Health Insurance: Why, When, and What

Jul 29, 2020

Why do I need health insurance?

When you’re covered by health insurance, you have peace of mind. Having a qualified health plan through Nevada Health Link means you’ll gain even more – knowing that your coverage includes the 10 Essential Health Benefits and any pre-existing condition is covered.

Affordable health insurance can sometimes seem a little out of reach, but ask yourself, what is the value of staying healthy and knowing you and your family are covered in times of an emergency? Or if someone is diagnosed with a chronic condition such as type-2 diabetes?

Insurance isn’t fun or sexy, but if you stop and think about it, being covered can help you stay healthier through access to preventative care, like screenings and vaccines. It can also help you avoid financial ruin in the wake of an unforeseen accident. The best part is, Nevada Health Link is the only place where Nevadans can qualify for financial subsidies to help pay their monthly insurance premiums. With subsidies, the cost of some plans may be lower than you think!

When can I enroll for health insurance?

Each year, there is an Open Enrollment period when you can choose a health insurance plan for the coming year. Open Enrollment begins on November 1 and ends on January 15 for Nevadans who purchase a plan through Nevada Health Link. If you do not have health insurance, do not re-enroll in a health insurance plan or choose to automatically re-enroll during this time, you will not be covered in the new year. During Open Enrollment, if you enroll by December 14th, your coverage will begin January 1st. If you enroll between December 15th and January 15th, your coverage will begin February 1st.

If you miss the Open Enrollment Period, you may still be eligible to enroll.

Outside of the Open Enrollment Period, certain Qualifying Life Events (QLEs) can make you eligible to enroll in health insurance through a Special Enrollment Period (SEP). There are several QLE’s including marriage, giving birth or adopting or loss of job or income.

It’s easy to find out if you’re eligible and how to enroll in health insurance coverage through Nevada Health Link. Our call center staff are standing by to assist you with answering your questions and directing you to a licensed insurance broker or assister who can meet with you individually in person or over the phone, at no additional cost to you. You can also search a list of licensed brokers and assisters in your area.

What do all those health insurance terms actually mean?

  • Deductible: A deductible is the amount of money that you are required to pay out of your pocket for covered services before your health insurance plan will pay for those covered services. For example, if your deductible is $2,000, you will pay the first $2,000 of your medical expenses on your own or “out-of-pocket.” Once you have paid your deductible, the rest of your covered services will be paid by your health insurance provider with or without a required copayment, depending on your plan. Deductible amounts vary from plan to plan. This is something you’ll want to take a look at and review before choosing your plan so you know what your deductible amount will be beforehand.
  • Copayment: A copayment or “copay,” is a fixed amount of money, set by your insurance provider, that you will pay for certain covered medical services, as specified by your plan. For example, if you break your arm and go to a clinic to have it set, you may be told your copay for service is $50. If you have met your deductible and your copay is $50, you will pay $50 and your insurance would cover the rest of the bill. Copayment amounts can also vary based on different services such as doctor visits, emergency room visits, filling prescriptions or lab tests.
  • Premium: Your premium is the monthly health insurance bill you pay to your insurance carrier for your health insurance coverage. A lower monthly premium could mean you’ll pay a higher deductible (i.e., money “out-of-pocket”) but does not mean you’ll pay more for each copay. One strategy is to pay a higher monthly premium with a lower deductible. This generally saves you money in the long run. Nevada Health Link offers free assistance from licensed enrollment professionals in your area who can help you determine which plan is best for you.
  • In-Network vs. Out-of-Network: Just like your circle of friends and colleagues, your insurance provider contracts with in-network providers, suppliers and facilities to provide approved health care services. You will likely pay less when using an in-network provider versus an out-of-network provider. Going “out-of-network,” or using services through a provider or facility that isn’t contracted by your insurance provider may result in a smaller amount of the service bill being covered (or none at all) leaving more out-of-pocket cost for you to pay.

Now that you know why and when to get health insurance, start shopping for a plan that works for you today!