* Unless you have a Qualifying Life Event ie. Marriage, Divorce, Relocation, Birth, etc.
All questions for Anthem plans please call directly 877-771-8951
If you do not want a subsidy or make too much money to qualify for a subsidy, you are still required to have health insurance (unless you are exempt). Enrollment is faster off exchange, and you don’t need to disclose your income or worry about estimating your income correctly.
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 (Catastrophic plans only).
The only PPO plan available in 2018 “Off Exchange” is Hometown Health if you reside in Nye, Washoe, Clark, Lyon, Carson City, Douglas and Story counties.
The best time to get your plan is during Open Enrollment which is November 1st through December 15th. This is the smartest time to get your plan to avoid waiting periods of 90+ days (unless you have a Life Event), and reduces your chance of having to pay tax penalties. 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, or enroll if you missed last year’s open enrollment.
1). Choose a Qualified Health Plan
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.
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)
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 2019 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.