Health Insurance

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1). If your income falls anywhere in between the 3rd column and the last column, and you would like to apply for a health insurance plan WITH a Subsidyclick the blue button.

2). If your income is greater than the last column, or you do not want a Subsidized Government plan, click the yellow NO Subsidy“button.

3). If your income is less than 138% (see chart above), you may qualify for Medicaid. Click the Red button for Medicaid. If it turns out you do not qualify for Medicaid after applying, come back to this page and click the blue “Subsidy” button.

4). Short Term Health Insurance. Click the Green button for lower cost, affordable Short Term Health Insurance.

Get Help When Selecting a Health Plan

At NO cost…absolutely FREE!

Getting help from one of our licensed agents costs you nothing, and your insurance plan will NOT go up in price for getting this help. We assist with Government subsidized health insurance AND unsubsidized private market health insurance.

Don’t navigate this by yourself! Insurance is confusing…let us guide you. Understanding your plan is more than co-pays and deductibles.

Why Do I Need Health Insurance?

♦ It helps protect your family’s health and financial well being

♦ Added cost reduction from “negotiated pricing” agreement the insurance companies have with doctors and hospitals helps you!

♦ Because accidents and health problems can happen at any time

♦ Healthcare expenses are the number one cause of bankruptcy

♦ Since 1/1/2014 it is the Law that ALL Nevadans MUST have Qualified Health Insurance →CLICK FOR DEFINITION← that has Minimum Essential Coverage. Unless you are Exempt.

♦ Even though the Affordable Care Act is still the law of the land (requiring all Americans to have a qualified health insurance plan with 10 “Essential Health Benefits“), after tax year 2019 there will no longer be a tax penalty for not having one.

Buying Health Insurance in Nevada

Nevada residents concerned that they can’t afford health insurance should absolutely call us. With the passage of the Affordable Care Act (ACA) also known as “Obamacare”, there are many programs and features of the ACA that assist with the cost of health insurance for those who qualify, like Medicaid and CHIP→Click Hereplus the Advanced Premium Tax Credit and Cost Sharing Reductions →Click Here to find out more .

Outside of Open Enrollment→CLICK FOR DEFINITION←you can still get a Qualified Health Plan if you have a Qualifying Life Event.

In addition, now in Nevada, we have other Low Cost options →Click Hereto find out more.

Focus On The Most Important Things

When researching and looking for a health insurance plan, you’ll need to focus on the big things first.

How many doctors and specialists and hospitals are in the “network“? Is my doctor in the network? Do you want a PPO or a HMO? Can I travel with this insurance plan? Is my prescription covered in the insurance plan’s PDL (Prescription Drug List) called a formulary?→CLICK FOR DEFINITION←Let’s break down each of these questions.

A Network:

Is a group of providers→CLICK FOR DEFINITION←which could be hospitals, doctors, labs, radiology centers, urgent care’s, etc., that have contracted with an insurance company on many things including pricing. So having a large network, with many choices for “providers” to choose from can be important. It’s always important, however, to make sure that you get prior authorization→CLICK FOR DEFINITION←for services that require prior authorization, for certain tests, prescriptions and procedures. If you don’t get prior authorization for a procedure, test, or prescription, you may have to pay that bill in full out of your own pocket.

Is my doctor in the network?:

Seems like a basic question, but it’s important to remember to ask us to check for you when you call.

Can I travel with this insurance plan?:

A PPO will allow you to see doctors without needing to get a referral to see who you want to see. You’ll always want to try and stay within that PPO’s provider network. This is true for all services: X-rays, labs, hospitals, ER’s, etc. You can go OUT of the PPO Network, but you’ll pay more for those services. An HMO health insurance plan will require you to stay within the insurance company’s network, and you must get a referral from your primary doctor to see a specialist. You cannot go outside of the HMO network, except for very serious emergencies.

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.

Is my prescription covered in the formulary?:

What is a Formulary?:

A “formulary” is a list of medications that are covered by your insurance plan. It is a list of generic and brand medication. Your copay→CLICK FOR DEFINITION←that you’ll pay will depend on the “Tier“. The higher the tier,→CLICK FOR DEFINITION←the more you’ll pay. A Tier 1 medication is generally a generic medication and is the cheapest copay you’ll pay of the medications covered by your insurance plan. A Tier 2 medication will have a higher copay and can be a more expensive generic medication and/or a cheaper brand medication. A Tier 3 medication is an even higher copay and is usually a more expensive brand medication and/or very expensive generic. Some insurance plans can have 4, 5, and even 6 Tiers. It’s important to make sure that you fill your prescriptions “in network”.

What is a Prescription Deductible?:

Some health insurance plans will have a Prescription Deductible→CLICK FOR DEFINITION← This means you must pay the full price of the medication until you’ve paid the deductible. Once you’ve paid the prescription deductible, then you’ll most likely just have to pay your copay. Sometimes they’ll have a prescription deductible to pay on Tiers 3, 4 and 5 and no prescription deductible for Tiers 1 and 2. This is important to pay attention to, especially if you take medications now.

If your doctor wants you to have a medication that is not on your insurance plan’s formulary, you may need to have your doctor ask for prior authorization of the medication or take your formulary into the doctor and have them choose one that is on the list.