Avoiding ACA look-alike Plans

Don’t Be Fooled

Avoiding ACA look-alike Plans

This will be the first year Nevada residents will not be able to purchase a plan outside of open enrollment. Due to this requirement, many people that missed the deadline on December 15th may feel pressured to find something to cover medical expenses. This will, unfortunately, lead to individuals enrolling in a plan the seems like health insurance. The Nevada Division of Insurance recently released a statement with tips on avoiding ACA look-alike plans to help consumers identify these policies and save their money. The plans the DOI referred to specifically were health care sharing programs or ministries.

Why These Plans Do Not Work

The Nevada Division of Insurance has no control over these policies. This means that if you receive medical services and the sharing program does not pay for those services, there is no way for you to recoup those costs. The DOI explained in their notice that many of these policies specifically say that they do not guarantee payment for services received and that the member is responsible for anything the policy does not pay for.

Real health insurance Nevada plans are contractually obligated to pay for services. These services are listed in the Summary of Benefits and Evidence of Coverage. If they don’t pay for these services, the insurance company can land in serious hot water with the state. In addition to vague language in contracts, these types of plans almost never cover pre-existing conditions. Health sharing plans also do not have contracts with doctors and hospitals to charge you less than the street rate.

Our Suggestion

Do your research. With health insurance, if it sounds too good to be true then it probably is. With an exception to Medicare Advantage plans, insurance policies that cover all your health conditions while providing you with financial protection are not cheap. You can also search on the DOI’s website or any other reputable source. This is a good way to find out which insurance companies are operating in Nevada. If the company you are considering is not listed there, then it is not health insurance. You can also always call our office and ask for help. As a health insurance broker, we will let you know which plans are available and for how much without charging you fees for our services.