Medicare Advantage in Las Vegas (2024 Guide) -

Overview of Medicare Advantage in Las Vegas

Diving into the landscape of Medicare Advantage in Las Vegas reveals some fascinating insights. As of 2023, the Kaiser Family Foundation states that over half (51%) of Medicare beneficiaries across the nation have chosen Medicare Advantage. Closer to home in Clark County, an array of plans await beneficiaries. Yet, amidst this variety, UnitedHealthcare and Humana dominate, with a combined enrollment of 79%¹.

A common question on many beneficiaries’ minds is, “Which Medicare Advantage plan is the top choice in Las Vegas?” Given the plethora of over 50 distinct Medicare Advantage plans in Clark County², it’s not surprising that this question emerges frequently. Navigating these options can feel overwhelming.

Everyone wants the best plan to access the best care. However, every person is unique, so we need to answer this carefully, and most importantly, keep your needs in mind.

The quest is often for the “best” plan – but what defines “best”? The answer is as individual as you are. Ultimately, the ideal Medicare Advantage plan in Las Vegas is the one that suits your needs best. It’s paramount to consider aspects such as providers, prescription options, network reach, the structure of plan benefits, and overall costs to find what works for you.

With your unique requirements in focus, let’s delve into some strategies to help guide your search and decision-making process.

Use facts, not noise to evaluate plan options
Read the Medicare & You guide (the Nevada edition)
Start with your needs
Evaluate senior-focused primary care clinics
Compare Medicare Advantage plans in Las Vegas
Review plan star ratings
Ask lots of questions about Medicare Advantage in Las Vegas
Talk to an independent, licensed insurance agent
You may still have options after you select a plan
Review your Medicare Advantage plan each year

Use facts, not noise to evaluate plan options

Opinions you hear don’t always account for the full picture

A challenge in choosing a plan is filtering through opinions from friends, neighbors, and providers. You’ll find there are no shortage of opinions about Medicare Advantage in Las Vegas (along with opinions related to our healthcare system across the city, county, and the entire state).

Remember, what works for one person might not work for you. Two people can be on the same plan and experience that plan very differently. Why? People have different medical needs and expectations. A licensed insurance agent can analyze your situation and help you identify what plans match your needs.

Advertisements start conversations

Historically, some marketers in the industry have engaged in a lot of unscrupulous activity around various extra benefits, though CMS has put new rules in place to curb that behavior³. As a result, some Medicare beneficiaries switch plans for a benefit, only to find higher costs elsewhere.

Many advertisers design their ads to start conversations with them about a plan, but this also means there should be a conversation about your needs before making the switch to a new plan (which sometimes isn’t being done thoroughly enough or at all, thus creating problems later down the road if you have unexpected surprises with the change).

Evaluate plans based on your needs, not popularity

Finally, you should know that licensed insurance agents are trained to not use superlatives (e.g. saying something like Medicare Advantage plan {insert plan name} is the best plan in town) when describing insurance plans. No two plans or people are alike and this is why we have to do our homework and evaluate plans based on your needs. We are, however, able to share with you what the plan ratings are for each plan, often referred to as the star-ratings (we’ll discuss that further down in the article).

Read the Medicare & You guide (the Nevada edition)

As Francis Bacon once said, knowledge is power. And when it comes to Medicare, knowledge is an important strategy to good decision making.

Start with the annual “Medicare & You” guide published by the Centers for Medicare & Medicaid Services (CMS). You might receive the guide in the mail each year, or if not, you can download a copy from the CMS website. If you want a paper guide, order it online for free delivery. I highly recommend the paper copy, as paper copies are state-specific, so when you order a guide being shipped to a Nevada address, they will send you the Nevada version of the guide (which includes an overview of all the Nevada Medicare plans in the back of the guide).

Some noteworthy sections in the Medicare & You 2024 guide are:

Front cover / inside flap / new changes for 2024 (page 2)
Medicare Advantage plans and other options (page 61)
Getting help paying your health & drug costs (page 91)
Compare health & drug plans in Las Vegas (page 119)

Start with your needs

When evaluating Medicare Advantage plans, start with your needs. And if you’re having a hard time identifying what you want, then work backwards from identifying what you don’t want in a plan–this will usually draw out what you need.

Here are some questions to think about:

Do you prefer an HMO or PPO?
What providers do you like? What physicians must-haves?
What hospitals and facilities do you prefer?
What medical services do you get frequently and what are they to likely cost you?
Are your prescriptions on the formulary? What’s the estimated cost?
How far will you have to travel to get to your appointments for the physicians in the network?
Do you qualify for a Medicare Savings program or Extra Help?
Will you continue working past 65 with company insurance? How does that compare?
Will you be traveling? Spend long periods of time outside your home market?
Do you have any upcoming major medical or surgeries?
Do you need benefits like dental, vision, hearing, transportation, etc.?
How does your current plan compare to the new plan you’re considering?

Evaluate senior-focused primary care clinics

87% of Medicare beneficiaries are seniors⁴ and the Las Vegas metro area continues to be one of the top destinations for retirees⁵. Considering this, the healthcare industry introduced 119 senior clinics in Las Vegas (or clinics with strong senior support). These clinics offer tailored healthcare focused on the senior market with the convenience of being able to reduce the number of different doctors visits by consolidating common medical procedures into one location.

Certain insurance companies own many of these clinics, or they operate as subsidiaries, even though the clinics might accept insurance from other carriers too. In other words, Medicare Advantage in Las Vegas is often closely aligned with these clinics by virtue of who owns them, and this may create some opportunity to help streamline your healthcare services.

Senior-Focused Primary Clinics in Las Vegas

Senior Clinic	Owned By	# of Locations
ArchWell	Not owned by insurance carrier	8
Cano Health	No owned by insurance carrier	9
Carelon Health	Elevance Health (formerly Anthem)	3
CenterWell	Humana	24
Intermountain myGeneration	Intermountain Health / Select Health	30
Southwest Medical	Optum / UnitedHealthcare	45

Award-Winning Senior-Focused Clinics in Las Vegas

In Las Vegas, residents across the valley submit votes annually for the Best of Las Vegas awards. Senior-focused clinics are a category in the survey, and the top 3 for 2022 were⁶:

Intermountain myGeneration (Gold)
CenterWell (Silver)
Southwest Medical (Bronze)

If the convenience of these clinics appeals to you, then you may want to consider their availability, performance, affiliation, and ratings in the community as part of your evaluation.

Compare Medicare Advantage plans in Las Vegas

Before deciding, compare your current plan side-by-side with the new one to understand cost-sharing. Be sure to compare the premiums, deductibles, copays, coinsurance, and the max out of pocket, along with whether your doctors are in the network and if the formulary includes your prescriptions.

Remember, plans with attractive supplemental benefits might reduce other features. When you compare plans side-by-side, you ensure that you don’t base your decision on just a shiny feature.

You can do side-by-side comparisons with the help of a number of resources.

Directly with Medicare

You can directly compare your Medicare Advantage options at Medicare.gov or by calling 1-800-Medicare. These are nationally available resources fully dedicated to the needs of Medicare beneficiaries across the entire country.

Directly with local resources

Knowledgeable local resources can help you navigate plan options. These resources can ask questions about your needs in relation to Las Vegas’s healthcare community structure.

State Health insurance Program (SHIP)

The federally-funded Nevada State Health Insurance Program, commonly known as SHIP, offers free local health insurance counseling to people with Medicare. To receive counseling, you can contact the Nevada State Health Insurance Program (SHIP).

Independent, Licensed Insurance Agent

Your other option is to contact a local, licensed insurance agent. If you want to evaluate multiple carriers side-by-side, you will need to contact an agent who is independent (meaning that agent is appointed by multiple carriers, rather than just working exclusively for one carrier).

Medicare & You Guide (the Nevada edition)

Page 119 of the Medicare & You guide for 2024 provides some additional guidance on how to do a plan comparison.

Special Needs Plans

With Medicare Advantage, you will also find unique plans that accommodate special needs–these plans are referred to as Special Needs Plans. If you have a chronic health condition and/or are receiving Medicaid or participating in a Medicare Savings Program (e.g. QMB), then you may also want to explore these special needs plans, as these plans are more tailored to the needs of those who qualify. There are several special needs plans available in Clark county.

Programs that help reduce costs

Extra Help

Extra Help, also known as Low Income Subsidy (LIS), helps pay for prescriptions for those who qualify. If you’re receiving Extra Help / LIS to help with the cost of your prescriptions, don’t forget to indicate that when doing your plan comparison, as it will provide a more accurate representation of estimated costs. If you are not receiving Extra Help and believe you may qualify, you can apply online.

Medicare Savings Programs

A Medicare Savings Program can help reduce your cost sharing for your healthcare costs. If you are not currently receiving benefits from a Medicare Savings Program in Nevada and believe you may qualify, you can contact the local Welfare Office for more information or to apply.

Review plan star ratings

Each Medicare Advantage plan has a star rating indicating the performance of the plan (unless the plan is new, in which case it will indicate that there is no performance rating data yet). You should be able to view the star rating when browsing plans online, however, you can also download a star rating sheet for each plan or ask for it.

Here’s how star ratings are explained by the Centers for Medicare & Medicaid⁷:

The Centers for Medicare & Medicaid Services (CMS) publishes the Medicare Advantage (Medicare Part C) and Medicare Part D Star Ratings each year to measure the quality of health and drug services received by consumers enrolled in Medicare Advantage (MA) and Prescription Drug Plans (PDPs or Part D plans). The Star Ratings system helps Medicare consumers compare the quality of Medicare health and drug plans being offered so they are empowered to make the best health care decisions for them. An important component of this effort is to provide Medicare consumers and their caregivers with meaningful information about quality alongside information about benefits and costs to assist them in being informed and active health care consumers.
– Centers for Medicare & Medicaid

The criteria plans are measured on for their star ratings are as follows:

Feedback from members about the plan’s service and care
The number of members who left or stayed with the plan
The number of complaints Medicare got about the plan
Data from doctors and hospitals that work with the plan

If you flip to page 122 in your Medicare & You guide for 2024 (Nevada edition), you can view the members’ rating of the plans (bullet 1 from above).

The highest rating a plan can receive is a 5-star rating. In Las Vegas, the only 5-star plan available is offered by Select Health⁸ ⁹.

Ask lots of questions about Medicare Advantage in Las Vegas

Understanding Medicare Advantage in Las Vegas (like any other city or state) can be a lot to digest. It’s good to ask questions and seek clarification. You can do that by contacting Medicare directly, SHIP, or talking with a licensed insurance agent.

For Las Vegas residents, I’ve also created a public group on the Nextdoor website and app called Medicare Q&A for Las Vegans. It’s free to join and a great place for local Medicare beneficiaries in our neighborhood to ask questions. I also monitor the group to help answer questions.

Talk to an independent, licensed insurance agent

Talking to an independent licensed agent is beneficial; they aren’t tied to just one company. An independent agent is appointed by multiple carriers and can offer a wide perspective on plans and help you ask the right questions about your needs, along with exploring how those needs match up to the available plans in your area.

Another thing to consider is that Medicare Advantage plans (and health insurance plans in general) are incredibly in-depth in the explanation of their features & benefits. It’s a lot for one person to study this on their own, let alone compare them from plan to plan, especially documents like Evidence of Coverage that are incredibly lengthy.

A knowledgeable independent agent studies local plans, offering valuable insights – just ask for help.

I am an independent, licensed insurance agent working locally in Las Vegas. You are welcome to schedule a consultation or shop for plans online through me. My services are free for you to use, with no obligation to enroll in a plan.

You may still have options after you select a plan

Even after you’ve made a decision, that doesn’t mean you’re stuck forever. You may still have options. If you find yourself in a plan you don’t like, you can:

Wait until your next enrollment period to enroll in a new plan
Or, you may be able to avail yourself of a Special Enrollment Period

Review your Medicare Advantage plan each year

Lastly, I urge you to review your plan annually. This is also recommended by Medicare (see bottom of page 13 on your Medicare & You guide for 2024).

If enrolled in a Medicare Advantage plan, you’ll receive an Annual Notice of Change detailing changes. You should receive this by September 30th each year.

Use this to review changes to your current plan. If your plan is still serving you well, you may not be interested in changing, however, if you feel you could do better, or would like to entertain the idea of a more competitive plan, then go for it!

Citations