If you do not want a subsidy, or make too much money to qualify for a subsidy, you can shop for health insurance “Off Exchange“ (in the private market). In Nevada we have HMO, EPO and PPO health insurance plan options available to enroll into. When you buy a health insurance plan in the private market, you don’t need to disclose your income or worry about updating your account throughout the year. You set it and forget it.
These plans are “Qualified Health Plans“ that contain the 10 “Essential Health Benefits“) that cover pre-existing conditions, no matter what the condition is.
Health Insurance Enrollment is only available during “Open Enrollment“ each year, unless you have a “Qualifying Life Event“. Enrolling into a health plan is fast and easy when you call our licensed and experienced health insurance agents (or click the button to quote yourself).
Please think twice about going without Health Insurance this year. If you miss Open Enrollment, you will be missing your only opportunity to get an ACA Qualified Health Plan that covers pre-existing conditions, mental health, wellness/preventative, Rx, and all the other ACA benefits you find in a “Qualified Health Plan”. Unless you have PROOF of a Qualifying Life Event ie. Marriage, Divorce, Relocation, Birth, etc., or someone in your family gets a job that has benefits through an employer, etc.
Buying “Off Exchange“ simply means NOT enrolling on the Governments website. Currently in Nevada, purchasing health insurance “Off Exchange” allows you to have more insurance plan choices from a larger group of Health Insurance companies. In Nevada, we currently have Sierra Health and Life, Hometown Health, HPN (Health Plan of Nevada), and Anthem Blue Cross Blue Shield.
The only PPO plan available (currently) “Off Exchange” is Hometown Health if you reside in Nye, Washoe, Clark, Lyon, Carson City, Douglas and Story counties.
You’ll have coverage all year long, provided you make your payments on time each month. “Open Enrollment“ is OPEN. What this means is that you can make changes to your health insurance plan, health insurance company, change from Gold to Silver or Silver to Bronze, or any change you wish. If you missed last year’s open enrollment, or you want off of Cobra coverage, and want to make a change, open enrollment is your one and possibly ONLY chance! Remember starting 2020, in Nevada, you can only buy a health insurance plan during Open Enrollment unless you have a “Life Event“.
Options range by County
Options range by County
All Nevada Counties
Clark County only
* You can ONLY enroll year round IF you have a Qualifying Life Event ie. Marriage, Divorce, Relocation, Birth, etc.
1). Choose a Qualified Health Plan
All major medical plans that will be sold from 1/1/2014 and on that sell on or off the “Exchange” (Marketplace) and the “SHOP Exchange” or in the private marketplace 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 cover pre-existing conditions, maternity, prescriptions, and much more. They are “qualified health plans”. These “Essential Health Benefits” will be covered.
♦ 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
Dental for “Pediatrics” means anyone under the age of 19. Check the plan “Summary of Benefits” to see if a dental plan for children under the age of 19 is already built into the plan. ON Exchange pediatric dental is offered for purchase separately, OFF Exchange there may be a plan built into the health plan or not. You’ll need to look at the “Summary of Benefits” in your plan.
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.
State or Federal Health Insurance Plans such as Medicare, Medicaid, VA, Tricare, CHIP etc., or part of an Employer Group that provides benefits, or are “Grandfathered,” are all considered Qualified Health Plans.
2). Choose how you want to apply for coverage (over the phone, online, or in person)
♦ Over the phone: simply call (702) 898-0554 and follow the prompts for Health Insurance
♦ In person: Appointment required
♦ Online: Click the button below
3). If needed, familiarize yourself with some of the common terms used (see below)
A HMO is a Health Maintenance Organization. HMO’s are 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, Pediatrician, OB/GYN) as your primary doctor to visit, and you must see your primary doctor to 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 your health care.
A PPO, is a Preferred Provider Organization. It’s a type of health plan that offers a larger network, so you most likely will 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 a network of doctors/hospitals (they are contracted with the insurance company to accept certain contracted payments), or you may see providers that are out of the network. You’ll pay more for out of network providers, but you can see providers in and out of a network if you choose. If you’re willing to pay a higher monthly premium to have more options in choosing your physician and hospitals, you don’t want to have to get a referral to see who you wish, you may want to choose a PPO health plan.
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 a very serious 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.
All individual and family health insurance plans will have these “Metallic” names. It gives you an easy to understand overview of how the plans will share the payment of your medical bills.
♦ Platinum covers 90% of your medical bills, up until the “out of pocket maximum”.
♦ Gold covers 80% of your medical bills, up until the “out of pocket maximum”.
♦ Silver covers 70% of your medical bills, up until the “out of pocket maximum”.
♦ Bronze covers 60% of your medical bills, up until the “out of pocket maximum”.
This percentage will not go on forever, there is always an “Out of Pocket Maximum”, so you’ll only pay your portion of the expenses until you’ve paid your out of pocket maximum.
The Out of Pocket maximums for 2020 are:
You’ll want to review your “Summary of Benefits and Coverage” to find out what your deductible is, your co-insurance, your out of pocket maximum, along with all of the important details of what your plan covers.