Qualified Health Plans

Understand the Differences Before You Buy

Qualified Health Plans

If you call into our office and ask about health insurance plans, you may hear us use the term qualified health plans and non-qualified. It is important to understand the difference between these before you buy. Doing so will help you make a better decision about the policy so there are no surprises when wanting to make a claim.

Max Out of Pocket

This is the main benefit that separates these two types of policies. A maximum out of pocket is what makes a policy “real insurance”. This is because, in the event of a catastrophic situation, this will limit your out of pocket costs to a certain amount. In 2019, the highest amount this can be for a Reno health insurance plan is $7,900. Medical bills are the number one cause of personal bankruptcy in the United States but a max out of pocket moves the risk of unaffordable medical costs away from you and onto the insurance company. Non-qualified plans do not have this benefit. In fact, these plans have the opposite benefit called a maximum allowable charge. This limits the amount the insurance company will give you before cutting benefits off.

Preventative Services and Pre-Existing Conditions

The Nevada Division of Insurance determines what plans are considered legal, real insurance. For health insurance Nevada plans to be approved, they must also include $0 preventative services and cover pre-existing conditions. Preventative services include check-ups to determine whether you are healthy. These include doctor visits, cancer screenings, blood pressure readings, and many others. If your doctor does diagnose something during the visit, you will be charged your copay or coinsurance for the service. Qualified health plans also do not exclude pre-existing conditions. When filling out an application, there will not be health questions that you have to answer. If there are health questions, the plan is not qualified and may not cover you for past conditions.

There are many other differences between these two types of plans. It can help to consult a health insurance broker to understand exactly what type of plan you are buying. Our office does not charge any fees for our services and can provide you with no cost assistance.