Health Insurance in Las Vegas, Nevada

Health Insurance MAIN page image

Call or Click to Get a Quote

(702) 898-0554

Health Insurance Agent / Broker

Health Insurance Quotes

(702) 898-0554

Search This Website

Search
Generic filters
Exact matches only
Search in title
Search in content

Health Insurance Agent / Broker

Health Insurance Quotes

(702) 898-0554

Call or Click to Get a Quote

(702) 898-0554

Search This Website

Search
Generic filters
Exact matches only
Search in title
Search in content

High Quality Health Insurance

From The Country's Top Insurance Companies

Authorized agent for Nevada Health Link, Anthem Blue Cross Blue Shield
Authorized agent for Health Plan of Nevada, Sierra Health and Life
Authorized agent for Aetna, Hometown Health, Friday Health Plans
Authorized agent for Select Health, ambetter
Choose Type of Insurance
Select the insurance that you think you will be using, or keep reading below
Health Insurance in Las Vegas, Nevada WITH a Subsidy
Health Insurance in Las Vegas, Nevada with NO Subsidy
Medicaid Health Insurance
Short Term Health Insurance in Las Vegas, Nevada
Three Ways to Enroll

1).  Apply by Phone

(Fast and Easy)

(702) 898-0554

2).  Apply in Person

(by appointment only)

In person appointments (by appointment only)

3).  Enroll Online

an agent will call you

Health Insurance Open Enrollment is Here!

You Can Only Buy Health Insurance During This Time

November 1st, 2021 through January 15th, 2022

Call today to book an appointment with a licensed agent

After 1/15/2022, you’ll need a Life Event (← hover mouse) to get an insurance plan.

No more health insurance subsidy cliff

BIG NEWS!

Don't Miss Your Chance!

More Americans are now eligible for a Health Insurance subsidy with The American Rescue Plan Act

So Important – MUST READ!

No More Subsidy Cliff for those making over 400% of the Federal Poverty Level

Now, higher income individuals are qualifying for a Government subsidy

Click Here ↓

+ READ MORE > click here to open/close

No More Subsidy Cliff for those making over 400% of the Federal Poverty Level.

For the first time, many Nevadan’s (those making over 400% of the Federal Poverty Level), may now be eligible for a health insurance subsidy! Plus, for existing members, the rate you are paying will most likely decrease.

For instance, if you were a 60 and 61 year old married couple, and your income was projected to be over $68,960 in 2021 you would not have qualified for a tax credit. Now, since the changes, that same couple making $80K per year would qualify for $1007 per month. This is HUGE!

You can now get a Government subsidy to help you pay for your health insurance premiums. Before these changes, if your income was over $51,040 for a single person in tax year 2021, or $104,800 for a family of 4, you were not eligible for a tax subsidy.

Now there is no income limit to receive these subsidies. The subsidy amount gradually slopes off to be no more than 8.5% of your household income (Modified adjusted gross – for most people, their “Adjusted Gross Income”). So, for many Nevadan’s, they’ll now be eligible for tax credits!

Also in this new law (and this is ONLY for tax year 2020), if you ended up making more than you estimated for tax year 2020, you will not be required to pay back those subsidies.

FREE or NEARLY FREE Health Insurance for any employee who lost their job and collects unemployment any time in 2021. For the tax credit, no matter how much they make on unemployment or otherwise, their income won’t be counted higher than 133% of the federal poverty level. If you are collecting unemployment for 2021, it’s most likely beneficial to apply for Obamacare than Cobra. Why? Free Cobra payments are only good for 5 months, but with Obamacare, the Free to nearly Free health plans are good all year!

These changes do not apply to those Nevadan’s that have jobs that offer insurance to their employees and their families (whether they take their employer, spouses’ employer, parents insurance or not).

Call our office, we can answer your questions, assist you with any changes to your current plan, or help you apply for these new subsidies.

Changes for 2022

There are MANY changes taking place with health insurance options for 2022

2 Big Changes are:

♦ Aetna Health Insurance

Available in for the first time since the passage of the ACA both ON Exchange (with subsidy) and OFF Exchange (no subsidy)

♦ Hometown Health

Available ON Exchange WITH a Subsidy for the first time since the passage of the ACA. Still available OFF exchange also. No longer offering plans in Southern Nevada.

website

Tool Tip

Hover mouse over (or click on mobile) any word in GREEN
A definition of the word will pop up.

Get Help When Selecting a Health Plan

At NO cost...absolutely FREE!

Get help at no cost

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. We assist with Government subsidized health insurance AND unsubsidized private market health insurance. Don’t navigate this by yourself! Insurance is confusing…let us guide you. Understanding your plan is more than co-pays and deductibles.

What is a “Qualified Health Plan”?

If your plan is a “limited benefit medical plan”, “mini-medical plan”, “discount plan”, “indemnity plan”, “short-term plan”, or looks and appears to be “insurance”, but does not cover the 10 “Essential Healthcare Benefits” then you are most likely buying a plan that is NOT considered to be a “Qualified Health Plan”. We STRONGLY recommend you do your research on these types of plans. Do a Google search or look at Yelp reviews of companies that sell these plans.

CHOOSE A QUALIFIED HEALTH PLAN:

Ask the person that is selling the insurance plan 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). Ask them if the plan covers the 10 Essential Healthcare Benefits. Additional Questions: Are they local? Will they be the person you talk to next year during Open Enrollment or if you have a policy question or will it be some other random agent that doesn’t know you or your personal situation?

A Qualified Health Plan Covers Pre-Existing Conditions
Qualified Health Plan
Health Insurance robo-callers

Have You Been Robo-Called To The Point of Exhaustion?

Telemarketers, Spam emails, Texts, Internet Ads and More

We hear about people terminating their Qualified Health Insurance and purchasing health plans from internet ads or tele-marketers thinking that they are saving lots of money. But nothing could be further from the truth. Everyone likes to pay less, but shopping for a plan that simply costs less may cause you more trouble than you think.

Health Insurance telemarketer not telling the truth

This includes plans advertised EVERYWHERE on the internet, including social media sites.

So many times, we see honest, hard working people buying what they think are Qualified Health Insurance Plans, but only to find out later that their plan isn’t what they thought it was. Then, when they find themselves in the hospital, they suffer the consequences of not understanding what they purchased and being severely underinsured. Once you’ve terminated your qualified health insurance plan, if you don’t have a life event, you won’t be able to simply sign up for a new plan after having a bad experience. You will have to wait for the next “Open Enrollment” which is November 1st through January 15th unless you have a Qualifying Life Event.

Health Insurance Agent / Health Insurance Quotes

Serving Las Vegas, Henderson, North Las Vegas and the entire state of Nevada

Call For FREE Help

(702) 898-0554

Read why it’s smart to use an insurance agent
Three Ways to Enroll

1).  Apply by Phone

(Fast and Easy)

(702) 898-0554

2).  Apply in Person

(by appointment only)

In person appointments (by appointment only)

3).  Enroll Online

an agent will call you

Authorized agent for Nevada Health Link, Anthem Blue Cross Blue Shield
Authorized agent for Health Plan of Nevada, Sierra Health and Life
Authorized agent for Aetna, Hometown Health, Friday Health Plans
Authorized agent for Select Health, ambetter

Nevada Health Insurance Companies by County

2022 Nevada Health Insurance Companies by County - Map

Health Plan of Nevada (HPN):

HMO
♦ “ON Exchange” and “OFF Exchange”
♦ Serving Washoe, Clark and Nye counties

Sierra Health and Life:

EPO
♦ “OFF Exchange” only
♦ Clark County only

Ambetter from Silver Summit:

HMO  (referrals to see a specialist are not required)
♦ “ON Exchange” and “OFF Exchange”
♦ Serving ALL Nevada counties

Hometown Health:

♦ “ON Exchange” and “OFF Exchange”
♦ Offering HMO, PPO & EPO in select counties
◊ ON Exchange (HMO only) Carson City, Lyon, Washoe, Douglas, Storey
◊ OFF Exchange (HMO, PPO, EPO) Carson City, Lyon, Washoe, Douglas, Storey

Anthem Blue Cross and Blue Shield:

HMO
♦ “ON Exchange” only
♦ Serving ALL Nevada counties
♦ PPO only available for “Catastrophic” plans (under 30 years old)

Friday Health Plans:

EPO
♦ “ON Exchange” and “OFF Exchange”
♦ Serving ALL Nevada counties

Select Health:

HMO
♦ “ON Exchange” and “OFF Exchange”
◊ ON Exchange – Nye and Clark County
◊ OFF Exchange – Nye and Clark County (1 Bronze Plan only)

Aetna:

HMO
♦ “ON Exchange” and “OFF Exchange”
◊ ON Exchange – Washoe, Nye and Clark County
◊ OFF Exchange – Washoe, Nye and Clark County

Call For FREE Help

(702) 898-0554

Animated male doctor - Health Insurance in Nevada

Start Here

Choose how you want to shop for a health insurance plan:

There are options OFF Exchange that are not available ON Exchange and vice versa.

1).  WITH a Government Subsidy:

Where the Government helps you pay your premiums (You must 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.

Click the blue button to enroll into a Government subsidized plan.

OR

2).  With NO Government subsidy: 

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 Market with no subsidy.

Click the yellow button to enroll into a private plan.

OR

3).  Medicaid: 

Medicaid is a joint State/Federal health insurance program that is administered by the State. It provides health coverage for low-income individuals, especially pregnant women, children and the disabled. The Division of Welfare and Supportive Services (DWSS) determines eligibility for the Medicaid program.

Click the red button to enroll into a Medicaid plan.

OR

4).  Short Term Health Insurance: 
Lower Cost, Affordable
These are REAL PPO (Nationwide Coverage) Health Insurance plans…

These health insurance plans will look at your “pre-existing conditions”. These plans work best for those individuals and families that don’t have pre-existing conditions. Short Term Health Insurance is not compliant with the Affordable Care Act. 

♦ These plans DO NOT cover pre-existing conditions, most wellness visits, mental health, others.

♦ These plans DO cover hospitals, surgery, outpatient procedures, doctors, specialists, radiology, urgent care, emergency room, labs, ambulance, DME, home health care, supplies, prosthetics, rehabilitation, radiation and chemo, transplant expense, others.

Click the green button to enroll into a low cost plan.

Have a Question

Not Sure Which Health Plan To Choose?

If you’re not sure, you may calculate your Modified Adjusted Gross Income (MAGI) and use the Health Insurance Subsidy Chart below to gauge if you may or may not qualify for a Health Insurance Subsidy. If you don’t qualify for a Government Subsidy, you’ll want to look at options OFF Exchange. This way you’ll know if you want to buy health insurance through the Government Marketplace (now Nevada Health Link) or if you want to shop for a Health Insurance plan privately, without the Government subsidy (call us for help either way).

To receive a “subsidy” On Exchange, you must apply during Open Enrollment (which is November 1st through January 15th). The only exception to this is if you have a Qualifying Life Event.

It is more important than ever to speak with a licensed health insurance agent agent.

Now, even higher income individuals will possibly qualify for a Government subsidy.

In previous years with the “Subsidy Cliff”, if your income was higher than 400% of the Federal Poverty Level, you would not be eligible for a subsidy. Now that subsidy “cliff” no longer exists, and subsidies taper off until the subsidy is gone. You are eligible for a subsidy up until the full cost of the State of Nevada’s “Benchmark plan” (which is the second lowest cost Silver plan offered) costs less than 8.5% of your total household income.

For example: If you were a 60 and 61 year old married couple, and your income was projected to be over $68,960 in 2021 you would not have qualified for a tax credit (subsidy). Now, since the changes, that same couple making $80K per year would qualify for $1007 per month!

It is VERY important you are honest and accurate when stating your Income. The amount of premium assistance (subsidy) depends on age, where you live, household income, and size of household.

Follow These Three Steps

1). Calculate your Income

This will determine your MAGI (Modified Adjusted Gross Income)

2). Use the Health Insurance Subsidy chart below

Using your MAGI, this chart will help determine if you qualify for a Subsidy

3). Select the insurance category you want to purchase from
Modified Adjusted Gross Income

How To Figure Your MAGI

+ click here to open/close - How to figure your MAGI

CALCULATING “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.

Add:

♦ 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:

♦ Wages

♦ Salaries

♦ Tips

♦ Alimony – After 1/1/2019 DO NOT 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

♦ Excluded (untaxed) foreign income

♦ Capital Gains

Don’t include:

♦ Gifts

♦ 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.

2022 Health Insurance Subsidy Chart

by household size and income

The chart below lists the income numbers the IRS will use for “subsidy” eligibility for tax year 2022

2022 Health Insurance Subsidy Chart - Federal Poverty Levels

* NOTE: You can buy a plan outside of the “Marketplace” that doesn’t have 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 only paying $200/month for your health insurance. When you do your taxes and file your tax return each year, the Government will check your income. If you were only supposed to receive an Advanced Tax Credit of $700/month instead of $800/month, you’ll owe the IRS an extra $100/month x 12 months which would equal $1,200 that you would owe the IRS.

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.

1.  If your income falls anywhere in between the 3rd 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.

Apply for a “subsidy”

OR

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.

Quote and Enroll with NO subsidy

OR

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.

Apply for Medicaid

OR

4.  Short Term Health Insurance. Click the Green button for lower cost, affordable Short Term Health Insurance

Short Term Health Insurance
For Your Taxes

For Your Taxes – Tax Year 2021

2021 Health Insurance Subsidy Chart

Income numbers the IRS used for “subsidy” eligibility

2021 Health Insurance Federal Poverty Level - chart UPDATED 4-13-21

click image to enlarge

Family with dog in yard

Buying Health Insurance in Nevada

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 and CHIP → Click here to find out more, plus the Advanced Premium Tax Credit and Cost Sharing ReductionsClick here to find out more  .

Outside of Open Enrollment, you can still get a Qualified Health Plan if you have a Qualifying Life Event.

In addition, now in Nevada, we have other Low Cost options → Click here to find out more.

Call For FREE Help

(702) 898-0554

Health Insurance Agent / Health Insurance Quotes

Serving Las Vegas, Henderson, North Las Vegas and the entire state of Nevada

Three Ways to Enroll

1).  Apply by Phone

(Fast and Easy)

(702) 898-0554

2).  Apply in Person

(by appointment only)

In person appointments (by appointment only)

3).  Enroll Online

an agent will call you

“ON Exchange”

Enrolling into a Health Insurance Plan WITH a Government “Subsidy”

Each year, you can only buy Health Insurance during “Open Enrollment” which is November 1st through January 15th, unless you have a “Life Event” ie. Marriage, Divorce, Relocation, Birth, etc.

Available Carriers for 2022

“ON” Exchange

In Nevada, there are 7 available insurance carriers “ON” Exchange

Authorized Agent for Health Plan of Nevada 300x90

HMO

Nye, Washoe, Clark

Authorized Agent for ambetter - Silver Summit Health Plans 300x90

HMO

All Nevada Counties

Authorized Agent for Hometown Health 300x90

HMO

Carson City, Lyon, Washoe, Douglas, Storey

Authorized Agent for Anthem Blue Cross Blue Shield 300x90

HMO

All Nevada Counties

Authorized Agent for Friday Health Plans 300x90

EPO

All Nevada Counties

Authorized Agent for Select Health 300x90

HMO

Nye and Clark

Authorized agent for Aetna

HMO

Nye, Washoe, Clark

“OFF Exchange”

Enrolling into a Health Insurance Plan WITHOUT a Government “Subsidy”

Each year, you can only buy Health Insurance during “Open Enrollment” which is November 1st through January 15th, unless you have a “Life Event” ie. Marriage, Divorce, Relocation, Birth, etc.

Available Carriers for 2022

“OFF” Exchange

In Nevada, there are 7 available insurance carriers “OFF” Exchange

Authorized Agent for Health Plan of Nevada 300x90

HMO

Nye, Washoe, Clark

Authorized Agent for Sierra Health and Life 300x90

EPO

Clark County only

Authorized Agent for ambetter - Silver Summit Health Plans 300x90

HMO

All Nevada Counties

Authorized Agent for Hometown Health 300x90

HMO, PPO, EPO

Carson City, Lyon, Washoe, Douglas, Storey

Authorized Agent for Friday Health Plans 300x90

EPO

All Nevada Counties

Authorized Agent for Select Health 300x90

HMO

Nye and Clark

Authorized agent for Aetna

HMO

Nye, Washoe, Clark

Unhappy little girl with crossed arms

Customers Complaining They Are Paying So Much More For Insurance Than Their Neighbors!

Please Note: There are many factors involved in determining what you will pay  when purchasing health insurance. Each person/family situation is unique: income, number of family members, zip code, if they smoke, who is working, age of each family member, what insurance company you choose, the coverage level (Plantinum/Gold/Silver/Bronze) etc. The only way to determine what you’ll pay is to apply.

Each year insurance companies make adjustments to their insurance plans. Sometimes if they remove a plan, they’ll move you to a plan that has “similar benefits”. It has been our experience that sometimes the “similar benefit” plans are not as robust as the plan you had before. Therefore, it’s important to look at ALL the new plans from ALL the different insurance company’s offerings each year. Don’t just accept the plan they suggest. Call us and together we’ll look at all the plans, to help you find the best plan for the best price.

Why Choose Nevada Insurance Enrollment?

As your agent, we will always be here to answer your calls and your questions. That’s right, YOUR agent, not a different person every time you call a 1-800 number out of state or out of the country, someone that doesn’t know you or your situation. We are local and living right here in Nevada.

We Don’t Just Sell Insurance, We Actually Care

Our friendly, knowledgeable and licensed insurance agents make it EASY to enroll and are available all year long – year after year. We have been helping Nevadans find the right insurance coverage and get the most for their money for years. We work hard to fit you into the smartest, most affordable, and best plan that conforms to your income and your needs. We work for YOU, not the insurance company. We will personally take you step-by-step through all the plans (from all the available insurance companies) and find the one best suited for you.

Our service doesn’t stop once you purchase a plan, you’ll get help and expert advice with your initial sign up and through every step of owning an insurance policy. Having us as your agent will also allow us to be your advocate for any of your insurance needs or problems. After you’ve enrolled into insurance, we’ll be here for any membership communication you’ll need with the insurance company, assist with billing questions or claims problems and so much more. But most importantly…do it with a pleasant and informed attitude. We will always be here to answer your calls and your questions, we are local and will be here when you need us.

Expert Advice at NO Cost!

Having an agent doesn’t cost you anything (the service we offer is FREE) because the insurance company pays us to assist you.

Call For FREE Help  (702) 898-0554

 

Let’s Compare

 

Calling Nevada Insurance Enrollment
vs.
Random Insurance Telemarketer
Nevada Insurance Enrollment compared to others

What Is Health Insurance?

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.

Authorized agent for Nevada Health Link, Anthem Blue Cross Blue Shield
Authorized agent for Health Plan of Nevada, Sierra Health and Life
Authorized agent for Aetna, Hometown Health, Friday Health Plans
Authorized agent for Select Health, ambetter

Be Your Own Best Advocate!

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 a HMO?  Can I travel with this insurance plan?  Is my prescription covered in the insurance plan’s PDL (Prescription Drug List) called a formularyLet’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, with 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.

Family of 5 - Health Insurance in Nevada

What is a HMO?:  A HMO is a Health Maintenance Organization which is a type of health insurance plan that has a group of local doctors and hospitals for you to choose from. You must choose a “Primary Care Doctor” (General practice, Internal Medicine, Family Practice, OB/GYN, Pediatrician) as your primary doctor to visit, and you must see your primary and get referrals to see specialists from your primary doctor to have any tests or procedures done. A HMO usually has lower monthly premiums than a PPO. A HMO may be right for you if you’re comfortable choosing a primary doctor, also called a PCP, to coordinate all of your health care.

What is a PPO?:  A PPO, is a Preferred Provider Organization. It’s a type of health plan that offers a larger network (generally speaking), so you have access to more doctors and hospitals. Your out-of-pocket costs can be higher with a PPO than with an HMO or EPO plan. You will have network doctors and hospitals (depending on the network) which are contracted with the insurance company to accept lower payments. Or, you may see providers that are out of the network, but you’ll pay more for out of network providers. You can see providers in and out of a network if you choose.

What is an EPO?:  An EPO, is an Exclusive Provider Organization, which is a type of health plan that offers a local network of doctors and hospitals for you to choose from. An EPO can be described as somewhat of combination of a PPO and HMO. You don’t have to select a primary care doctor, and you may see any of the providers in the EPO network, but there are no out of network benefits. If you choose to get care outside of your plan’s network, you will pay full price, there is no coverage, unless it’s an emergency. If you’re looking for lower monthly premiums, and are okay with using local doctors and hospitals, but don’t want to have to get referrals for specialists, you may want to consider an EPO plan.

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, 5, and even 6 Tiers. It’s important to make sure that you fill your prescriptions “in network”.

Some health insurance plans will have a Prescription Deductible. This means you must pay the full price of the medication until you’ve paid the deductible. Once you’ve paid the prescription deductible, then you’ll most likely just have to pay your co-pay. Sometimes they’ll have a prescription deductible to pay on Tiers 3 and 4 and 5 and no prescription deductible for Tiers 1 and 2. This is important to pay attention to, especially if you take medications now.

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.

What is Obamacare and the ACA, Healthcare Reform and the Affordable Care Act?

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.

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).  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 be buying a non-qualified health plan.

If your plan is a limited benefit medical plan, mini-medical plan, discount plan, indemnity plan, short-term plan, or looks and appears to be “insurance”, but does not cover the 10 “Essential Healthcare Benefits” then you are most likely buying a plan that is NOT considered to be a “Qualified Health Plan”. We STRONGLY recommend you do your research on these types of plans. Do a Google search or look at Yelp reviews of companies that sell these plans.

shock of medical bill

Why Do I Need Health Insurance?

♦ It helps protect your family’s health and financial well being

♦ Cost reduction from “negotiated pricing” the insurance companies make with doctors/hospitals/providers helps you!

♦ 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 Qualified Health Insurance that has Minimum Essential Coverage.  Unless you are Exempt.

♦ Even though the Affordable Care Act is still the law of the land (requiring all Americans to have a Qualified Health Insurance plan with 10 Essential Health Benefits), there won’t be a tax penalty starting tax year 2019 if you don’t have a “Qualified Health Plan”.

Path Image - Insurance is confusing

Search This Website

Enter a search term here

Search
Generic filters
Exact matches only
Search in title
Search in content

Why Go Anywhere Else?

When you can have an experienced and caring professional guide you.
Insurance Quotes | Plans | Coverage
Nevada Insurance Enrollment NEW logo with TV 300x155
Read why it’s smart to use an insurance agent
Navigation