The Affordable Care Act (ACA) has changed the landscape for all health insurance companies. Qualified health plans now include the 10 essential health benefits. Many of these benefits existed pre-affordable care act, but now in order to be a Qualified Health Plan, they need to be included. This does not just include “Obamacare” plans. This includes any plan certified by our Nevada Division of Insurance.
The 10 essential health benefits in Nevada are…
- Ambulatory care
- Emergency services
- Maternity and newborn care
- Mental health and substance use disorder services, including behavioral health treatment
- Prescription drugs (not generic only coverage)
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventive and wellness services and chronic disease management – covered at no cost to members
- Pediatric services, including oral and vision care – regardless if you have a child enrolled or not
Being covered not mean you only pay a co-pay. There is a huge difference. A co-pay is a fixed amount per use of that service. For example, you might pay a $20 co-pay to see a doctor. Covered means the insurance recognizes the charge. They will eventually pay something towards the cost. However, you might need to pay your deductible of $500 to $8,000 before the insurance starts paying.
What about plans that don’t include these?
Numerous plans sold in Nevada by insurance companies that don’t include the 10 essential health benefits. These other “non-qualified” plans or short term health plans. Nevada law requires these plans to be no more than 3 months long. They also only allow 2 of these plans to be sold back-to-back. This totals 6 months. There are numerous differences between “Qualified” health plans and short term health plans but the biggest are:
- Short term plans are significantly cheaper in monthly premium than Qualified Health Plans
- Qualified plans have a “maximum out of pocket” limiting your out of pocket expenses in case of a catastrophic emergency.
- Most short term plans don’t contract with doctors. They will, however, reimburse you based on the service you received. Unfortunately, this reimbursement will usually fall short of what the actual cost is for the service.
- If a Qualified Health Plan fails to hold up to their side of the contract, you have the right to file a complaint with the Nevada Division of Insurance. Non-qualified plans are not held to the same standard.