Medicare Advantage Plans in Las Vegas and Nevada
Medicare Advantage plans, also called Medicare Part C, are another way to receive your Medicare benefits.
Instead of receiving your Part A and Part B benefits directly through Original Medicare, you
receive them through a Medicare-approved private insurance company. Many Medicare Advantage plans
also include Medicare Part D prescription drug coverage, and some plans may offer additional benefits
such as dental, vision, hearing, fitness, transportation, and over-the-counter allowances, depending on
the plan and service area.
If you live in Las Vegas, Henderson, North Las Vegas, Boulder City, Mesquite, Pahrump, Laughlin, or
another Nevada community, choosing a Medicare Advantage plan is not just about the monthly premium.
North Las Vegas residents can also review our local Medicare help page for North Las Vegas to learn more about Medicare Advantage, Medicare Supplement Insurance, Part D, VA-related questions, and local plan review options.
The right plan should be reviewed based on your doctors, specialists, hospitals, prescriptions, pharmacy,
provider network, out-of-pocket costs, travel needs, and county of residence.
At Medicare in Las Vegas, we help people with Medicare compare available Medicare Advantage options
in plain language. Our goal is to help you understand how the plan works before you enroll, not after you
have a problem using it.
What Is a Medicare Advantage Plan?
A Medicare Advantage plan is an alternative way to receive your Original Medicare benefits. These plans
are offered by private insurance companies that contract with Medicare. You must have both Medicare
Part A and Medicare Part B to join a Medicare Advantage plan, and you must continue to pay your
Medicare Part B premium.
Medicare Advantage plans must cover medically necessary services covered by Original Medicare, but the
way you access care can be different. Depending on the plan, you may need to use a provider network,
choose a primary care doctor, follow referral rules, or receive prior authorization for certain services.
Copays, deductibles, drug coverage, benefits, provider networks, and maximum out-of-pocket costs can
vary from plan to plan.
What Medicare Advantage Plans May Include
Many Medicare Advantage plans combine several types of coverage into one plan. Depending on the plan
and county, coverage may include:
• Medicare Part A hospital coverage
• Medicare Part B medical coverage
• Medicare Part D prescription drug coverage, if included in the plan
• A network of doctors, specialists, hospitals, and provider groups
• A yearly limit on covered in-network medical out-of-pocket costs
• Dental, vision, hearing, fitness, transportation, and over-the-counter benefits, depending on the plan
• Care coordination or condition-specific benefits in certain Special Needs Plans
Benefits and costs can change each year. That is why reviewing the Annual Notice of Change and
comparing your plan options during the appropriate enrollment period is important.
Why Las Vegas Provider Networks Matter
Provider networks are one of the most important parts of choosing a Medicare Advantage plan in Las
Vegas and Nevada. A plan may look attractive because of its benefits or premium, but it still needs to work
with your doctors, specialists, hospitals, prescriptions, and pharmacy preferences.
Before enrolling in a Medicare Advantage plan, review:
• Your primary care doctor and specialists
• Your preferred hospital or medical group
• Your prescriptions and drug tiers
• Your preferred pharmacy and mail-order options
• Referral rules and prior authorization requirements
• In-network and out-of-network costs
• Emergency, urgent care, and travel coverage rules
• The plan maximum out-of-pocket limit for covered medical services
A local review can be helpful because provider groups, networks, and plan availability can differ by county
and ZIP code.
HMO vs. PPO Medicare Advantage Plans in Las Vegas
Two common types of Medicare Advantage plans in Las Vegas are HMO and PPO plans.
HMO plans usually require you to use doctors, hospitals, and providers in the plan network, except for
emergencies, out-of-area urgent care, or out-of-area dialysis. Some HMO plans may require a primary
care doctor and referrals to see specialists.
PPO plans usually provide more flexibility to see out-of-network providers, but you may pay more when
you go outside the plan network. PPO plans generally do not require you to choose a primary care doctor
or get referrals to see specialists, although plan rules can vary.
The right choice depends on your doctors, medications, health needs, travel habits, budget, and comfort
level with provider networks.
Special Needs Plans, D-SNPs, and C-SNPs
Some Medicare Advantage plans are designed for people with specific health or financial situations. These
plans are called Special Needs Plans, or SNPs. A Dual Eligible Special Needs Plan, often called a D-SNP,
may be available to people who have both Medicare and Medicaid. A Chronic Condition Special Needs
Plan, often called a C-SNP, may be available to people with certain qualifying chronic health conditions,
depending on plan availability and eligibility rules.
SNPs may include care coordination and benefits designed around the needs of the people they serve.
Eligibility, plan rules, benefits, networks, and prescription coverage should be reviewed carefully before
enrolling
Do Medicare Advantage Plans Have Monthly Premiums?
Some Medicare Advantage plans may have a $0 monthly plan premium, while others may charge a monthly premium. However, you must continue to pay your Medicare Part B premium to stay enrolled in a Medicare Advantage plan.
"In fact, certain Medicare Advantage plans available here in Clark County include a Part B Giveback benefit — a feature that actually reduces or eliminates that $202.90 monthly deduction from your Social Security check. It is one of the most overlooked benefits in the Las Vegas Medicare market and worth understanding before you choose a plan."
The monthly premium is only one part of the decision. You should also compare copays, coinsurance, prescription costs, specialist costs, hospital costs, dental coverage, provider access, and the plan’s yearly maximum out-of-pocket limit.
Medicare Advantage plans, also called Medicare Part C, are another way to receive your Medicare benefits.
Instead of receiving your Part A and Part B benefits directly through Original Medicare, you
receive them through a Medicare-approved private insurance company. Many Medicare Advantage plans
also include Medicare Part D prescription drug coverage, and some plans may offer additional benefits
such as dental, vision, hearing, fitness, transportation, and over-the-counter allowances, depending on
the plan and service area.
If you live in Las Vegas, Henderson, North Las Vegas, Boulder City, Mesquite, Pahrump, Laughlin, or
another Nevada community, choosing a Medicare Advantage plan is not just about the monthly premium.
North Las Vegas residents can also review our local Medicare help page for North Las Vegas to learn more about Medicare Advantage, Medicare Supplement Insurance, Part D, VA-related questions, and local plan review options.
The right plan should be reviewed based on your doctors, specialists, hospitals, prescriptions, pharmacy,
provider network, out-of-pocket costs, travel needs, and county of residence.
At Medicare in Las Vegas, we help people with Medicare compare available Medicare Advantage options
in plain language. Our goal is to help you understand how the plan works before you enroll, not after you
have a problem using it.
What Is a Medicare Advantage Plan?
A Medicare Advantage plan is an alternative way to receive your Original Medicare benefits. These plans
are offered by private insurance companies that contract with Medicare. You must have both Medicare
Part A and Medicare Part B to join a Medicare Advantage plan, and you must continue to pay your
Medicare Part B premium.
Medicare Advantage plans must cover medically necessary services covered by Original Medicare, but the
way you access care can be different. Depending on the plan, you may need to use a provider network,
choose a primary care doctor, follow referral rules, or receive prior authorization for certain services.
Copays, deductibles, drug coverage, benefits, provider networks, and maximum out-of-pocket costs can
vary from plan to plan.
What Medicare Advantage Plans May Include
Many Medicare Advantage plans combine several types of coverage into one plan. Depending on the plan
and county, coverage may include:
• Medicare Part A hospital coverage
• Medicare Part B medical coverage
• Medicare Part D prescription drug coverage, if included in the plan
• A network of doctors, specialists, hospitals, and provider groups
• A yearly limit on covered in-network medical out-of-pocket costs
• Dental, vision, hearing, fitness, transportation, and over-the-counter benefits, depending on the plan
• Care coordination or condition-specific benefits in certain Special Needs Plans
Benefits and costs can change each year. That is why reviewing the Annual Notice of Change and
comparing your plan options during the appropriate enrollment period is important.
Why Las Vegas Provider Networks Matter
Provider networks are one of the most important parts of choosing a Medicare Advantage plan in Las
Vegas and Nevada. A plan may look attractive because of its benefits or premium, but it still needs to work
with your doctors, specialists, hospitals, prescriptions, and pharmacy preferences.
Before enrolling in a Medicare Advantage plan, review:
• Your primary care doctor and specialists
• Your preferred hospital or medical group
• Your prescriptions and drug tiers
• Your preferred pharmacy and mail-order options
• Referral rules and prior authorization requirements
• In-network and out-of-network costs
• Emergency, urgent care, and travel coverage rules
• The plan maximum out-of-pocket limit for covered medical services
A local review can be helpful because provider groups, networks, and plan availability can differ by county
and ZIP code.
HMO vs. PPO Medicare Advantage Plans in Las Vegas
Two common types of Medicare Advantage plans in Las Vegas are HMO and PPO plans.
HMO plans usually require you to use doctors, hospitals, and providers in the plan network, except for
emergencies, out-of-area urgent care, or out-of-area dialysis. Some HMO plans may require a primary
care doctor and referrals to see specialists.
PPO plans usually provide more flexibility to see out-of-network providers, but you may pay more when
you go outside the plan network. PPO plans generally do not require you to choose a primary care doctor
or get referrals to see specialists, although plan rules can vary.
The right choice depends on your doctors, medications, health needs, travel habits, budget, and comfort
level with provider networks.
Special Needs Plans, D-SNPs, and C-SNPs
Some Medicare Advantage plans are designed for people with specific health or financial situations. These
plans are called Special Needs Plans, or SNPs. A Dual Eligible Special Needs Plan, often called a D-SNP,
may be available to people who have both Medicare and Medicaid. A Chronic Condition Special Needs
Plan, often called a C-SNP, may be available to people with certain qualifying chronic health conditions,
depending on plan availability and eligibility rules.
SNPs may include care coordination and benefits designed around the needs of the people they serve.
Eligibility, plan rules, benefits, networks, and prescription coverage should be reviewed carefully before
enrolling
Do Medicare Advantage Plans Have Monthly Premiums?
Some Medicare Advantage plans may have a $0 monthly plan premium, while others may charge a monthly premium. However, you must continue to pay your Medicare Part B premium to stay enrolled in a Medicare Advantage plan.
"In fact, certain Medicare Advantage plans available here in Clark County include a Part B Giveback benefit — a feature that actually reduces or eliminates that $202.90 monthly deduction from your Social Security check. It is one of the most overlooked benefits in the Las Vegas Medicare market and worth understanding before you choose a plan."
The monthly premium is only one part of the decision. You should also compare copays, coinsurance, prescription costs, specialist costs, hospital costs, dental coverage, provider access, and the plan’s yearly maximum out-of-pocket limit.
5 Star Plans, Special Needs Plans, D-SNPs, and C-SNPs
What Is a 5-Star Medicare Advantage Plan?
Medicare rates Medicare Advantage plans each year on a scale of 1 to 5 stars based on factors such as member experience, customer service and quality of care. A 5-star rating represents Medicare’s highest quality rating. However, ratings are only one consideration—benefits, prescription coverage, provider networks and out-of-pocket costs should also be reviewed when choosing a plan that fits your needs.
What are Special Needs Medicare Advantage Plans?
Some Medicare Advantage plans are designed for people with specific health or financial situations. These
plans are called Special Needs Plans, or SNPs.
What are DSNP Medicare Advantage Plans?
A Dual Eligible Special Needs Plan, often called a D-SNP
These plans may be available to people who have both Medicare and Medicaid.
What are CSNP Medicare Advantage Plans?
A Chronic Condition Special Needs Plan, often called a C-SNP, may be available to people with certain qualifying chronic health conditions, depending on plan availability and eligibility rules.
SNPs may include care coordination and benefits designed around the needs of the people they serve.
Eligibility, plan rules, benefits, networks, and prescription coverage should be reviewed carefully before
enrolling
Medicare rates Medicare Advantage plans each year on a scale of 1 to 5 stars based on factors such as member experience, customer service and quality of care. A 5-star rating represents Medicare’s highest quality rating. However, ratings are only one consideration—benefits, prescription coverage, provider networks and out-of-pocket costs should also be reviewed when choosing a plan that fits your needs.
What are Special Needs Medicare Advantage Plans?
Some Medicare Advantage plans are designed for people with specific health or financial situations. These
plans are called Special Needs Plans, or SNPs.
What are DSNP Medicare Advantage Plans?
A Dual Eligible Special Needs Plan, often called a D-SNP
These plans may be available to people who have both Medicare and Medicaid.
What are CSNP Medicare Advantage Plans?
A Chronic Condition Special Needs Plan, often called a C-SNP, may be available to people with certain qualifying chronic health conditions, depending on plan availability and eligibility rules.
SNPs may include care coordination and benefits designed around the needs of the people they serve.
Eligibility, plan rules, benefits, networks, and prescription coverage should be reviewed carefully before
enrolling
Learn More about Special Medicare Advantage Plans
Medicare Advantage plans rated
5 stars have earned Medicare’s highest quality rating. Compare benefits, costs, prescriptions and provider networks to determine which plan fits your needs. |
Dual Eligible Special Needs Plans
(D-SNPs) are designed for people who qualify for both Medicare and Medicaid. These plans may provide coordinated care and additional benefits based on eligibility and service area. |
Chronic Condition Special Needs Plans (C-SNPs) are Medicare Advantage plans designed for people with certain qualifying chronic or disabling conditions. Eligibility, benefits and plan availability vary by service area.
|
Prescription Drug Coverage and Medicare Advantage
Many Medicare Advantage plans include Medicare Part D prescription drug coverage. These plans are
often called MAPD plans. If your Medicare Advantage plan includes drug coverage, you generally receive
your medical and prescription drug benefits through that one plan.
Important warning: If you are enrolled in a Medicare Advantage plan that includes prescription drug
coverage and you join a separate stand-alone Medicare Part D drug plan, in most cases you may be
disenrolled from your Medicare Advantage plan and returned to Original Medicare. Always review your
current coverage before making a Part D change.
Prescription formularies, drug tiers, deductibles, preferred pharmacies, and copays can change.
Reviewing your prescriptions every year can help you avoid surprises.
Important Prescription Drug Coverage Warning
Many Medicare Advantage plans include prescription drug coverage. If you are enrolled in a Medicare Advantage plan that includes Part D drug coverage, enrolling in a separate stand-alone Medicare Part D prescription drug plan may cause you to be disenrolled from your Medicare Advantage plan and returned to Original Medicare.
Before making any changes, review your plan carefully or speak with a licensed Medicare agent.
When Can You Enroll in or Change a Medicare Advantage Plan?
You can usually join, switch, or leave a Medicare Advantage plan only during certain Medicare enrollment
periods. Common enrollment periods include:
• Initial Enrollment Period: when you are first eligible for Medicare Part A and Part B.
• Annual Enrollment Period: October 15 through December 7, with changes generally effective January 1.
• Medicare Advantage Open Enrollment Period: January 1 through March 31 for people already enrolled in a
Medicare Advantage plan.
• Special Enrollment Periods: available after certain life events, such as moving, losing other coverage,
qualifying for Extra Help or Medicaid, or other situations allowed by Medicare.
• 5-Star Special Enrollment Period: if a 5-star Medicare Advantage plan is available in your area, Medicare may
allow one plan change during the eligible window.
Enrollment rules depend on your current coverage and the reason for the change. Before changing plans,
confirm the effective date and how the change may affect your doctors, prescriptions, and current
benefits.
How Medicare in Las Vegas Helps You Compare Plans
At Medicare in Las Vegas, we provide local Medicare guidance for people comparing Medicare Advantage
plans in Las Vegas and throughout Nevada. We review the details that often matter most when you
actually use the plan.
Our Medicare Advantage plan review may include:
• Your doctors, specialists, hospitals, and medical groups
• Your prescription drug list and pharmacy preferences
• HMO, PPO, D-SNP, C-SNP, and other available plan types
• Monthly premiums, copays, deductibles, and maximum out-of-pocket costs
• Dental, vision, hearing, fitness, transportation, and over-the-counter benefits
• Plan rules, referrals, prior authorizations, and network access
• Enrollment periods and plan-change opportunities
We focus on education first. Our role is to help you compare available options, understand how they work,
and decide which direction may fit your needs.
Many Medicare Advantage plans include Medicare Part D prescription drug coverage. These plans are
often called MAPD plans. If your Medicare Advantage plan includes drug coverage, you generally receive
your medical and prescription drug benefits through that one plan.
Important warning: If you are enrolled in a Medicare Advantage plan that includes prescription drug
coverage and you join a separate stand-alone Medicare Part D drug plan, in most cases you may be
disenrolled from your Medicare Advantage plan and returned to Original Medicare. Always review your
current coverage before making a Part D change.
Prescription formularies, drug tiers, deductibles, preferred pharmacies, and copays can change.
Reviewing your prescriptions every year can help you avoid surprises.
Important Prescription Drug Coverage Warning
Many Medicare Advantage plans include prescription drug coverage. If you are enrolled in a Medicare Advantage plan that includes Part D drug coverage, enrolling in a separate stand-alone Medicare Part D prescription drug plan may cause you to be disenrolled from your Medicare Advantage plan and returned to Original Medicare.
Before making any changes, review your plan carefully or speak with a licensed Medicare agent.
When Can You Enroll in or Change a Medicare Advantage Plan?
You can usually join, switch, or leave a Medicare Advantage plan only during certain Medicare enrollment
periods. Common enrollment periods include:
• Initial Enrollment Period: when you are first eligible for Medicare Part A and Part B.
• Annual Enrollment Period: October 15 through December 7, with changes generally effective January 1.
• Medicare Advantage Open Enrollment Period: January 1 through March 31 for people already enrolled in a
Medicare Advantage plan.
• Special Enrollment Periods: available after certain life events, such as moving, losing other coverage,
qualifying for Extra Help or Medicaid, or other situations allowed by Medicare.
• 5-Star Special Enrollment Period: if a 5-star Medicare Advantage plan is available in your area, Medicare may
allow one plan change during the eligible window.
Enrollment rules depend on your current coverage and the reason for the change. Before changing plans,
confirm the effective date and how the change may affect your doctors, prescriptions, and current
benefits.
How Medicare in Las Vegas Helps You Compare Plans
At Medicare in Las Vegas, we provide local Medicare guidance for people comparing Medicare Advantage
plans in Las Vegas and throughout Nevada. We review the details that often matter most when you
actually use the plan.
Our Medicare Advantage plan review may include:
• Your doctors, specialists, hospitals, and medical groups
• Your prescription drug list and pharmacy preferences
• HMO, PPO, D-SNP, C-SNP, and other available plan types
• Monthly premiums, copays, deductibles, and maximum out-of-pocket costs
• Dental, vision, hearing, fitness, transportation, and over-the-counter benefits
• Plan rules, referrals, prior authorizations, and network access
• Enrollment periods and plan-change opportunities
We focus on education first. Our role is to help you compare available options, understand how they work,
and decide which direction may fit your needs.
Call to Request a Medicare Advantage Plan Review
Have questions about Medicare Advantage plans in Las Vegas or Nevada?
Call Medicare in Las Vegas at
702.403.6348 (TTY: 711)
Request a personal Medicare plan review.
David Karel, Nevada Licensed Insurance Agent #210603
Have questions about Medicare Advantage plans in Las Vegas or Nevada?
Call Medicare in Las Vegas at
702.403.6348 (TTY: 711)
Request a personal Medicare plan review.
David Karel, Nevada Licensed Insurance Agent #210603
Frequently Asked Questions About Medicare Advantage Plans in Las Vegas
What is a Medicare Advantage Plan?
A Medicare Advantage plan, also called Medicare Part C, is another way to receive your Medicare benefits. These plans are offered by private insurance companies approved by Medicare. A Medicare Advantage plan includes your Medicare Part A hospital coverage and Part B medical coverage, and many plans also include Medicare Part D prescription drug coverage. Some plans may also offer extra benefits, such as dental, vision, hearing, fitness, transportation, or over-the-counter benefits, depending on the plan and service area.
Are Medicare Advantage Plans the same as Medicare Supplement plans?
No. Medicare Advantage plans and Medicare Supplement plans, also called Medigap, are different types of coverage. A Medicare Advantage plan replaces the way you receive your Original Medicare benefits through a private Medicare-approved plan. A Medicare Supplement plan works with Original Medicare to help pay certain out-of-pocket costs, such as deductibles, copays, or coinsurance. In most cases, you cannot use a Medicare Supplement plan to pay costs from a Medicare Advantage plan.
What is a Medicare Advantage Plan?
A Medicare Advantage plan, also called Medicare Part C, is another way to receive your Medicare benefits. These plans are offered by private insurance companies approved by Medicare. A Medicare Advantage plan includes your Medicare Part A hospital coverage and Part B medical coverage, and many plans also include Medicare Part D prescription drug coverage. Some plans may also offer extra benefits, such as dental, vision, hearing, fitness, transportation, or over-the-counter benefits, depending on the plan and service area.
Are Medicare Advantage Plans the same as Medicare Supplement plans?
No. Medicare Advantage plans and Medicare Supplement plans, also called Medigap, are different types of coverage. A Medicare Advantage plan replaces the way you receive your Original Medicare benefits through a private Medicare-approved plan. A Medicare Supplement plan works with Original Medicare to help pay certain out-of-pocket costs, such as deductibles, copays, or coinsurance. In most cases, you cannot use a Medicare Supplement plan to pay costs from a Medicare Advantage plan.
Las Vegas and Nevada Medicare Advantage Plan Types
HMO(Health Maintenance Organization) Plan:
All of your health and wellness services (with the exception of emergency care, out-of-area urgent care, or out-of-area dialysis), will generally go through a primary care physician along with any hospitals and/or specialists that are in your plan’s network. (If you see someone outside of this network, you may be responsible for the full cost of service/treatment.)
PPO (Preferred Provider Organization) Plan:
Although you will generally pay less if you go to a doctor, hospital, or other health care provider in your plan’s network, you have the option of going to an out-of-network provider. You do not need to choose a primary care physician, and, in most cases, you do not need a referral to see a specialist.
SNP (Special Needs) Plan:
This type of plan is for people who require specialized health care, such as those who live in a nursing home, or have chronic health conditions, or who are on both Medicare and Medicaid. You will generally need to select a primary care physician who can refer you to a specialist in the network, if/when one is needed. Medicare Prescription Drug coverage is included in this plan.
To find out more about Special Needs Plans visit Medicare.gov
DSNP Plans
Health plans for people who have both Medicare and Medicaid
Dual plans offer extra benefits and features at no extra cost
Dual plans go beyond either Medicaid or Original Medicare alone. You’ll still get to keep your Medicaid benefits and better yet, with a dual plan, you could get additional extra benefits and features than Original Medicare at no extra cost.
As a bonus, people who are Dual Eligible usually have a Zero premium plan cost.
HMO(Health Maintenance Organization) Plan:
All of your health and wellness services (with the exception of emergency care, out-of-area urgent care, or out-of-area dialysis), will generally go through a primary care physician along with any hospitals and/or specialists that are in your plan’s network. (If you see someone outside of this network, you may be responsible for the full cost of service/treatment.)
PPO (Preferred Provider Organization) Plan:
Although you will generally pay less if you go to a doctor, hospital, or other health care provider in your plan’s network, you have the option of going to an out-of-network provider. You do not need to choose a primary care physician, and, in most cases, you do not need a referral to see a specialist.
SNP (Special Needs) Plan:
This type of plan is for people who require specialized health care, such as those who live in a nursing home, or have chronic health conditions, or who are on both Medicare and Medicaid. You will generally need to select a primary care physician who can refer you to a specialist in the network, if/when one is needed. Medicare Prescription Drug coverage is included in this plan.
To find out more about Special Needs Plans visit Medicare.gov
DSNP Plans
Health plans for people who have both Medicare and Medicaid
Dual plans offer extra benefits and features at no extra cost
Dual plans go beyond either Medicaid or Original Medicare alone. You’ll still get to keep your Medicaid benefits and better yet, with a dual plan, you could get additional extra benefits and features than Original Medicare at no extra cost.
As a bonus, people who are Dual Eligible usually have a Zero premium plan cost.
Understanding Medicare Advantage Plans
Your Health Plan Options
Your Health Plan Options
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