NEW
Extended Hours For Open Enrollment
What Does My Premium Payment Pay For?
Before you blame the health insurance companies for being “greedy”, it’s important to note, there is a clause in the Affordable Care Act that is called the Medical Loss Ratio (MLR).
This Medical Loss Ratio states that insurance companies must pay a minimum of 80-85% of all the dollars they collect in premiums towards medical bills they receive (claims). In other words, if an insurance company collects $100 in a premium, $80 to $85 MUST pay a medical claim.
If at the end of the year they have collected too much from their members, they must send their members back a “rebate” check or give the members a credit for a future premium. So that leaves the insurance company the remaining 20% to pay all of their expenses (employees, buildings, marketing, broker costs etc). Within the 80-85% ratio’s, the insurance company can also spend money on things that improve healthcare quality. This medical loss ratio requires all insurance companies to send detailed reports to the Government about money being spent. The reports are a big responsibility and are very time consuming for the insurance companies to comply with.
When you hear someone talk about their premiums going up, have them read this definition and explanation.
Getting a Refund
We read an article a while back stating that the residents in Florida, almost 1 million customers, received a $65 refund because of this rule. The insurance company collected too much money in premiums and had to refund their customers the overage collected. Here in Nevada, we’ve had many customers receive a medical loss ratio refund too.
Your Health Insurance Benefits
Health insurance is very expensive these days. Your ACA qualified health insurance plan must cover these 10 “essential health care benefits”.
- Outpatient Treatment “Ambulatory Services”
- Emergency Care
- Hospitalization
- Maternity and Newborn Care
- Mental Health and Substance Abuse
- Prescriptions
- Rehab services and devices
- Laboratory
- Preventive / Wellness
- Pediatric Services – dental and vision
All of these services alone are very expensive, but ACA Qualified health plans must cover all of them. Prescription coverage alone accounts for a huge percentage of your premium.
Seeking Guidance With Nevada Insurance Enrollment
Navigating through the many options of insurance can be confusing and chaotic, but speaking with a locally licensed insurance agent will help you obtain the right coverage. You’ll have the peace of mind knowing that you are adequately insured when life complications arise. We work hard to find the most competitive quotes for your needs. Contact us today to begin the process of finding the best insurance plan for your family.
Recent Posts
Employer Group Health Insurance Options and the ICHRA
Beginning in 2020, some employers will have the option of reimbursing employees’ health insurance premiums by using an ICHRA as an alternative to providing a group health insurance plan.
Does Health Insurance Cover Hair Loss?
If you are experiencing hair loss due to an underlying medical condition, then there is a good chance that your health insurance will cover treatment for the condition, either completely or at least a portion of the cost. To be sure, you’ll want to check your “Agreement of Coverage” document.
Health Advice From Centenarians
Gardening has been shown to positively impact our moods, reduce stress and alleviate symptoms of anxiety and depression. However, studies have shown that the benefits of this hobby may extend even beyond promoting a sense of contentment and well-being.
Search This Website
Most Popular Pages
By page visits (this month)
#1) Health Insurance Subsidy Chart
#2) Health Insurance
#3) Health Insurance WITH a Subsidy
#4) Insurance Blog
#5) Request a Quote
Top 5 Most Popular
By page visits (this month)
#1) Health Insurance Subsidy Chart
#2) Health Insurance
#3) Health Insurance WITH a Subsidy
#4) Insurance Blog Posts
#5) Request a Quote
Recent Posts
Does Health Insurance Cover Sex Change?
Gender reassignment surgery in order to be considered medically necessary, certain criteria must be met, such as if a qualified mental healthcare professional provides a referral and medical or mental health concerns are present.
Catastrophic Health Insurance Explained
Like major medical health insurance plans, catastrophic health insurance covers the 10 essential health benefits outlined in the Affordable Care Act. However, if you have this type of plan, your out-of-pocket costs for services are considerably higher than with regular health insurance.
Health Insurance Requirements For Small Businesses
On the employer’s end, providing health insurance can be costly and complicated. However, it can also be a reliable way to bring in new hires, improve productivity and boost morale and job satisfaction. Small businesses that want to provide this benefit have options that let them do so affordably.
Health Insurance For Snowbirds
Finding a health insurance plan that covers your preferred healthcare providers and necessary medications can be a challenge, especially if you split your time between two states or travel frequently.