Medicare FAQ

Medicare is the federal health insurance program for people age 65 and older, plus some younger people with qualifying disabilities. It has four parts:

• Part A — Hospital coverage: inpatient stays, skilled nursing facility care, hospice, and limited home health. Most people pay $0 premium for Part A (if you or your spouse worked and paid Medicare taxes for 10+ years).
• Part B — Medical coverage: doctor visits, outpatient care, preventive services, and durable medical equipment. The standard monthly premium in 2025 is $185/month.
• Part C (Medicare Advantage) — An all-in-one alternative to Original Medicare sold by private insurers. Typically bundles Parts A, B, and often D, plus extras like dental and vision. Many Clark County plans have $0 premium.
• Part D — Prescription drug coverage. Sold as a standalone plan (to go with Original Medicare) or included in a Medicare Advantage plan.

Most people end up choosing either Original Medicare (A + B) + Part D, or Medicare Advantage (C). The right choice depends on your doctors, medications, and how much healthcare you use.

There are three main windows to enroll or change plans:

• Initial Enrollment Period (IEP) — A 7-month window around your 65th birthday: 3 months before your birthday month, your birthday month itself, and 3 months after. This is your primary chance to enroll without a penalty.
• Annual Enrollment Period (AEP) — October 15 through December 7 every year. Anyone can switch plans, add or drop drug coverage, or move between Original Medicare and Medicare Advantage. Changes take effect January 1.
• Special Enrollment Periods (SEPs) — Triggered by qualifying life events: losing employer coverage, moving to a new service area, a plan terminating, or becoming eligible for Extra Help (low-income subsidy).

Missing your IEP can result in a late enrollment penalty — a permanent 10% increase to your Part B premium for each 12-month period you were eligible but didn't enroll. Don't miss it.

	Original Medicare	Medicare Advantage
Who runs it	Federal government	Private insurer (CMS-approved)
Networks	Any doctor/hospital that accepts Medicare nationwide	In-network required (HMO) or preferred (PPO)
Out-of-pocket max	None (unlimited exposure)	Yes — capped (typically $4K–$8K/year)
Extras	Medical only	Often includes dental, vision, hearing, fitness
Premium	Part B only ($185/mo in 2025)	Often $0 (on top of Part B)

For most Clark County seniors who use a specific network of doctors and want predictable costs, Medicare Advantage is the popular choice. But if you travel frequently or have very specific specialists, Original Medicare's nationwide acceptance may be worth the higher potential out-of-pocket cost.

Every Medicare Advantage and Part D plan publishes an online provider directory. You can search your doctor's name to see if they're listed as in-network. The problem: these directories go stale. Doctors join and leave networks throughout the year, and insurers aren't always quick to update.

The safest approach — call your doctor's office directly before enrolling and ask: "Do you accept [plan name]?" Confirm as close to the enrollment deadline as possible.

MediPilot's plan matcher checks provider network data and flags which plans include your doctors, giving you a starting point. But always confirm with the doctor's office before committing to a plan.

Clark County is one of the most competitive Medicare markets in the country. Here's what to expect:

• Medicare Advantage premiums: Many plans carry $0 monthly premium (beyond your standard Part B). Premiums range from $0 to ~$75/month depending on plan and benefits.
• Copays: Typically $0–$15 for primary care, $35–$55 for specialists, $90–$130 for emergency room visits.
• Part D (drugs): Standalone drug plans start around $0–$25/month. Drug copays vary by tier — generics often $0–$5/fill, brand names $30–$100+/fill.
• Medigap (supplement): If you stay on Original Medicare, a Medigap plan covers the 20% gap. Premiums for a 65-year-old in Nevada typically run $110–$260/month depending on the plan letter (G and N are most popular).
• Your out-of-pocket max on Medicare Advantage: typically $3,500–$8,300/year in Clark County — once you hit it, the plan covers 100% for the rest of the year.

The "cheapest" plan isn't always the best value — a $0 premium plan with high specialist copays can cost more than a $30/month plan if you see specialists regularly.

You have two main windows to change your plan each year:

• Annual Enrollment Period (AEP): October 15 – December 7. You can switch Medicare Advantage plans, switch between Original Medicare and Medicare Advantage, or add/drop drug coverage. Changes take effect January 1.
• Medicare Advantage Open Enrollment (MA OEP): January 1 – March 31. If you're already on a Medicare Advantage plan, you can switch to a different MA plan or go back to Original Medicare once. (You cannot enroll in a new MA plan during this period if you're on Original Medicare.)

Outside these windows, you generally need a Special Enrollment Period (SEP) to make changes — triggered by events like moving out of your plan's service area, losing employer coverage, or your plan being terminated.

Important: If you're switching from Medicare Advantage back to Original Medicare and want a Medigap supplement, insurers in Nevada can medically underwrite you (except during certain protected periods). Enrolling in Medigap when you first turn 65 gets you guaranteed issue.

A Medicare broker is a licensed insurance professional who represents multiple insurance carriers — as opposed to a captive agent who only works for one company and can only sell that company's plans.

A good independent broker:

• Compares plans across all available carriers in your area
• Checks whether your specific doctors and prescriptions are covered
• Calculates total out-of-pocket costs — not just the premium
• Helps you enroll and handles paperwork
• Reviews your coverage every year at AEP

Crucially, brokers are paid by insurance companies — not by you. Their services are free to seniors. Sarina Janney is a licensed independent Medicare broker serving Clark County, NV seniors in Las Vegas, Henderson, and the surrounding area.

MediPilot is completely free. No fees, no subscriptions, no phone calls required to use the plan matcher or get your results.

MediPilot is a tool built by Sarina Janney, a licensed Medicare broker in Clark County, NV. It helps seniors research and compare plans on their own terms — without pressure, without cold calls, and without a salesperson. If you want personalized help after reviewing your matches, you can contact Sarina directly. Her broker services are also free to you (brokers are paid by insurance carriers, not by clients).

MediPilot takes four inputs — your ZIP code, doctors, prescriptions, and monthly budget — and uses them to score every available Medicare plan in your county. Here's how:

1. Network check: It cross-references your doctors against each plan's provider network, flagging which plans include your doctors in-network.
2. Formulary check: It checks your prescriptions against each plan's drug formulary, showing tier and estimated copay for each medication.
3. Cost scoring: It compares each plan's monthly premium to your budget and scores how well it fits.
4. Match score: A composite score (0–100%) reflects how well each plan covers your specific needs across all three dimensions.

Plans are sorted by match score so your best options rise to the top — not the plans with the lowest premium or the ones with the highest broker commission.

Yes — MediPilot has plan data for most major states, including Florida, California, Texas, New York, Arizona, Nevada, Ohio, Pennsylvania, Illinois, and North Carolina. Enter your ZIP code and the matcher pulls plans available in your specific area.

That said, MediPilot was built specifically to serve Nevada seniors, and Sarina Janney is licensed in Nevada. If you're outside Nevada and want to speak with a broker, Sarina can refer you to a trusted local licensed agent in your state.

Yes — MediPilot works for any Nevada ZIP code. While it was originally built to serve Las Vegas and Henderson seniors, it now supports seniors across all of Nevada:

• Reno & Sparks (Washoe County)
• Carson City (state capital)
• North Las Vegas and the broader Clark County metro
• Rural counties — Elko, Pahrump (Nye County), Fernley (Lyon County), and more

Enter your ZIP code and MediPilot pulls the Medicare Advantage and Supplement plans certified for your specific service area. Sarina Janney holds a Nevada broker license covering all 17 counties, so you can get personalized help no matter where in the state you live.

Nevada has over 50 Medicare Advantage plans available statewide, but the number in your county varies significantly:

• Clark County (Las Vegas, Henderson, North Las Vegas): 40+ plans — one of the most competitive Medicare markets in the country.
• Washoe County (Reno, Sparks): 20+ plans — strong selection with most major carriers represented.
• Rural counties (Churchill, Douglas, Elko, Nye, Lyon, etc.): typically 5–15 plans — fewer options, which makes comparing them carefully even more important.

The best way to see exactly what's available to you: enter your ZIP code in MediPilot. It pulls only plans certified for your specific service area — no guessing, no generic lists.