Common Questions

There are four types of plans available in Nevada Sometimes they’re considered the metal plans.  The bronze plan pays 60 percent of medical costs and has the lowest premiums; the silver plan—the standard plan– pays 70 percent of costs; the gold plan pays 80 percent; and the most robust plan, the platinum, pays 90 percent of costs and

has the highest premiums. In all cases, the lower the premium, the higher the deductible. There’s also the catastrophic plan offered only to those 30 and under or those with the hardship exemption. These plans contain very bare bones coverage and have very narrow provider networks.

What is the Penalty Fee for Not having health insurance in Nevada?

 

• Premium A premium is a fixed amount you pay to your insurance plan, usually every month. You pay this even if you don’t use medical care that month.
• Deductible If you need medical care, a deductible is the amount you pay for care before the insurance company starts to pay its share. Once you meet your deductible, your insurance company begins to cover some costs of your care. Some plans have lower deductibles, like $250. Some have higher deductibles, like $2000. Many plans provide preventative services and sometimes other health care, before you’ve met your deductible.
• Copayment A copayment is a fixed amount you’ll pay for a medical service after you’ve met your deductible. For example, after meeting your deductible you may pay $35 for a visit to the doctor’s office that would cost $125 if you didn’t have coverage. The health plan pays the rest.
• Coinsurance Coinsurance is similar to copayment, except it’s a percentage of costs you pay. For instance, you may pay 30% of the cost of a $100 medical bill. So you would pay $30 and the health plan would pay the rest.

• Out-of-pocket maximum This is the total amount you’ll have to pay if you get sick. For example, if your plan has a $3000 Out of pocket maximum, once you pay $3000 in deductibles, coinsurance, and copayments the plan will pay for any covered care above that amount for the rest of the year.
• No yearly or lifetime limits Health plans in the HealthCare Marketplace can’t put dollar limits on how much they’ll spend each year or over your lifetime to cover essential health benefits. After you’ve reached your out-of-pocket maximum, your insurance company must pay for all of your covered medical care with no limit according to the affordable care act ACA or the marketplace.
  

 

 Q: How Do we sign up for obama care or the marketplace in Nevada?

1. Go direct to your states marketplace website and sign up.  State marketplaces offer free help over the phone and in-person help for signing up. Details found below. Plans are limited to those sold on the marketplace in your area. The draw back is they cannot give advice on which plan to choose. If you think you qualify for Medicaid please see go to your local office about medicaid.  If you know you are eligible for cost assistance or Medicaid this is a great option.

2. Go direct. You’ll see top providers listed on our site you can sign up directly with a provider. Any provider will be able to sign you up for plans they sell in your state on or off the marketplace. If you know what plan you want or what provider you want to use this is a great option. The drawback to this option is that you’re dealing direct with only one carrier where as an licensed insurance agent could give you multiple options with out pushing one company.

3. Use a health insurance broker or agent. A broker or a Nevada health insurance agent can help you sign up for the marketplaces and help you to see if you qualify for cost assistance online, in-person, or on the telephone. Most Brokers and insurance agents also have access to different plans from different providers both inside and outside of the health insurance marketplace.And remember Brokers are paid by the insurance companies so you won’t pay more by using this service. The price is the same regardless of where you go. If you aren’t sure if you qualify for cost assistance or know you don’t this is a great option agents offer a valuable service when it comes to choosing a health plan.All the providers and brokers listed on our site can help you to see if you qualify for cost assistance subsidies via your states marketplace. However, if you choose a plan not offered on the marketplace you won’t be able to get cost assistance. All plans sold on and off the marketplace are regulated so you won’t pay more or less barring cost assistance no matter how you shop for a health insurance plan.The best way is just to pick up phone and start talking to an agent. Call  702-410-8002 if you need a certified licensed insurance agent. It cost nothing to use an agent that is certified with the healthcare marketplace.

• How much is the premium per month with and with out subsidy?
• Is your current doctor or hospital part of the plan’s provider network?
• Is there a deductible on this plan?
• Is there coinsurance
• Will you have copayments?
• How does the plan handle visits to the emergency room? Does a copay exist?
• Are hospitalization and major medical expenses covered? If so What percentage.
• What is the policy’s annual individual (or family) out-of-pocket expense limit? What costs are included vs. excluded in the out-of-pocket expense limit?
• Is there a waiting period before you’re fully covered? Should be not waiting period but ask the agent anyway
• Do you offer all the metal plans including Bronze, silver, gold and platinum.
• Do you need additional coverage, such as dental, vision or prescription drug coverage?
• Are you planning any major medical expenses for the following year (for example, having elective surgery)?
• What is the average rate increase per year with the company
• How long has the company been in business for?
• Are my prescriptions covered on this plan. Not all companies treat prescription cost the same. Make sure you have the agent look your RX prescription and see if it comes in a tier rating or just percentage.
• Does the plan offer an HSA
• What is the out of pocket maximum? Find out your worst case scenario.
• Am I eligible for obamacare?
• How does my income year to year effect my subsidy with the affordable care act?

What types of individual plans does the healthcare marketplace offer?

Individual HMO Health Insurance Plans

HMOs, or Health Maintenance Organizations, offer health care from a network of health care providers. HMOs tend to have lower premiums and deductibles, but offer limited flexibility for choosing doctors and hospitals. Under an HMO plan, you need a referral from your primary care physician to see a specialist and you may have to pay 100% of cost if you see a doctor out-of-network.

Individual PPO Healthcare Plans

PPOs, or called  Preferred Provider Organizations, also have affordable premiums and deductibles – however, they offer more flexibility to see any doctor you want and don’t require a referral from your primary care physician to see a specialist (as is required from an HMO). Under a PPO, out-of-network costs are covered, but at a lower rate than in-network costs. These plans sometimes tend to be higher in cost.

Individual High Deductible Healthcare Plans

High Deductible Health Plans, tend to have lower premiums than both HMOs and PPOs, but much higher deductibles. Deductibles are the out-of-pocket expenses you have to pay before insurance starts to cover you. You can use an HSA to lessen the financial burden of covering the high deductibles. These plans generally have similar flexibility to PPO plans.

Individual Health Savings Account

HSAs, or Health Savings Accounts, are growing in popularity for a variety of reasons. Though they may not be for everyone, if you can afford to put up the money up front, you can benefit from tax savings, and people typically save a decent chunk of money when all is said and done because they don’t have to pay the expensive premiums.

Essential Health Benefits for Individuals

Every single health insurance marketplace and private health insurance plan sold must cover the following essential health benefits:

• Ambulatory patient services (outpatient care you get without being admitted to a hospital)
• Emergency services
• Hospitalization (such as surgery)
• Maternity and newborn care (care before and after your baby is born)
• Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
• Prescription drugs
• Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
• Laboratory services
• Preventive and wellness services and chronic disease management
• Pediatric services