What Is a 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.