There are MANY changes taking place with health insurance options for 2018. Some insurance companies are leaving us, while new insurance companies are coming into Nevada. If you aren’t 100% certain that your insurance company and health insurance plan will be available in 2018, you need to call your insurance company and verify this. Your insurance plan may NOT be available.
Getting help from one of our licensed agents costs you NOTHING $$$, and your insurance plan will NOT go up in price for getting this help. Don’t navigate this by yourself! Call for your appointment now, our slots are already filling up.
If you call after December 15th, 2017 to enroll into a health insurance plan, you will be sad to find out that you missed the time frame to enroll. You’ll then need a “life event” (getting married, having a baby, divorce, moving to Nevada, etc.,) to enroll without a waiting period, otherwise, you’ll have a minimum 90+ day waiting period to enroll.
All the major medical plans that will be sold from 1/1/2014 and on that sell on the individual “Exchange” and the “SHOP Exchange” must comply with all the rules and regulations in order to be a “Qualified Health Plan”. All health insurance plans for families and individuals MUST cover these 10 items called “Essential Health Benefits.” These 10 benefits must be covered without any lifetime or annual limits on the “Essential Health Benefits.”
From 1/1/2014 and beyond, all new health plans (insured small group and individual health insurance plans) must cover the 10 bulleted benefits below. These are the plans you’ll want to have in order to avoid a tax penalty. These “Essential Health Benefits” will be covered. There are exceptions to those that have to buy these plans. Those folks that have a State or Federal plan (Medicare, Medicaid, VA, Tricare, CHIP etc.) or are part of an Employer Group that provides benefits, or are “Grandfathered,” or if the insurance is “unaffordable” (see definition) then you won’t need to buy. All the rest of us, unless we are “Exempt” (see definition) our health insurance plan must cover these benefits to be the correct kind of insurance to avoid paying the tax penalty, or until our insurance company tells us our current policy we have now (only if it’s a major medical policy) renews and we must buy a “Qualified Health Plan” that has the following benefits:
♦ Ambulatory patient services (clinics, doctors office, same-day surgery centers, etc.)
♦ Emergency services
♦ Maternity and newborn care
♦ Mental health and substance use disorder services, including behavioral health treatment
♦ Prescription drugs
♦ Rehabilitative and habilitative services and devices
♦ Laboratory services
♦ Preventive and wellness services and chronic disease management
♦ Pediatric services, including dental and vision care (see below)
Dental for “Pediatrics” means anyone under the age of 19 must be offered a dental plan ON Exchange, and a built in dental plan OFF Exchange.
Vision for children under the age of 19 is covered, 1 visit per year, 1 pair of glasses per year are covered. The pediatric vision has to be covered on and off of the exchange.
Your insurance company must also allow members to request to have a drug covered that they need that the insurance company does not cover.
**This list does not apply to large employers in 2015 or Self-Funded Insurance plans. Starting in 2015 Large employers (see definition) have to have plans that are “affordable” (employee’s portion is not more than 9.66% of the employees Box 1 income) and cover at least 60% of the medical costs, and cover their dependents (kids.)
Nevada Insurance Enrollment can assist with any of these plans.
If your plan is a discount plan, or indemnity plan, or looks and appears to be a qualified health plan but does not cover the above 10 “essential healthcare benefits” then you are buying a plan that does not comply, and you’ll have to pay the tax penalty.
Many folks are talked into health plans thinking that if they have a health plan, then they are good, but nothing could be further from the truth. Everyone likes to pay less, but shopping for a plan that costs less may cause you more trouble than you think. SO MANY TIMES, we see honest good people buying what they think are insurance plans, but only find out later that their plan isn’t what they thought it was. Then, when they file their taxes, they suffer the consequences or misrepresent that they had a qualified health plan on their tax return, hoping to not be audited.
Ask your broker if your plan is ACA compliant. If your plan covers these 10 Essential Healthcare Benefits you are good to go. Your insurance company, or the “Marketplace” is required to send you a 1095B or 1095A at the end of the year proving that you had a qualified health plan for whichever months you had the qualified health plan. This form is needed when you file your taxes. If you get insurance from your employer, you should get your 1095C form from them.
Ask the person that is selling the insurance plan to you if they are a licensed agent with the State of Nevada. Ask them if the plan is a “Qualified Health Plan” and if it meets the guidelines of the ACA (Obamacare). Additionally, ask them if you’ll have to pay a tax penalty with the insurance plan they are selling to you.
♦ It’s now the law called the Individual Mandate
♦ It helps protect your family’s health and financial well being
♦ Because accidents and health problems can happen at any time
♦ Healthcare expenses are the number one cause of bankruptcy
Since 1/1/2014 it is the Law that ALL Nevadans MUST have a Qualified Health Insurance Plan that has Minimum Essential Coverage. Unless you are Exempt.
All questions for Anthem plans please call them directly. 877-771-8951
Where the Government helps you pay your premiums (IF you qualify, based on your income and family size). If you want to apply for a Government “Subsidy“, you’ll be enrolling into a health insurance plan “On Exchange“, which is where you enroll with the “Marketplace”. *
Click the blue button below to enroll into a Marketplace plan.
You don’t qualify for a Government “Subsidy“, because you make too much money yearly, OR you just don’t want a subsidy. No questions on income are required. If you want to buy your own plan without a Government subsidy, or know you won’t qualify for Government help because you make too much money each year, you can shop and enroll into health insurance “Off Exchange”, which means you are buying a health insurance plan in the private Marketplace with no subsidy.
Click the yellow button below to enroll into a private plan.
* NOTE: You can buy a plan through the Governments “Marketplace” that doesn’t have a subsidy
If you’re not sure, you may calculate your income (see below) and use the Health Insurance Subsidy Chart to determine if you may qualify for an Individual / Family Health Insurance subsidy. It is VERY important to find out FIRST if you qualify for a Subsidy (also called an Advanced Premium Tax Credit). This way you’ll know if you want to buy health insurance from the Government “Marketplace“ or an Individual / Family Health Insurance plan privately, without the Government’s assistance.
To receive a “subsidy” On Exchange, your income must be below 400% of the Federal Poverty level (see chart below) and you must apply during Open Enrollment (which is November 1st, 2017 through December 15th, 2017). The only exception to this is if you have a Qualifying Life Event. It is VERY important you are honest and accurate when stating your “Income“. The amount of premium assistance (subsidy) depends on household income and size of household.
In Nevada, you can apply for health insurance Off Exchange at any time, but you’ll have a 90 day wait if you enroll outside of Open Enrollment. The only exception to this is if you have a Life Event, you’ll have a 60 day window called a Special Enrollment Period to apply and see if you qualify for a subsidy. If you do have a Qualifying Life Event, you’ll have to prove this event. Correct documentation is required. Here are some examples of documentation you can use.
Consumers who qualify for a special enrollment period (SEP) will receive a Marketplace Eligibility Determination Notice that includes a list of acceptable documents they may provide to prove their eligibility for the SEP. Examples of acceptable documents for each type of SEP that requires documentation are listed below.
SEP for Marriage: Document to Prove the Marriage
SEP for Birth: Document to Prove the Child’s Date of Birth
SEP for Adoption, Placement for Adoption, Placement in Foster Care, or Child Support or Other Court Order: Document to Prove the Adoption, Placement for Adoption, Placement in Foster Care, or Child Support or Other Court Order
SEP for Permanent Move: Document(s) to Prove BOTH Previous Address and New Address
SEP for Loss of Minimum Essential Coverage: Document(s) to Prove Loss or Planned Loss of Qualifying Health Coverage (Visit HealthCare.gov to learn more about qualifying coverage types)
1). Calculate your Income
This will determine your MAGI (Modified Adjusted Gross Income)
When you apply for a “Subsidy” you’ll need to estimate your income (before taxes) for the year in which you’re applying for insurance. If you are not sure, you’ll have to make your best estimate. We recommend you speak with your accountant to get your “Modified Adjusted Gross Income” calculation.
Modified Adjusted Income for most folks will be the Adjusted Gross Income on line 37 of your 1040, or 21 of your form 1040A or line 4 of your 1040EZ of your tax return.
♦ You and your spouse’s income, if you’re married and will file a joint tax return
♦ Any dependents who make enough money to be required to file a tax return
You’ll need to include:
♦ Unemployment compensation
♦ Self Employed or business (generally the amount of money you take in from your business minus your business expenses)
♦ Social Security payments, including disability payments – but not Supplemental Security Income (SSI)
♦ Retirement income, Investment income, pension income, rental income, prizes, awards, gambling winnings
♦ Generally withdrawals from an IRA (Not Roth IRA.) See IRS Form 8606
♦ Withdrawals from a 401k plan (less distributions from a Roth Account) See IRS Pub. 575
♦ Child support
♦ Supplemental Security Income (SSI)
♦ Veterans’ disability payments
♦ Workers’ compensation
♦ Qualified withdrawals from a Roth IRA. See IRS Pub. 590
♦ Proceeds from loans (like student loans, home equity loans, or bank loans)
We suggest you refer to your federal income tax return to get a quick estimate of your AGI. On your tax return, please refer to:
♦ Line 4 if you filed a Form 1040EZ
♦ Line 21 if you filed a Form 1040A
♦ Line 37 if you filed a Form 1040
Keep in mind, the subsidies are based off the “Household Modified Adjusted Income.”
We recommend you speak with your accountant to get your “Modified Adjusted Gross Income” calculation.
Disclaimer: The material in this site is provided for educational purposes only and does not substitute consultation with an Attorney or Accountant. We do not guarantee the accuracy or completeness of the definitions or any information or other items within this website. Any inclusions of incorrect data or omissions of correct data is unintentional. We will make periodic changes to these materials at any time and make no commitment to update the information contained herein, although we will continue to update as often as possible. The Nevada Insurance Enrollment Marketplace shall not assume any responsibility or liability for any such inadvertent errors or inaccuracies, and shall have no obligation to honor transactions or information affected by such inaccuracies.
2). Use the Health Insurance Subsidy chart below, as a guide, to determine if you may qualify for a Subsidy
3). Select the category (click the button) that you think you may belong to, or keep reading below
The chart below lists the income numbers the IRS will use for “subsidy” eligibility for tax year 2018.
1. If your income falls anywhere in between the 1st column and the last column, and you would like to apply for a health insurance plan WITH a government subsidy, click the Blue “Subsidy” button.
A “Subsidy” is where the Government and you share in paying your monthly health insurance payments. The Government helps you pay your health insurance payments monthly, by sending a certain dollar amount of your insurance payment (premium) to the insurance company, and you send in the other portion of your monthly insurance payment to the insurance company. This is called “APTC” (Advance Premium Tax Credit). The factors that affect the percentage or portion of the health insurance premium you pay is your household income and household size (members of your family on your tax return).
Your Subsidy is based on your CURRENT household “MAGI” (Modified Adjusted Gross Income – see definition). If your income changes, or “household” changes, like getting married, having a baby, changes in your income/employment, it’s important to call us and we’ll help you make those changes to your account as they happen throughout the year.
The only way to get a “Subsidy” is to get a health insurance plan through the Governments “Exchange” (also called the “Marketplace”), and only if your income is between 138% to 400% of the federal poverty level. Nevada Insurance Enrollment can help you with a “subsidized” or “unsubsidized” health plan, we are a Full Service Agency.
Your income will be checked with the IRS records or a Federal Database, so if you claim a certain income, the “Exchange” will check with the IRS of your past years’ income tax records – before you get approved for a subsidy.
Individuals and families will state their income based on their MAGI or Modified Adjusted Gross Income (see definition). That information will then be verified through the IRS against your previous tax returns. If the stated income on the application is more than 10% lower than what the IRS shows, the State will require the individual to prove their income within 90 days, but you’ll still get enrolled. Your financial information is run through a Data Services Hub (a tool the government is using to verify applicant information and income for the “Advanced Premium Tax Credits”) to see if you qualify for a subsidy.
BE CAREFUL HERE!!! You do not want to understate your income or you could end up owing money to the IRS. For example, if your premiums are $1,000/month and you get an Advanced Premium Tax Credit of $800/month and you only have to pay $200/month. When you do your taxes and file your tax return each year, the Government will check your income. IF you were only supposed to have received an Advanced Tax Credit of $700/month instead of $800/month, you’ll owe the IRS an extra $100/month X 12 months equals $1,200. The Advanced Premium Tax Credit is an “estimation” of your pre-tax credit, so if you’ve received too much “credit,” you’ll end up paying it all back, or a portion of it back. Your percentage of Federal Poverty Level determines this. If you end up making over 400% of the Federal Poverty Level, you’ll end up paying back ALL of your subsidy.
2. If your income is greater than the last column, or you do not want a Subsidized Government plan, click the Yellow “NO Subsidy” button.
3. If your income is less than 138% (see chart above), you may qualify for Medicaid. Click the Red button for Medicaid. If it turns out you do not qualify for Medicaid after applying, come back to this website and click the Blue “Subsidy” button. Medicaid and CHIP eligibility is primarily based on current monthly income.
4. Low Cost Health Insurance. Click the Green button for Low Cost Health Insurance
The chart lists the income numbers the IRS used for “subsidy” eligibility for tax year 2017.
Nevada residents concerned that they can’t afford health insurance should absolutely call us. With the passage of the Affordable Care Act (ACA) also known as “Obamacare”, there are many programs and features of the ACA that assist with the cost of health insurance for those who qualify, like Medicaid, CHIP, Advanced Premium Tax Credits and Cost Sharing Reductions.
Plus, we Nevadan’s are very blessed because we can buy health insurance year round. Outside of Open Enrollment, you can still get health coverage, but you’ll have a 90 day wait before your coverage begins. Call us to find out how.
Each year, you can only buy Health Insurance during “Open Enrollment” which is November 1st 2016 through January 31st 2017, unless you have a “Life Event” ie. Marriage, Divorce, Relocation, Birth, etc.
In Nevada, there are 2 available insurance carriers “ON” Exchange
Washoe, Nye, Clark
You should enroll into health insurance during “Open Enrollment”. Open Enrollment is November 1st 2016 through January 31st 2017. BUT…in Nevada, you can ALSO enroll YEAR-ROUND, but you’ll have a 90+ day waiting period, unless you have a “Life Event” ie. Marriage, Divorce, Relocation, Birth, etc.
In Nevada, there are 4 available insurance carriers “OFF” Exchange
Only PPO in NV for 2018
(HMO & PPO) Washoe, Carson City, Storey, Douglas
(PPO only) Clark
Washoe, Nye, Clark
Catastrophic plans only
ALL Nevada Counties
All questions: call Anthem directly 877-771-8951
NOTE: We get many phone calls from customers complaining that they are paying so much more for their insurance than their neighbors! There are many factors involved in what folks pay when shopping the Marketplace. Because each person’s situation is unique, you may or may not qualify for a subsidy, every person or family will have different circumstances such as income, number of people in the family, zip code, if they smoke, who in the family is working and has an income, the age of each family member, what insurance company you choose, the coverage level (Plantinum/Gold/Silver/Bronze/Catastrophic) etc. MANY factors contribute to the premium you’ll pay when applying for insurance. The only way to determine what you’ll pay is to apply. We recommend you call us for assistance, because there are circumstances that may affect you adversely if questions are answered incorrectly on the application.
Health insurance is a type of insurance that helps cover the high cost of medical and surgical expenses. It helps pay for health care and protects you from paying the full costs of medical services when you’re injured or sick.
Unlike Group Insurance you get from your employer or spouse’s employer, Individual and Family Health Insurance you purchase on your own. When you buy insurance on your own, it is a private health insurance plan.
Similar to choosing other types of insurance like auto, home or life insurance, you can choose from a variety of insurance company’s and many levels of plan coverage (Platinum, Gold, Silver, Bronze) to meet your budget and health care needs. Health insurance plans vary in deductibles, costs, co-pays, prescription costs, networks of doctors and hospitals etc., and what you’ll have to pay.
Don’t worry; we know this can get confusing. We’d encourage you to call us and speak with one of our friendly, knowledgeable, licensed health insurance agents. We will take you step-by-step through the enrollment process (from the available insurance companies here in Nevada) and find the one best suited for you.
When researching and looking for a health insurance plan, you’ll need to focus on the big things first.
How many doctors and specialists and hospitals are in the “network”? Is my doctor in the network? Do you want a PPO or an HMO? Can I travel with this insurance plan? Is my prescription covered in the insurance plan’s PDL (Prescription Drug List) called a “formulary”? Is your health insurance plan a compliant plan with the Affordable Care Act so you don’t have to pay a penalty for having the wrong insurance coverage? Let’s break down each of these questions.
A Network: Is a group of providers which could be hospitals, doctors, labs, radiology centers, urgent care’s, etc., that have contracted with an insurance company on many things including pricing. So having a large network, of many choices for “providers” to choose from can be important. It’s always important, however, to make sure that you get “prior authorization” for services that require prior authorization, for certain tests, prescriptions and procedures. If you don’t get prior authorization for a procedure, test, or prescription, you may have to pay that bill in full out of your own pocket.
Is my doctor in the network?: Seems like a basic question, but it’s important to remember to ask us to check for you when you call.
Can I travel with this insurance plan?: A PPO will allow you to see doctors without needing to get a referral to see who you want to see. You’ll always want to try and stay within that PPO’s provider network. This is true for all services: X-rays, labs, hospitals, ER’s, etc. You can go OUT of the PPO Network, but you’ll pay more for those services. An HMO health insurance plan will require you to stay within the insurance company’s network, and you must get a referral from your primary doctor to see a specialist. You cannot go outside of the HMO network, except for very serious emergencies.
Is my prescription covered in the formulary of the plan I’m choosing to enroll into?: A “formulary” is a list of medications that are covered by your insurance plan. It is a list of generic and brand medication. Your “Co-Pay” that you’ll pay will depend on the “Tier”. The higher the Tier, the more you’ll pay. A Tier 1 medication is generally a generic medication and is the cheapest Co-Pay you’ll pay of the medications covered by your insurance plan. A Tier 2 medication will have a higher Co-Pay and can be a more expensive generic medication and/or a cheaper brand medication. A Tier 3 medication is an even higher Co-Pay, and is usually a more expensive brand medication and/or very expensive generic. Some insurance plans can have 4 and 5 Tiers. It’s important to make sure that you fill your prescriptions “in network”. If your doctor wants you to have a medication that is not on your insurance plan’s formulary, you may need to have your doctor ask for prior authorization of the medication or take your formulary into the doctor and have them choose one that is on the list.
Is my health plan compliant so I don’t have to pay a tax penalty?: This is VERY important to know so you won’t have to pay for a penalty. The plan must be a “Qualified Health Plan”. Sometimes it’s referred to as having “Minimum Essential Coverage” or for employers meeting “Minimum Value”. Call us for assistance.
On March 23, 2010, President Obama signed into law the Affordable Care Act (ACA) also known as “Obamacare”. They mean the same thing. Obamacare is a nickname for the Affordable Care Act. The new law requires most of us to have health insurance or get a tax penalty.
The intent of congress and the president when enacting the ACA was to achieve the following goals:
♦ To reduce the number of uninsured Americans
♦ To improve the quality of care for health insurance coverage
♦ To make health insurance more affordable for individuals and families
♦ To reduce the overall costs of health care for Federal and State Governments
These new reforms set a minimum standard for acceptable coverage. From 1/1/2014 on, all new health plans (insured small group and individual health insurance plans) must be a Qualified Health Insurance Plan that has Minimum Essential Coverage in order to avoid a tax penalty. These plans must be considered to be “Qualifying Health Coverage”. If you are unsure about your plan, call your insurance company and ask them if it’s a qualified health plan that is ACA compliant, otherwise you will have to pay the tax penalty.
There are exceptions to those that have to buy these plans. Those folks that have a State or Federal plan (Medicare, Medicaid, VA, Tricare, CHIP etc.) or are a part of an Employer Group that provides benefits or are “Grandfathered” or that the insurance is “unaffordable” won’t need to buy.