based on their age. In special circumstances, individuals who are younger than 65 can apply for Medicare, provided that they meet certain requirements. State governments, on the other hand, manage Medicaid and typically offer health insurance based on applicants’ income. For Nebraska, the Nebraska Department of Health and Human Services manages Medicaid through the Medicaid and Long-Term Care Program.
How do I qualify for Medicaid in Nebraska?
There are a number of different circumstances that can make you eligible for Medicaid in Nebraska. You can qualify for Medicaid if you are:
- 65 years of age or older
- An individual under 65 years of age who has a disability or is visually impaired according to Social Security guidelines
- An individual 18 years of age or younger
- A pregnant woman
- A parent or caretaker
- A former foster care youth
Conclusion: Compare Nebraska Medicare Plans Before You Buy
There are a lot of different options to wade through as you look for the right Medicare plan. Be sure to take stock of your medical and budgetary needs so that you can find the right plan for you. More importantly, compare different plans so that you can see the pros and cons with calm and clarity. Check out our plan comparison tool below; it’s free and easy to use!
The Easy Way to Get More Out of Medicare