Health insurance plans may differ significantly in costs and benefits. Consider scheduling an appointment with one of our certified professionals who can walk you through the process. Get free enrollment assistance in your area.
Insurance you can purchase through Nevada Health Link:
Open Enrollment runs from November 1 to January 15. For coverage beginning January 1, you must enroll by December 31st. Outside the Open Enrollment Period, you generally can enroll in a health insurance plan only if you’ve recently lost your job, or have experienced a Qualifying Life Event (QLE), you may qualify for a Special Enrollment Period.
Nevada Health Link offers stand alone dental plans. Six carriers offer 21 Qualified Dental Plans to Nevada residents statewide. Learn how to enroll in a dental plan ONLY. If you are Medicare-eligible (65+) and are interested in a Qualified Dental Plan (QDP), the SBE platform allows consumers to purchase a QDP without purchase of a Qualified Health Plan (QHP).
Individual Vision Plans provide quality, full-service plan options without the inflated costs. Enrollees pay as little as $14 per month for excellent coverage and enrolling is easy – only 5-7 minutes! Visit https://www.vspdirect.com/4NV/welcome to get your free quote today!
Ten Essential Health Benefits
When the Affordable Care Act was passed and put into law, one of the most substantial sections centered around essential benefits. For any qualified health plan (QHP), insurance companies are required to cover 10 categories while following established limits on deductibles and payments
1. Ambulatory Services and Care
Any outpatient treatment you receive without being admitted to a hospital, including hospice and home health services, must be covered. Some plans may limit coverage to no more than 45 days. Some examples of outpatient care include blood tests, colonoscopies, chemotherapy, ultrasounds, and x-rays.
2. Emergency Service
An emergency service is care that could lead to disability or death if not immediately treated. This often involves an emergency room and/or transport by an ambulance. It doesn’t matter if you are out-of-network because you cannot be penalized for any emergency service.
As a hospital patient, the treatment you receive from doctors, nurses and other hospital staff is covered. Hospital coverage also includes surgeries, transplants, and skilled nursing facilities. Some plans may limit your facility coverage to no more than 45 days. However, not all plans cover the majority of hospitalization cost. If you have a high-deductible plan, you may pay more out-of-pocket.
4. Maternity and Newborn Care Services
Maternity and Newborn Care Services that women receive throughout their pregnancy, delivery and post-delivery are covered, including care for newborn babies.
5. Mental Health and Substance Abuse
Inpatient and outpatient care to evaluate, diagnose or treat a mental health disorder or substance abuse has applicable coverage. Examples include behavioral health treatment, counseling, and psychotherapy. Your health insurance may limit the coverage to a specific amount of days per year.
6. Prescription Drugs
At least one medication for each category and classification of federally approved drugs must be covered under your health insurance. Some prescription drugs may be excluded, or only generic drugs may be covered. When a cheaper and equally effective medicine is available, the insurance may decline coverage. Out-of-pocket drug expenses under the ACA count toward your deductible.
7. Rehabilitation or Habilitation Services and Devices
Rehabilitative services, habilitative services and devices to help you gain or recover mental and physical skills lost to injury are included in coverage. This coverage extends to rehab after a stroke or speech therapy for children. Plans must provide 30 visits each year for speech therapy and 30 visits for cardiac or pulmonary rehab.
8. Lab Services
Lab services include any testing that is done to help a doctor determine an injury or condition. Some screenings, such as mammograms or prostate exams, are provided free of charge. Plans must pay 100 percent of the costs of tests if doctors use them to diagnose an illness.
9. Preventive or Wellness Services and Chronic Disease Support
Care for many chronic conditions such as asthma and diabetes fall under this category. Counseling, physicals, immunizations, and cancer screenings are covered under your insurance.
10. Pediatric Services, Including Dental and Vision
Dental and vision services provided to infants and children under 19-years-old are covered by insurance when enrolled. This includes two routine dental exams, one eye exam and corrective lenses each year.
While all qualified plans must offer these ten essential health benefits, the scope of each plan may differ slightly. Pay attention to your premiums and decide what plan is best for you.
Shop on price and value: Make sure you know co-pay and deductible amounts and how much you’ll need to pay out-of-pock. A low sticker price may hide the fact that the plan doesn’t cover things like hospital visits or you prescriptions, or places a dollar cap on your benefits, leaving you at risk for hundreds or even thousands of dollars in medical bills.
Things to consider before you decide on a plan:
- Consider your health, are you healthy and don’t expect to need many costly medical services throughout the year? Or do you or your family have a medical condition or are planning to have any surgeries? Depending on your answer a bronze or gold plan may be a better choice for you. Learn more about the coverage levels (or metal tiers).
- Write down what medical services you and your family routinely use. For each plan you are considering, read the Summary of Benefits and Coverage (SBC) to make sure they are covered. Reminder: Preventive services – such as an annual check-up or a flu shot – are usually free, when delivered by an in-network provider.
- Think beyond the monthly premium amount and imagine what your costs might look like throughout the year. Consider the deductible – how much could you afford to pay upfront before your insurance starts to help you pay? Then, once the insurance kicks in, what is the percentage of the bill you will have to pay? What about prescriptions and doctor visits – do you have a copay (fixed amount) or will you pay the full cost until the deductible is met? What is the out-of-pocket maximum?
- If you have specific doctors, hospitals, and pharmacies that you prefer to use, make sure they are in-network for the plan you are considering. Most plans (HMOs and EPOs) won’t pay anything if you go out-of-network (and those costs won’t count towards your deductible or out-of-pocket maximum). Networks change from plan to plan. If your doctor is in-network (covered) by one health insurance company’s plan, do NOT assume that he/she is covered by ALL plans offered by that insurance company.
- Not all health plans cover all prescriptions. Each insurance company has a list of prescriptions they cover, called a formulary or drug list, on their website. These lists often split drugs into ‘tiers’ or categories, which determine your share of the costs. While some plans have a copay for prescriptions, a fixed amount that starts right away, other plans require you to pay the full cost until you hit a prescription deductible (if there is one) or your overall plan deductible (which is more common). Generics can save you money: There may be multiple brand and generic medications that address the same health issue. Generic options cost less than the brand name drugs and are typically covered by a larger number of health plans. Ask your doctor if a generic is right for you.
Here’s a list of common trade-offs between plans that impact how much you will pay:
- Big vs. small provider network (doctors, hospitals, pharmacies, etc. that are covered by that plan)
- 20% to 50% coinsurance (percentage of the bill that you pay)
- Copay right away for prescriptions vs. needing to pay the full amount until the deductible is met
- Need a referral to see a specialist or not
- Additional services beyond the minimum required that may be important to you
- Low premium with higher costs when you receive care vs. higher premium with lower costs when you receive care
How to Contact Your Insurance Carrier
Once you enroll in a plan, you will need to pay your monthly premium directly to your insurance carrier. Their contact information is listed below.
Medical Carriers, contact information:
- Health Plan of Nevada (HPN)
- Call: 1-800-777-1840, M-F 8:00 AM to 5:00 PM
- Send Email/Fill out form
- Silver Summit (Centene)
- Call: 1-844-366-2880
- Send Email/Fill out contact us form
- Anthem (HMO Nevada)
- Call: 1-866-755-2680, M-F 8:00 AM to 8:00 PM
- Contact Us & Forms – Anthem NV
- Friday Health Plans
- Call: 1-844-535-2000
- Select Health
- Call: 1-800-538-5038
- Aetna CVS Health
- Call: 1-844-365-7373 (TTY: 711)
- Fill out contact us form
- Hometown Health Plan
- Call: 775-982-3232
Dental Carriers, contact information:
- Alpha Dental
- Call: 1-800-807-0706
- Fill out Contact Form
- Anthem – Rocky Mountain
- Call: 1-800-331-1476
- Shop Dental Plans in NV through Anthem
- Best Life
- Call: 1-877-205-8767
- Shop Dental Plans in NV through Best Life
- Delta Dental
- Call: 1-800-422-4234
- Call: 1-800-662-5851, M-F 6:00 AM to 6:00 PM
- Contact Us and Forms
Customer Assistance Service line: 1-800-547-2927 (TTY 711)
Hours: Monday through Friday 9:00 AM to 5:00 PM PST