The number of insured individuals is continuing to rise, and the supply of doctors is tapering or falling here in Northern Nevada. As a result, the wait times to see a doctor have taken a sharp increase. Many times it’s taking several months to get to a doctor that accepts same day appointments. It’s quickly reaching a crisis point and I’m being asked more and more, “What about covering doctors outside of Nevada?”
Sometimes it’s for a rare disease that the member feels doctors here are unable to treat. Other times it’s a general practitioner they used to have when they lived in a different state. And still, other times they’re wondering what happens if an emergency or car accident happens outside of the state. The short answer – it depends on your health plan.
Medicare
For Medicare Supplement Reno members: These plans cover any doctor or provider in the US who accepts Medicare. This is regardless of the state they’re located.
For Medicare Advantage Reno members: The plan you selected will determine the doctors you can use out of state. Many plans have a national PPO list (Aetna, Humana). Others have a stronger local list but no coverage doctors outside of Nevada unless it is an emergency (Prominence).
Individual Health Insurance
Many grandfathered plans purchased before March 23rd, 2010 will still offer coverage for doctors outside of Nevada. Non-grandfathered plans with annual renewals every January are different. In past years, insurance companies like Anthem and Sierra Health and Life used to cover doctors outside of Nevada. This year Northern Nevada has 3 health insurance companies. They are Hometown Health, Health Plan of Nevada, and Silver Summit (Ambetter). Unfortunately, none of the 3 allow you to see a doctor outside of Nevada without going through other steps. These other steps include:
- Making sure a doctor here cannot treat the disease adequately.
- Emergency care situations.
- Some companies allow urgent care situations to be covered by doctors outside of Nevada.
- Other circumstances (with prior approval from local doctors).
Group Health Insurance
Health insurance small business plans are the best resource for covering doctors outside of Nevada. If the group is eligible, our national carriers (Aetna, United, Anthem) offer the best coverage nationwide. However, these companies will, on average, charge more for their plans than our local companies. Prominence and Hometown Health both offer coverage for doctors outside of Nevada, but only for groups with at least 10 employees. Also, no more than 15% (Prominence) or 25% (Hometown) may be located outside of Nevada. Unless you have 1 or 2 employees out of state and the rest are here, it’s best to go with a National Carrier for coverage outside of Nevada. As your broker, we can produce group health insurance quotes with every major carrier.
- When I talk about a “doctors list” or “coverage outside of Nevada”, I’m speaking of an in-network provider covered by your particular health plan.
