Qualifying for a SUBSIDY means you make less than 400% of what the Federal Government says is the “Federal Poverty Level”. 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 to the insurance company to help you pay your premiums, and you’d pay the other portion of the premium to the insurance company.
The only way to get a “Subsidy“ is to get a health insurance plan through Nevada Health Link (we will walk you through this) and only if your income is between 138% to 400% of the federal poverty level.
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, or 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 as your broker, of these changes. We can help you with this.
ON Exchange Marketplace plans for 2020 include Health Plan of Nevada (HMO), Anthem Blue Cross Blue Shield (HMO), and Ambetter / Silver Summit (HMO). In 2020, different counties in Nevada will have between 2 insurance companies or all 3 insurance companies as an option to choose from.
Nye, Washoe and Clark County
All Nevada Counties
All Nevada Counties
* Unless you have a Life Event ie. Marriage, Divorce, Relocation, Birth, etc.
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”.
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 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!
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.
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 continue to enroll and 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.
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
♦ Online: Click the button below
2). 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 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.
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“.