“In-Exchange” Verses “non-exchange” Part 1 of our Healthcare Reform Series

By: Robert Pusateri, Capstone Brokerage

There are several things going on right now in the state of Nevada with the Health Insurance Exchange Program and the Affordable Health Care Act. The first major item may be about which carriers have become part of the exchange, which have opted out and what that means to individual consumers looking to shop the market for approved health insurance plans.

The Nevada Division of Insurance’s closely investigated each proposed plan’s assumptions and proposals, asking carriers to justify the statistics driving their rates. This will help ensure that the rates are fair and meet all criteria for Essential Health Benefits coverage by law. According to NV.GOV, all plans and rates on the site meet these requirements. They state, “The premiums shown are for ACA compliant plans in which premiums may only be based on age, geographic location, family composition, and tobacco use. Other rating factors including, but not limited to, sex/gender, health history, current health status, and history of being insured are prohibited. All plans must cover the Essential Health Benefits with no annual or lifetime limits. As a result, it is difficult to accurately compare the premiums shown to plans in the Nevada market prior to January 1, 2014.”

It may surprise some to know that only 3 providers will be offering insurance though the exchange. Twelve other Nevada Health insurance carriers have chosen not to participate in the first year. The 3 that will offer plans through the exchange market place are Anthem, Health Plan of Nevada, and Nevada Health CO-OP. Some of the big names that opted out of offering coverage in the exchange include Cigna and Aetna. The reason they may be waiting it out, perhaps to see how the new changes all play out in reality.

Even though some carriers chose to not participate they will still offer plans that meet the essential health benefits. So how do people get coverage with “non-exchange” carriers if they chose to do so? They have to go through an agent. In other words they will not be able to visit the states exchange market place, shop, sign up and pay for the coverage. Perhaps most importantly, eligible individuals will not be able to use the government subsidies to help pay for monthly premiums.

The important thing to remember is that this is all a very confusing and a new process. A broker can make it easier to navigate and to determine which route to take, their service is free to use. It only makes sense to have expert advice and assistance when choosing the plan you will have and the service is free, speak to a live Licensed Agent at 702-579-2250 or visit Silverstateinsuranceexchange.comfor help with the entire process.

If you are eligible for a government subsidy in the state of Nevada then you MUST go through one of the 3 exchange carriers to use these credits toward your monthly premium. If you are not eligible for a subsidy and would like to shop “non-exchange” carriers you must go through an agent. Some other things to consider…

• Whether your doctor will be in network with a “non-exchange” carrier or “in-exchange” carrier

• What level of plan you would like (they are broken up into “metal” tiers including, silver,
bronze, gold and platinum).

• How often I plan on going to the doctor for regular visits

Confused yet? Don’t worry more to come and as always you can contact 702-579-2250 with any direct questions.