If you qualify for a Health Insurance Subsidy (financial assistance), it’s kind of like getting a gift card from the Government to help you pay your health insurance premium. 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.
You may now be able to get a Government subsidy to help 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 because your income was too high.
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! This is AMAZING news and will make a HUGE difference in so many people lives. If you know of anyone that DID NOT qualify for a subsidy in years past, please have them call us to assess their potential for a subsidy now.
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!
We will work hard to fit you into the smartest, most affordable plan that meets your needs. Our friendly, knowledgeable and licensed health 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 plan 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.
* Unless you have a Life Event ie. Marriage, Divorce, Relocation, Birth, etc.
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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 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 the “Cost Sharing Reduction”.
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 when 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 simply 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 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.
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!
“Qualified Health Plans“ are certified by Nevada Health Link verifying they provide the 10 essential health benefits. These plans follow required limits on how much you the member has to pay, and how much the insurance company pays. These health insurance plans meet rigorous requirements, including covering pre-existing conditions, with no maximum lifetime or annual limits.
QHP’s (Qualified Health Plans):
♦ 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”.
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.
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 one of our licensed and experienced health insurance agents.
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.
Do you have changes to your family size or income? Call us to update your info.
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.
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.
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 HMO, PPO, and EPO options.
You can’t have an employer offering health insurance to you AND receive a subsidy. If you have employer insurance OFFERED to you, or through your spouse or parent, you are most likely NOT eligible for a subsidy. In the Nevada Health Link application, one of the questions asks if you are “Offered Employer Coverage”. If you are, BE VERY CAREFUL! If you apply for 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.
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.
In Nevada, there are 7 available insurance carriers “ON” Exchange
Nye, Washoe, Clark
All Nevada Counties
Carson City, Lyon, Washoe, Douglas, Storey
All Nevada Counties
All Nevada Counties
Nye and Clark
Nye, Washoe, Clark
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.
(Fast and Easy)
(by appointment only)
In person appointments (by appointment only)
Please Be Careful...
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.
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.
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.
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Authorized Agent for: Nevada Health Link, Anthem Blue Cross & Blue Shield, Sierra Health & Life, Health Plan of Nevada, Friday Health Plans, Select Health, Hometown Health, Ambetter
Farmers Insurance – Shelly Rogers Agency in Las Vegas, Nevada