The State of Nevada is known for its freedom to gamble, tourist attractions, mountains and desert climate. A backdrop for many films and a magnet for extraterrestrial activity, Nevada is one of the largest states and certainly an intriguing one. For residents of Nevada, there are many options for health insurance plans and companies. East Coast Health Insurance connects you with the most trusted Nevada health insurers, including Aetna, Anthem Blue Cross Blue Shield of Nevada, Cigna, Humana, UnitedHealth Care, Coventry and Health Plan of Nevada. To check availability and compare prices in your specific area, enter your zip code below – or call one of our Nevada agents for assistance at 888 803 5917.
Though the health of Nevada residents still has room for improvement, it has been getting better over the past two years. In the last ten years, smoking has decreased from 29% to 21% of the population over age 19. There is also a very low rate of infectious disease occurrence in Nevada. Compared to the rest of the country, the amount of adults affected by obesity is less prevalent at 23% of the population. These factors have made the health status of Nevada seem to be on the rise and may keep improving over time.
Some of the areas that need work include the amount of uninsured individuals, which is significantly higher than most of the U.S. at 21%, as well as binge drinking and low availability of primary care physicians. Although there is a lower percentage of obese adults in Nevada, the number has increased in the past ten years. Diabetes among adults is also more frequent, growing from 7.1 to 8.5 percent over the past five years. If Nevada residents use their health care plans and state-run programs, or get active and eat healthy foods, there could be a continuous improvement in health in the future.
Health Insurance Plans
- Open Access Managed Choice plans in Nevada are available in PPO, Value and High Deductible options, with deductibles ranging from $1,500 to $7,500 for individuals. These plans offer you the option of choosing in-network providers or out-of-network providers for your care, though in-network will cost much less. The High Deductible plans are qualified for use with a health savings account (HSA), which gives you control over your health care expenses with tax-advantaged funds. These plans cover a range of services, from doctor’s office visits and prescription drugs to inpatient and outpatient hospital care at a varying level of coinsurance based on the plan you choose. The higher the deductible, the less your premium and coinsurance will be, and the more benefits you receive.
- Preventive and Hospital Care plans come in two deductible choices, $2,750 for individuals and $5,500 for families, or $3,000 for individuals and $6,000 for families. These plans give a basic level of coverage, ideal for those who do not anticipate frequent hospital trips or major medical bills, yet want coverage just in case. Preventive care is covered at 100% when using in-network providers as soon as your plan starts, and other medical services such as inpatient hospitalization and outpatient care are available after meeting the deductible.
Anthem Blue Cross Blue Shield of Nevada
- Premier plans are PPOs with the most coverage offered by Anthem. These plans have unlimited doctor’s office visits with a predictable copay before meeting the deductible, in addition to prescription drug coverage. Deductibles for Premier plans range from $1,000 to $5,000 for individuals, and double the amount for families. After you have met the deductible, you can receive in-network care for 25% coinsurance, or out-of-network for 50% coinsurance. Preventive care is available as soon as your plan begins, with 100% coverage in-network.
- SmartSensePlus plans are basic plans that give members access to the Anthem PPO network and a limited number of benefits. The first three doctor’s office visits are available for a $30 copay, and covered at 70% afterward. Most medical care, including diagnostic services, inpatient hospitalization, outpatient care, emergency room visits, will cost 30% coinsurance after you meet the deductible. These plans are very cost effective, and provide preventive care services for no charge immediately when your plan starts.
- CoreShare plans are easy to use, with low monthly premiums in exchange for higher cost sharing. After meeting the deductible, the plan covers 50% of covered medical expenses until you reach the $3,500 out-of-pocket maximum. These plans also have coverage on prescription drugs as soon as your plan starts, in addition to preventive care such as immunizations and routine physicals.
- ClearProtection plans offer benefits as soon as your plan starts, such as your first two non-preventive primary care visits for a $40 copay, and prescription drugs for a $15 copay on generics. Preventive care is also available from the day your plan starts, including well child care, vaccinations, mammograms, cancer screenings and GYN exams. After you meet your deductible, major medical services such as inpatient care and emergency room visits are covered at 70%.
- Tonik plans are designed for a young adult audience to receive health benefits in a simplified way. These plans cover the first four doctor’s office visits for a $20 copay and prescription drugs immediately when your plan starts. Preventive care is covered at 100% when using in-network providers before deductible. After you meet your deductible, physician care and various hospital services are covered in full by Anthem. Basic dental and vision coverage is also included.
- Open Access plans give members access to the Cigna PPO network, with the choice of $1,000, $2,000, $3,000 or $5,000 in-network deductibles for individuals. After meeting your deductible, the plan pays for 80% of all covered benefits. Services covered include but are not limited to doctor’s office visits, lab work, X-rays, ultrasounds, physician services, and emergency care. Open Access plans also connect you to Cigna’s pharmacy benefits, which can be received at a retail pharmacy or delivered to your home. These plans also have additional dental coverage available.
- Health Savings plans are high deductible plans that are compatible with using a health savings account. These plans cover most health care costs in full after deductible, including office visits to primary care doctors and specialists, inpatient hospital services, and outpatient care. Other benefits include prescription drug coverage through a retail pharmacy or home delivery service. Health Savings plans are very comprehensive and give you control over your health care spending with tax-free funds. Preventive care is covered at 100% when using in-network providers as soon as your plan begins.
- Prism Choice plans are high deductible health plans that are not qualified for use with a health savings account, but still provide a comprehensive level of coverage. There are three types/deductible options to choose from with PrismChoice plans, including PrismChoice 1500, 2500 and 5000. Primary care visits are available as soon as your plan starts for a $25 copay, and preventive care is covered in full. After you have met the deductible, you can receive care from a specialist for a $50 copay, and emergency and urgent care for a copay as well. Inpatient and outpatient hospital care is covered at 100% in-network after deductible, and 70% out-of-network.
- Torchlight plans come with deductible choices ranging from $2,000 to $10,000 for individuals, and $4,000 to $20,000 for families. These plans offer primary care visits for a $50 copay, and specialist visits for a $70 copay before deductible, and other services in-network for a copay such as chiropractic and emergency care. Once your deductible is met, you pay 50% of the cost for in-network inpatient and outpatient hospital services. Prescription drugs are also covered for a $10 copay on generics, $40 for brand names, and $75 for non-formulary drugs.
Health Plan of Nevada
- HMO plans from Health Plan of Nevada (a UnitedHealth Care subsidiary) are available in three types, Option 1, which has maternity coverage, Option 2 and Option, which do not. Both of these plans have physician services available for a copay for primary care ($10 with Option 1, $25 with Option 2) and specialists ($20 with Option 1, $50 for Option 2). All services covered are available for a set copay from the day your plan starts, using the HMO network of providers. Services include surgery, lab work and X-rays, emergency care, urgent care and inpatient hospital stays.
- POS plans have more freedom and flexibility than the HMO plans, though you still have access to the HMO network if you choose. You may also choose to seek care from an expanded network as well as out-of-network providers. When using the HMO, you can receive care for a set of very low copayments for all types of medical services. With the expanded network, you pay a copay for doctor’s office visits and prescription drugs, and most other services are covered at 80% by your plan after deductible. Preventive care is available immediately with either network for no cost.
- Copay plans in Nevada are preferable for those who want a plan similar to an employer-sponsored plan, with a copay for doctor’s office visits and prescription drugs. These plans are available in two types, Portrait Share 80 and Autograph Share 80 Plus Rx/Copay. Portrait share plans have deductible options of $1,000 or $2,500, and cover an unlimited number of in-network doctor’s office visits for illness or injury for a copay. Autograph Share 80 plans have deductibles of $5,000 or $6,000 for individuals. In-network preventive care is covered in full as soon as your plan starts, and inpatient and outpatient hospital care is covered by your plan at 80% after deductible with both plans.
- 100% After Deductible plans come in three types: Monogram, Autograph Total Plus Rx/HSA and Autograph Total HSA. Each of these plans provides coverage in full on major medical services after you meet the deductible, including doctor’s office visits, diagnostic lab and X-ray, surgery, outpatient surgery, inpatient hospital stays, mental health care and more, Prescription drugs are available for a copay and a separate deductible for each individual on the plan. HSA plans are qualified for use with a health savings account to have better control and convenience when it comes to your medical costs.
- High Deductible plans have very low premiums with high deductible, and give you access to the Nevada PPO network, or the ability to go out of network for health care if you prefer. Plan members receive discounts on prescriptions, and there is no charge for preventive care in-network, such as immunizations, well child care, women’s health and routine physical exams. You can also add vision or supplemental accident coverage.
- Copay plans are convenient and simple, with a designated cost for certain types of medical services, such as physician office visits and prescription drugs. Most other services are available for a coinsurance payment after meeting your deductible. Covered care includes inpatient hospitalization, surgery, emergency room visits, diagnostic services and more. Preventive care is covered at 100% immediately when your plan starts when using in-network providers.
- HSA plans are high deductible plans with the option of opening an health savings account (HSA). These plans have the most comprehensive level of benefits, with most medical services covered at either 100% or 70% after deductible. HSAs allow you to use tax-advantaged funds for medical expenses or save up for future needs. There are several deductibles to select from, and a variety of optional benefits available such as prescription discount cards, and vision.
Public Health Options
For residents of Nevada who have special medical needs, low income, or belong to another group which is eligible for medical assistance, there are many programs available. The state funds a variety of services and programs, including Medicaid, for individuals who need help paying medical bills, are uninsured, or have disabilities. Some services are available to help prevent disease and promote wellness and nutrition as well. For a full list of services, visit the Nevada Department of Health & Human Services site. Below is a selection of commonly used and important public programs in Nevada.
- Medicaid: health care coverage for low income families, children, pregnant women, elderly and disabled individuals and more.
- Healthy Kids: provides preventive care, dental, vision and other health care services to children living in Nevada.
- Nevada Check Up (CHIP): medical coverage for child residents of Nevada with low-income and no insurance, who do not qualify for Medicaid.
- Health Insurance for Work Advancement (HIWA): Medicaid Infrastructure Grant Program for individuals with disabilities who want to return to work in Nevada
Health Insurance Laws
In the state of Nevada, the laws on health insurance currently are much in favor of the health insurance company. As far as their stance on pre-existing conditions, insurers define them by whether a person has received treatment or medical advice for a condition in the past. If an individual applies for health insurance and is decided as having a pre-existing condition, the insurer can deny them coverage altogether. Health insurance companies can also accept an individual with a pre-existing condition for a plan, but charge higher premiums and issue an exclusion period where they do not cover medical costs related to that condition.
Exclusion periods in most states have a 12 month limit, but in Nevada, there is no limit, so the insurer is free to set it for as many months or years as they choose. Nevada insurers can also attach an elimination rider to a plan, which acts as a permanent exclusion period. The legislation for pre-existing conditions is changing for every state under the Affordable Care Act, including Nevada, in 2014. All adults with pre-existing conditions will be accepted for private health insurance plans in the beginning of the year. In the meantime, there is the Pre-Existing Condition Insurance Plan.
Pre-Existing Condition Insurance Plans are available in Nevada for anyone who has been determined as having a pre-existing condition, and wants affordable health care coverage. These plans are run by the U.S. Department of Health and Human Services, and will be given to those who qualify until the end of 2013. Once the ACA provision becomes effective, those who have PCIP plans will have to apply for a plan with a private insurer.
The guaranteed renewability provision is another law important to health insurance companies and the insured. This law is part of HIPAA, and allows individuals with insurance to renew the same plan they had the previous year for another term once their plan expires. Guaranteed renewal is only effective as long as the insured has paid for all of their medical bills and premiums, as well as not having committed fraud. Under this provision, a policy-holder must be allowed to keep their plan, even if they acquire an illness during the course of the term. Insurance companies cannot cancel benefits due to health status, so you are able to remain insured.