Finding an ACA Qualified Health Insurance Plan
When it comes to health insurance coverage, there are a lot of options available. If you are looking for affordable coverage, you have probably seen limited benefit insurance plans like indemnity health plans and medical services discount programs. While these plans are cheap upfront, they are limited in benefits. Qualified Health Plans (QHP’s) may cost more (unless you are eligible for Government Subsidy), but in ALL cases offer more comprehensive coverage. They can also help save a lot of money in the long run, especially for large medical bills.
What Is an ACA-Qualified Health Plan?
A Qualified Health Plan, or QHP, is a health insurance plan that provides coverage for the 10 essential benefits outlined in the 2010 Affordable Care Act. What are “Essential Health Benefits” and who must have them? From 1/1/2014 and forward, all new health insurance plans (insured small group and individual health insurance plans) must cover the 10 bulleted benefits below, called “Essential Heath Care Benefits” to qualify as being an ACA plan (Obamacare). Qualified Health Plans MUST cover these 10 items without any lifetime or annual limits on these “Essential Health Benefits.”
These essential benefits include:
- Outpatient care
- Prescription drugs
- Laboratory services
- Prenatal and postnatal care
- Hospitalization, such as for surgeries and overnight stays
- Pediatric services, including vision and dental care for children
- Chronic disease management and preventative and wellness services
- Emergency services, including services provided at an out-of-network hospital
- Rehabilitative and habilitative services for policyholders with injuries, illnesses or chronic conditions
- Treatment for mental health and substance abuse disorders, such as counseling services and psychotherapy
These essential health benefits are the minimum requirements for all Marketplace ACA (Obamacare) plans. They are broad categories, and the specific services that are covered vary from one state to another, depending on what that state requires.
In addition to these requirements, Qualified Health Plans must also comply with limits regarding your cost-sharing expenses (your out-of-pocket expenses) including deductibles, co-payments and annual out-of-pocket limits.
How Much Does a Qualified Health Plan Cost?
Those who are purchasing a qualified health plan on the Marketplace or a state exchange like Nevada Health Link have multiple levels of coverage to choose from. These are typically referred to as the “metallic levels” because they are called bronze, silver, gold, and platinum plans. In Nevada, there are four types of plans, including catastrophic, bronze, silver, and gold. Although we haven’t seen a Platinum plan in a few years, we have seen a few Gold plans available.
All of these plans provide coverage for the 10 essential benefits, but out-of-pocket costs differ. Lower-level plans like the bronze plans have lower premiums but higher deductibles and co-pays. You will pay more in medical bills with the Bronze plans, however, the monthly costs for these plans are more affordable. With Bronze plans you will have to pay 40% or more for healthcare services. On the other hand, if you have a gold plan, you pay more each month for your coverage, but you will only pay 20% of your medical costs. In Nevada in 2020, the average person with a bronze plan pays $307 per month and $482 per month for a gold plan.
Finding Affordable Health Insurance with Nevada Insurance Enrollment
Health insurance costs are calculated based on numerous personal factors and vary widely from one person to another, so your monthly premium may be lower or higher than average. A health insurance agent at Nevada Insurance Enrollment can help you find a health insurance plan that meets your needs and budget.
Recent Posts
Health Insurance Benefits for American Indians
Health insurance for American Indians offers zero cost-sharing, monthly enrollment, and IHS access via Nevada Health Link. The ACA ensures affordable Nevada tribal health coverage with premium tax credits and Medicaid/CHIP options. Learn how to navigate tribal health insurance benefits.
What is a Summary of Benefits and Why Should I Read It?
A summary of benefits (SBC) is a 4-page document explaining a health insurance plan’s coverage, costs, and examples. It helps compare plans, understand costs like premiums and deductibles, and assess coverage for services like doctor visits or preventive care. Available through Nevada Health Link, the SBC is standardized for easy comparison but does not include provider networks or full exclusions. Learn how to use the SBC to choose a plan that fits your needs.
Nevada Insurance Requirements for Vehicle Registration
Confused about insurance requirements for vehicle registration in Nevada? Learn why auto insurance is mandatory, with minimum liability coverage of 25/50/20. Understand how to provide proof, navigate the registration process, and avoid costly lapses. From required documents to penalties, this guide covers it all. Discover optional coverages and cost-saving tips to stay protected.
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
What is a Summary of Benefits and Why Should I Read It?
A summary of benefits (SBC) is a 4-page document explaining a health insurance plan’s coverage, costs, and examples. It helps compare plans, understand costs like premiums and deductibles, and assess coverage for services like doctor visits or preventive care. Available through Nevada Health Link, the SBC is standardized for easy comparison but does not include provider networks or full exclusions. Learn how to use the SBC to choose a plan that fits your needs.
Nevada Insurance Requirements for Vehicle Registration
Confused about insurance requirements for vehicle registration in Nevada? Learn why auto insurance is mandatory, with minimum liability coverage of 25/50/20. Understand how to provide proof, navigate the registration process, and avoid costly lapses. From required documents to penalties, this guide covers it all. Discover optional coverages and cost-saving tips to stay protected.
What Is a Health Insurance Carrier?
A health insurance carrier provides plans to cover medical expenses, like doctor visits and prescription medications. Understanding your insurer’s network, plan types (HMO, PPO), and costs (premiums, deductibles) is key to choosing coverage. In Nevada, carriers collaborate with Nevada Health Link to offer ACA-compliant plans, ensuring access to preventive care and essential benefits. Learn how to select a dependable health insurance company and manage costs effectively.
What is a Prescription Drug Deductible?
In the world of health insurance, “deductible” is a common word. It refers to an amount of money that you pay out of your pocket before the insurance company begins to pay. A prescription deductible is the portion you’d pay first, then after you’ve paid the deductible, you may only have to pay a co-pay when you pick up your medication.
If you are single, you would only have to meet your prescription deductible. If you have two or more people in your family, each member may have to meet their own prescription deductible which could be up to 2 deductibles in the family. A prescription deductible is different and separate from the medical deductible, unless otherwise stated. One deductible is for medical, ie: hospitalization, doctors, etc., and the other deductible is for filling your prescriptions.