Medicare Basics: Your Complete Guide to Medicare in Nevada
What You'll Learn
- How Medicare works and who's eligible
- The differences between Medicare Parts A, B, C, and D
- When and how to enroll without penalties
- What Medicare covers and what it doesn't
- How much Medicare costs in 2024
- Your Medicare choices in Nevada
Medicare is federal health insurance for people 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD). Understanding how Medicare works is crucial for Nevada seniors to make informed healthcare decisions and avoid costly mistakes.
What is Medicare?
Medicare is the federal health insurance program created in 1965. It's not a single plan but rather a collection of coverage options that work together to provide healthcare for seniors and disabled Americans.
Who's Eligible?
- Age 65 or older
- Under 65 with certain disabilities
- Any age with End-Stage Renal Disease
- Any age with ALS (Lou Gehrig's disease)
Key Facts
- Over 64 million Americans have Medicare
- ~550,000 Nevadans are enrolled
- Run by Centers for Medicare & Medicaid Services (CMS)
- Accepted by most doctors nationwide
Important: Medicare is NOT...
- • Medicaid (state program for low-income individuals)
- • Veterans benefits (separate VA system)
- • Private insurance (it's federal insurance)
- • Free healthcare (you pay premiums, deductibles, and coinsurance)
The Four Parts of Medicare
Part A
Hospital Insurance
✓ Covers
- • Inpatient hospital stays
- • Skilled nursing facility care
- • Hospice care
- • Home health care
- • Inpatient mental health care
✗ Doesn't Cover
- • Private-duty nursing
- • Private room (unless medically necessary)
- • Personal care items
- • Custodial care
Part B
Medical Insurance
✓ Covers
- • Doctor visits
- • Outpatient care
- • Preventive services
- • Ambulance services
- • Durable medical equipment
- • Mental health services
- • Lab tests and X-rays
✗ Doesn't Cover
- • Most prescription drugs
- • Routine dental/vision/hearing
- • Cosmetic surgery
- • Acupuncture
Part C
Medicare Advantage
✓ Covers
- • Everything in Parts A & B
- • Usually Part D (drugs)
- • Often dental, vision, hearing
- • Gym memberships
- • Over-the-counter benefits
✗ Doesn't Cover
- • Care outside plan network (except emergencies)
- • Medigap supplements
Part D
Prescription Drug Coverage
✓ Covers
- • Generic drugs
- • Brand-name drugs
- • Specialty drugs
- • Vaccines
- • Insulin (capped at $35/month)
✗ Doesn't Cover
- • Drugs not on formulary
- • Over-the-counter medications
- • Vitamins
- • Drugs for cosmetic purposes
💡 Nevada Tip: Original Medicare vs. Medicare Advantage
Original Medicare (A + B)
- • See any doctor who accepts Medicare
- • No referrals needed for specialists
- • Works nationwide
- • Add Medigap + Part D separately
Medicare Advantage (Part C)
- • Network restrictions (HMO/PPO)
- • May need referrals
- • Usually includes Part D
- • Often has extra benefits
When Can You Enroll in Medicare?
Initial Enrollment Period (IEP)
Duration: 7 months total
Timing: 3 months before turning 65 + birthday month + 3 months after
Use for: First chance to sign up for Medicare Parts A & B
Late penalty: None - this is your first opportunity
Example: If you turn 65 in June, you can enroll March 1 - September 30
General Enrollment Period (GEP)
Duration: January 1 - March 31
Timing: Every year
Use for: Sign up if you missed initial enrollment
Late penalty: 10% Part B premium increase for each year delayed
Example: Coverage starts July 1 if you enroll during GEP
Annual Enrollment Period (AEP)
Duration: October 15 - December 7
Timing: Every year
Use for: Change Medicare Advantage or Part D plans
Late penalty: N/A - for plan changes only
Example: Changes take effect January 1
Medicare Advantage Open Enrollment
Duration: January 1 - March 31
Timing: Every year
Use for: Switch Medicare Advantage plans or return to Original Medicare
Late penalty: N/A - for MA members only
Example: One change allowed during this period
Special Enrollment Period (SEP)
Duration: Varies
Timing: When qualifying events occur
Use for: Change plans due to special circumstances
Late penalty: None if qualifying event
Example: Moving, losing coverage, qualifying for Extra Help
⚠️ Avoid Late Enrollment Penalties!
Part B Penalty: 10% premium increase for each 12-month period you were eligible but didn't enroll. This penalty lasts for life!
Part D Penalty: 1% of the national base premium for each month without creditable drug coverage. Also permanent!
Example: Delay Part B by 2 years = 20% higher premiums forever. On a $174.70 premium, that's an extra $35/month or $420/year!
How Much Does Medicare Cost? (2024 Rates)
Original Medicare Costs
Part A (Hospital Insurance)
Part B (Medical Insurance)
Income-Related Monthly Adjustment (IRMAA)
Higher earners pay more for Part B:
- • Individual income $103,000-$129,000: $244.60/month
- • Individual income $129,000-$161,000: $349.40/month
- • Individual income $161,000-$193,000: $454.20/month
- • Individual income > $500,000: $594.00/month
Part D (Prescription Drugs)
Estimated Annual Costs for Nevada Seniors
Healthy Senior
$3,000-4,000/year
- • Part B premiums
- • Part D premiums
- • Minimal medical use
Average Use
$5,000-7,000/year
- • Premiums + deductibles
- • Some specialist visits
- • Regular medications
High Medical Needs
$8,000+/year
- • All premiums/deductibles
- • 20% coinsurance adds up
- • Consider Medigap
What Does Medicare Cover?
✓ Medicare Covers
Preventive Services (FREE)
- • Annual wellness visit
- • Mammograms & colonoscopies
- • Flu shots & pneumonia vaccines
- • Diabetes & cardiovascular screenings
Medical Services
- • Doctor visits & specialist care
- • Hospital stays & surgeries
- • Lab tests & X-rays
- • Physical/occupational therapy
- • Mental health services
Equipment & Supplies
- • Wheelchairs & walkers
- • Oxygen equipment
- • Diabetic supplies
- • Prosthetics
✗ Medicare Doesn't Cover
Routine Care
- • Dental exams, cleanings, fillings
- • Eye exams for glasses
- • Hearing exams & hearing aids
- • Foot care (except diabetes)
Long-Term Care
- • Nursing home care (custodial)
- • Assisted living facilities
- • Adult day care
- • Home care (non-medical)
Other Services
- • Cosmetic surgery
- • Acupuncture
- • Medical care abroad
- • Concierge care fees
Nevada Coverage Note
While Medicare is a federal program, some Nevada Medicare Advantage plans offer additional benefits like gym memberships at local Las Vegas and Reno fitness centers, transportation to medical appointments, and over-the-counter allowances at Nevada pharmacies.
5 Common Medicare Mistakes to Avoid
Mistake: Assuming Medicare is free
Reality: While Part A is usually premium-free, Part B has monthly premiums, and you'll have deductibles and coinsurance
💡 Tip: Budget for premiums, deductibles, and 20% coinsurance
Mistake: Thinking Medicare covers everything
Reality: Original Medicare doesn't cover dental, vision, hearing, or long-term care
💡 Tip: Consider Medicare Advantage or separate coverage for these services
Mistake: Missing enrollment deadlines
Reality: Late enrollment can result in lifetime penalties and coverage gaps
💡 Tip: Mark your calendar 3 months before turning 65
Mistake: Not comparing drug plans annually
Reality: Plans change formularies and costs every year
💡 Tip: Review your Part D plan every October during AEP
Mistake: Confusing Medicare with Medicaid
Reality: Medicare is federal health insurance; Medicaid is state assistance for low-income individuals
💡 Tip: You may qualify for both (dual eligible)
Medicare in Nevada: What You Need to Know
Nevada Medicare Statistics
- Total Medicare beneficiaries:~550,000
- Original Medicare:~65%
- Medicare Advantage:~35%
- Have Part D coverage:~75%
- Dual eligible (Medicare + Medicaid):~15%
Popular in Nevada
Top Medicare Advantage Plans
- • Humana (largest network)
- • UnitedHealthcare
- • Anthem Blue Cross Blue Shield
- • SelectHealth (Intermountain)
Major Hospital Systems
- • UMC (Las Vegas)
- • Sunrise Health System
- • Renown Health (Reno)
- • St. Rose Dominican
Nevada-Specific Resources
Nevada SHIP (State Health Insurance Assistance Program)
Free, unbiased Medicare counseling
📞 1-800-307-4444
🌐 adsd.nv.gov
📍 Offices in Las Vegas, Reno, Carson City
Nevada Medicaid (for dual eligibles)
May help with Medicare costs if you qualify
📞 1-800-992-0900
🌐 dwss.nv.gov
💰 Income limits apply
Your Medicare Checklist: Getting Started
3 Months Before Turning 65
- • Create your Medicare.gov account
- • Decide: Original Medicare or Medicare Advantage?
- • Research Medigap plans if choosing Original Medicare
- • Check if your doctors accept Medicare
Month of 65th Birthday
- • Enroll in Medicare Parts A & B (if not automatic)
- • Choose and enroll in Part D or Medicare Advantage
- • Apply for Medigap during open enrollment
- • Apply for Extra Help if income-qualified
After Enrollment
- • Get your Medicare card (keep it safe!)
- • Schedule your "Welcome to Medicare" visit
- • Review your coverage annually during AEP
- • Keep all Medicare communications
Key Takeaways: Medicare Basics
Medicare has 4 parts
A (Hospital), B (Medical), C (Advantage), D (Drugs)
Sign up on time
Avoid lifetime penalties by enrolling during your IEP
It's not free
Budget for premiums, deductibles, and 20% coinsurance
Gaps in coverage exist
Consider Medigap or Medicare Advantage for full protection
Review annually
Plans and needs change - use Annual Enrollment Period
Help is available
Nevada SHIP offers free Medicare counseling
Ready to Make Smart Medicare Choices?
Get personalized help understanding your Medicare options in Nevada.