Buying Health Insurance: What to Know About Plans Outside the Exchange

Updated: KTVN – Monday, September 10th 2018

Open enrollment for health insurance through Nevada Health Link starts November first.  And new rules mean Federal requirements for some health insurance plans sold outside of the Exchange have been loosened; these short-term plans are sometimes called “junk plans.”

“They are calling them junk plans because they’re not as comprehensive as qualified health plans,” said Heather Korbulic, Executive Director of Silver State Health Insurance Exchange.  “They don’t have to cover the 10 essential health benefits and they don’t connect you to subsidies.”

The 10 essential health benefits are services that insurance plans must cover under the Affordable Care Act.  Plans purchased through Nevada Health Link with the two participating companies –  Health Plan of Nevada and Silver Summit – cover these services.

“The qualified health plans cover the 10 essential health benefits like maternity and newborn care, substance abuse services and prescriptions,” Korbulic said.   “So on an exchange plan they’re not allowed to discriminate against you based on your preexisting conditions; you get the same rate despite what your medical conditions are.”

She says that’s not necessarily the case with some of these short-term plans.

“With those plans, they’re more designed to basically take your preexisting condition and charge you more or tell you you can’t be on those plans at all,” Korbulic said.  “What’s really concerning is they can do post-claim underwriting –  meaning they can retroactively terminate you if they find that you’ve not disclosed a medical condition,  and then you’re left high and dry with no insurance.”

She says while the premiums might look appealing at first glance, they could cost customers more in the long run.

Before the Affordable Care Act this is kind of how the entire insurance market operated,” Korbulic said.  “By discriminated pricing based on preexisting conditions and sometimes pricing you out entirely.”

With open enrollment coming up, state health officials want to make sure Nevadans looking for health coverage know all their options before they buy.

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