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Qualifying for a Government SUBSIDY (Financial Assistance)
If you qualify for an Individual / Family Health Insurance Subsidy (financial assistance), it’s kind of like getting a Gift Card from the Government to help you pay your health insurance premiums. This “subsidy” is sent directly to the insurance company, which pays a portion of your premium, and you will be responsible to pay the remaining balance.
The only way to get a “Subsidy“ is to get a health insurance plan through Nevada Health Link (we will walk you through this).
Be careful not to get TOO MUCH subsidy. At the end of the year, the IRS will adjust what you’ve received, and what you should have received, and if you ended up getting too much subsidy, you’ll have to pay it back. If you didn’t get enough subsidy, you’ll get it back on your tax return. If your income goes up or down, or you had changes to your family, you need to notify us immediately so we can make the necessary changes. We can help you with this.
We recommend you watch this video it’s VERY informative
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ON Exchange Marketplace plans for 2021 include Health Plan of Nevada (HMO), Anthem Blue and Cross Blue Shield (HMO), Ambetter (HMO). Friday Health Plans (EPO), and Select Health (HMO).
Open Enrollment begins November 1st
Call Us! (702) 898-0554
We will help, guide, and advise you with your enrollment
We are health insurance experts, let us guide you! We will work hard to fit you into the smartest, most affordable plan that meets your needs. Our friendly, knowledgeable and licensed insurance agents make it easy to enroll and are available day after day, all year long, year after year. They will take you step-by-step through the available options and find the health insurance that’s best suited for you. We have been helping people find the right health insurance coverage and get the most for their money for years.
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, 2020 through January 15th, 2021
HMO
Nye, Washoe, Clark
HMO
All Nevada Counties
HMO
All Nevada Counties
EPO
All Nevada Counties
HMO
Nye and Clark
Do you make less than 250% of the Federal Poverty Level?
Receive Additional Assistance!
There is additional assistance called “Cost Sharing Reduction“. This is in addition to a ““Subsidy“.
If your family size and income ranks you under 250% of the “Federal Poverty Level“, you are most likely going to be eligible for additional assistance to reduce your overall out of pocket medical expenses on your expenses like lower deductibles, and/or co-insurance, and/or out of pocket maximum, and/or co-pays. You must apply, and the enrollment process determines if you are eligible for “Cost Sharing Reduction”.
This benefit is only available when you buy a “Silver” plan.
Call For FREE Help
(702) 898-0554
If your income is under 250% of the Federal Poverty Level, this “Cost Sharing Reduction” will cover more of your portion of the medical expenses. So in addition to getting the “Advanced Premium Tax Subsidy”, you’ll also have the “Cost Sharing Reduction” to reduce deductibles, co-pays, and/or co-insurance. If your income is under 250% of the Federal Poverty Level, this is a very important financial benefit you’ll want to take advantage of!
Sadly, we’ve seen Nevadan’s enroll into a health insurance plan WITHOUT help from a broker/agent, they buy the cheapest health plan available, shopping for the cheapest premium possible, and remove themselves from being eligible for the “Cost Sharing Reduction”.
If they’d understood this benefit, in some instances for just a few dollars more a month, their deductible could go from around $7000 (example) down to sometimes as low as $0!
This benefit is only available when you buy a “Silver” plan.
IMPORTANT!
DO NOT harm yourself financially by picking a plan and not understanding the benefits you may be entitled to and may miss out on.
Health Insurance Agent in Las Vegas, Nevada
Serving Las Vegas, Henderson, North Las Vegas and the entire state of Nevada
Three Ways to Enroll
1). Apply by Phone
(702) 898-0554
2). Apply in Person
(by appointment ONLY)
Due to Covid-19, we’ll be conducting phone appointments
3). Enroll Online
an agent will call you
What Does This Mean?
This means you should have us help you! Let’s say you pick a bronze plan (the cheapest plan you can find), just because you want to pay the least amount possible. Then, during the year you actually end up needing to use your insurance, like needing to have a surprise procedure. What if you got very sick and were diagnosed with a kidney stone? The hospital may and most likely will ask you to pay your (as an example) $7000 deductible first, even before they perform your procedure!! Even if you were to get lucky and they are willing to bill you later, you still could owe $7,000 plus!!
Now, if you would have gotten good advice and assistance from a licensed agent, and enrolled into a SILVER plan (when you are entitled to a Cost Sharing Reduction), it’s possible your deductible could have been $0, or at least lower than the $7000 deductible plan you chose.
Was your decision to save a few bucks worth it? Is that the insurance company’s fault? Getting a good health insurance agent is as important as getting a good accountant or attorney.
We’ve sadly seen it too many times, that someone purchases the cheapest plan they can, not understanding that they were giving away a $0 deductible plan (or much lower deductible than $7,000, depending on household income), instead of selecting a $7,000 deductible plan, only to save themselves a few dollars a month.
Get sound advice from a local health insurance agent that knows Nevada’s plans.
Call us. Our services are FREE to you, we are local, we are licensed with the State of Nevada, we study Nevada’s health insurance plan benefits, the network of doctors and hospitals, and the insurance plan formularies (drug lists on the insurance plan). You will NOT pay more for your insurance by getting help from our Agents and your premium will NOT go up!
It is VERY IMPORTANT to stay on top of your account when you get a subsidy from the Government. If your “Household” changes (including your income), you’ll need to update your account by contacting us.
Eligibility for a subsidy and additional help called “cost-sharing reductions” is based on annual household income and size of your household.
Changes in Your Household
If your “Household” changes (family members on your tax return) like having a baby, getting a divorce, getting married, or adoption, etc. Changes to your “Income” like getting a job with benefits, lose your job with benefits, have an increase or decrease in your income…any changes to your income or changing from Part Time to Full Time or Full Time to Part Time. These “Household” changes you’ll need to update your account by contacting us as your licensed health insurance agent.
The reason for this is because when you file your taxes next year, for this year, the IRS will look back at your overall household income and family size. If you received TOO MUCH subsidy, you’ll have to pay back the overage, and if you didn’t get all the subsidy you were entitled to, you’ll get credit for having too little subsidy. It is very important to be honest and accurate when filling out your application for a subsidy.
Have you or your family been offered Health Insurance at work?
If you are offered “affordable” insurance (even if you didn’t take it) at your job or your spouse’s job, you won’t be able to receive a subsidy from the government. Employer coverage is considered “affordable” (meaning you are not eligible for a Government subsidy) if the lowest priced plan offered by your employer (for the employee – not family, just employee) is NOT greater than 9.78% of annual household (everyone on the tax return) income.
Anyone in the family that is “Offered“ employer-sponsored coverage will not be eligible for a subsidy. Whether you accept that coverage or not. The rules of health care reform are that if the EMPLOYEE’S PORTION of the CHEAPEST health insurance plan offered by the employer is less than 9.78% of the employees “household” income, then the employee and their families are BLOCKED from getting a subsidy.
What if you or your spouse have been offered Health Insurance coverage at work…what do you do?
If it’s NOT “affordable” you can apply for a subsidy.
If it IS “affordable” you can look at plans “Off Exchange” (without a Government subsidy) to have more PPO options.
You can’t have an employer offering health insurance to you AND receive a subsidy. If you ignore this rule, you may find yourself paying back the IRS for the entire subsidy.
If you receive a subsidy you weren’t supposed to have, you’ll have to pay it back. It is VERY important you are honest and accurate when stating your income and answering questions when applying for a “Marketplace” plan.
Start Here
Follow these steps
1). 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 (due to Covid-19, we’ll be conducting phone appointments)
♦ Online: Click Here
2). If needed, familiarize yourself with some of the common terms used (see below)
Health Insurance Agent in Las Vegas, Nevada
Serving Las Vegas, Henderson, North Las Vegas and the entire state of Nevada
Three Ways to Enroll
1). Apply by Phone
(702) 898-0554
2). Apply in Person
(by appointment ONLY)
Due to Covid-19, we’ll be conducting phone appointments
3). Enroll Online
an agent will call you
What is an 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.
PLATINUM | GOLD | SILVER | BRONZE
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 2021 are:
Individuals: $8,550
Families: $17,100
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.
You can Enroll into these plans during Open Enrollment November 1st through December 15th. After Open Enrollment, the only time you can get a subsidy is if you have a “Qualifying Life Event“.
Health Insurance Common Terms
Let’s Get You Covered!
We know this is confusing, but we’re here to help you and guide you.
Choose one of the options below
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