Medicare in Nebraska
- Is it time to enroll in Medicare? Take time to learn more about Medicare in Nebraska and what plans you might choose from.
What Nebraska Medicare Plans Are Available?
In 2020, Nebraska Medicare provided healthcare coverage to 351,668 qualified residents, with 286,574 beneficiaries enrolled in Original Medicare and 65,094 opting for a Medicare Advantage plan. These plans are available to state residents who meet the program’s federal eligibility requirements, and qualified applicants may choose to receive coverage through Original Medicare Parts A and B or a Medicare Advantage policy administered by a private insurer.
Medicare enrollees who choose coverage through Original Medicare may elect to purchase one more of its components, which include:
- Part A: Medicare Part A covers hospitalization and other inpatient care at Medicare-approved facilities such as rehab centers and skilled nursing residences. Coverage includes expenses related to inpatient stays, including meals and medically necessary supplies. This component may also pay for services such as hospice and home health care.
- Part B: Medicare Part B covers general medical expenses and outpatient care at Medicare-approved facilities. Covered services may include vaccinations, ambulance transport, diagnostic tests and other preventative care.
Part D plans are Medicare prescription drug plans. Part D coverage may be added to Parts A and/or B and to Medicare Advantage plans that don’t include prescription drug coverage. Part D deductibles and copays may vary depending on the terms of the individual policy.
Medicare Advantage plans offer beneficiaries an alternative to Original Medicare. MA plans, which are sometimes referred to as Part C, are purchased through Medicare-approved private insurers, who adhere to guidelines established by Medicare. Coverage includes inpatient and outpatient services, and many policies include prescription drug benefits. Extras such as dental, vision and hearing benefits, which are not typically covered under Original Medicare, may be offered through Part C plans.
There are several types of Medicare Advantage plans:
- Health Maintenance Organizations: For HMO plan enrollees, care is coordinated by a primary care physician and services are provided by in-network practitioners and facilities.
- Preferred Provider Organizations: PPO plans also maintain a network of physicians and facilities, but members may elect to receive out-of-network care, typically at a higher cost.
- Private Fee-for Service: PFFS plan enrollees may receive medical services from any practitioner or facility that agrees to the plan’s terms.
- Special Needs Plans: SNPs are designed for individuals with certain diagnosed conditions or unique medical needs. SNP availability may vary by geographic location, and their networks usually include specialists and drug formularies that cater to beneficiaries’ healthcare requirements.
Medigap/Medicare Supplement Insurance
Medigap plans are designed to work alongside Medicare policies, covering out-of-pocket costs such as deductibles, copays and co-insurance. This supplemental insurance is issued by private insurers, and individual plans may cover all or some of these Medicare-related costs.
Who Is Eligible for Nebraska Medicare?
If you live in Nebraska and you're 65 or older, you may qualify to receive health care benefits through Medicare. If you’re younger than 65 and are disabled or have been diagnosed with end-stage renal disease, you may also qualify for Medicare benefits.
Automatic Enrollment in Medicare
Seniors who’ve been receiving retirement benefits from Social Security or the Railroad Retirement Board for four months or longer prior to their 65th birthday are automatically enrolled in Original Medicare, with coverage beginning the first day of their birthday month. Beneficiaries who would prefer Medicare Advantage may select an MA plan during the qualifying enrollment period.
Medicare Enrollment Periods
Applicants may only enroll in Medicare during its official enrollment periods. During these specified times, applicants and current beneficiaries may sign up for initial coverage, change plans or switch between Original Medicare and Medicare Advantage. Initial enrollment and plan changes should be made during the applicable enrollment period:
- Initial Enrollment Period (IEP): Your Medicare IEP runs for seven months. The enrollment period begins three months prior to the month you turn 65 and ends three months after your birthday month.
- General Enrollment Period (GEP): Qualified individuals who didn’t sign up during their IEP may enroll in Original Medicare during the annual GEP. This period begins on January 1 and ends on March 31.
- Special Enrollment Period (SEP): SEPs are designed for applicants who experience qualifying events such as job loss, which result in the loss of private insurance. SEPs last eight months, beginning on the first day of the month after the qualifying event. Beneficiaries who enroll in a plan during an SEP don’t typically have to pay a late-enrollment fee.
Medicare Advantage and Prescription Drug Plan Enrollment Periods
Initial enrollment for Medicare Advantage may be completed during Medicare’s 7-month initial enrollment period or during the annual enrollment period, which occurs between October 15 and December 7. At this time, beneficiaries may switch between Original Medicare and Medicare Advantage plans. Enrollees who haven’t previously purchased a Part D plan may also do so at this time.
A second Medicare Advantage enrollment period is available between January 1 and March 31. During this period, current MA beneficiaries may switch to a different Advantage plan or revert coverage back to Original Medicare.
How Do I Enroll in Medicare in Nebraska?
Eligible applicants who aren't automatically enrolled may apply for Medicare benefits through the Social Security Administration. You may sign up for benefits by doing one of the following:
- Filling out an online application through the Social Security Administration's website
- Calling Social Security at (800) 772-1213
- Visiting your local Social Security office
Contact Information for Nebraska Medicare, Medicaid and Insurance Help
Applying for medical insurance through state or federal programs can be complex. If you need help with the process, several Nebraska agencies offer no-cost counseling or other helpful resources to state citizens.
Nebraska Medicaid provides vital health care coverage to low-income residents and other qualified groups. HelpAdvisor offers comprehensive information about the state’s Medicaid guidelines and application process and other available insurance programs. If you need additional information or resources, an online contact form is available.
Medicare-eligible state residents can learn more about the program through Nebraska SHIP. Interested individuals may contact SHIP’s toll-free hotline at (800) 234-7119 to ask questions or schedule an appointment with a SHIP counselor.
Nebraska Rx Card
The Nebraska Rx Card program was designed to help Nebraskans afford the prescription medications they need. The program is open to all state residents, regardless of income. Information is available by calling (402) 909-1128.
Nebraska State Unit on Aging
The State Unit on Aging offers seniors a wide array of services, including insurance-related education and resources. The agency may be reached by calling (402) 471-2307 or by emailing DHHS.Aging@nebraska.gov.