* Unless you have a Life Event ie. Marriage, Divorce, Relocation, Birth, etc.
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 the Governments “Marketplace” (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 back, or if you didn’t get enough subsidy, you’ll get back on your tax return. If your income goes up or down, or you had changes to your family, you need to notify the “Marketplace” or us as your broker, of these changes. We can help you with this.
ON Exchange Marketplace plans for 2019 include Health Plan of Nevada (HPN) HMO, and Ambetter (Silver Summit). In 2019, different counties in Nevada will have between 1 insurance company or a combination of 2 insurance companies as an option to choose from.
There is additional assistance called the “Cost Sharing Reduction”.
If your family size and income ranks you under 250% Federal Poverty Level, you are eligible for additional assistance to reduce your overall out of pocket medical expenses.
This benefit is only available when you buy a “Silver” plan.
Your deductible, out of pocket maximum, co-pays and/or co-insurance will be less. If your income is under 250% of the Federal Poverty Level, you’ll be eligible for this “cost sharing reduction” which 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 the 250% poverty level, this is a very important and financially beneficial benefit 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. If they’d understood this benefit, in some instances for just a few dollars more a month, their deductible could go from around $6000 down to sometimes as low as $0!
What does this mean exactly?
This means you should have us help you! Let’s say you pick a bronze plan (the cheapest plan you can find), just to avoid getting a tax penalty. Then, during the year you actually use your insurance, like needing to have surgery. What if you had a badly broken leg, the hospital may ask you to pay your $6000 deductible first before they will perform your surgery. Even if they bill you later, you still owe $6,000 (or whatever your deductible is).
Now, if you would have gotten good advice and assistance 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 $6000 deductible plan you chose.
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) for a $6,000 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 study Nevada’s 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.
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, adoption, etc or changes to your “Income” like getting a job with benefits, lose your job with benefits, have an increase or decrease in your income, changing from Part Time to Full Time or Full Time to Part Time, any changes to your income, these kind of changes you’ll need to update your account by contacting your 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 members and 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 a credit for having too little. 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 subsidy) if the lowest priced plan offered by your employer (for employee only coverage – not family, just employee) is not greater than 9.66% of annual household 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 9.66% 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 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.
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“.