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Health insurance might be one of the most complicated purchases you will make throughout your life, so it is important to understand the terms and definitions insurance companies use. Keep these in mind as you are comparing health insurance plan options to choose the right plan for you and make the most of your health insurance benefits. One area of health insurance that can cause confusion is the difference between a plan's deductible and out-of-pocket maximum. They both represent points at which the insurance company starts paying for covered services, but what are they and how do they work? What is a deductible? A deductible is the dollar amount you pay to healthcare providers for covered services each year before insurance pays for services, other than preventive care. After you pay your deductible, you usually pay only a copayment (copay) or coinsurance for covered services. Your insurance company pays the rest. Generally, plans with lower monthly premiums have higher deductibles. Plans with higher monthly premiums usually have lower deductibles. What is the out-of-pocket maximum? An out-of-pocket maximum is the most you or your family will pay for covered services in a calendar year. It combines deductibles and cost-sharing costs (coinsurance and copays). The out-of-pocket maximum does not include costs you paid for insurance premiums, costs for not-covered services or services received out-of-network.  Here's an example: You get into an accident and go to the emergency room. Your insurance policy has a $1,000 deductible and an out-of-pocket maximum of $4,500. You pay the $1,000 deductible to the hospital before your insurance company will pay for any of the covered services you need. If you received services at the hospital that exceed $1,000, the insurance company will pay the covered charges because you have met your deductible for the year. The $1,000 you paid goes toward your out-of-pocket maximum, leaving you with $3,500 left to pay on copays and coinsurance for the rest of the calendar year. If you need services at the emergency room or any other covered services in the future, you will still have to pay the copay or coinsurance amount included in your policy, which goes toward your out-of-pocket maximum. If you reach your out-of-pocket maximum, you will no longer pay copays or coinsurance and your insurance will pay for all of the covered services you require for the rest of the calendar year.

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Are you looking for health insurance coverage for the upcoming year? In that case, it's time to browse your options for an Individual or Family Plan. The Open Enrollment Period is from Nov. 1, 2024 until Jan15, 2025. So, if you're looking for coverage by Jan 1, 2024, you must enroll by Dec 15, 2023. Get a Quote Online Suppose you don't qualify for a health insurance subsidy, no need to worry! You can still choose an individual and family health insurance plan from Hometown Health. Get a quote online by providing your location, the type of coverage you're looking for and your personal/family details. Once you've provided this information, you'll receive health plan options and pricing. And, if you find a plan you like, you can easily self-enroll online. Get Your Online Quote Today Enroll Through the Nevada Health Link Hometown Health offers Individual and Family health insurance plans on Nevada's Healthcare Marketplace, the Nevada Health Link. Through Nevada Health Link, eligible Nevada consumers can shop for, compare and purchase quality and affordable health insurance plans with ease. Nevada Health Link is the only health insurance resource that can provide eligible candidates with federal tax credits and subsidies to help cover the cost of your health insurance. Use Hometown Health's Insurance Subsidy Federal Poverty Level Calculator to see if you qualify for a tax credit or subsidy. Enroll via Nevada Health Link Work with a Health Insurance Broker  Hometown Health is northern Nevada's local insurance provider and if you have questions about Individual and Family Plan insurance benefits, you’re in luck! Hometown Health partners with our local health insurance brokers who will work with you, typically at no cost, to help you understand health insurance plans and benefits and find the plan that is best for you. Need assistance finding a broker? Connect with our team by submitting the form below. They'll provide you with a list of our local broker partners. Find a Broker Near You

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When it comes to purchasing a health insurance plan, you’ve probably heard of the two plan types, HMO and PPO, but what exactly do these terms mean, and what is an EPO? Let’s learn more about these plan types and how you can choose the plan that meets your needs. What is an HMO Plan? HMO stands for “Health Maintenance Organization.” HMO plans contract with doctors and hospitals creating a network to provide health services for members in a specific area at lower rates, while also meeting quality standards. HMO plans typically require you to select a primary care physician (PCP) and obtain a referral from your PCP to see a specialist or to have certain tests done. If you choose to see a provider outside of the HMO’s network, the plan will not cover those services and you will be responsible for all charges. What is an EPO Plan? An EPO stands for “Exclusive Provider Organization.” This plan provides members with the opportunity to choose in-network providers within a broader network and to visit specialists without a referral from their primary care doctor. EPO plans offer a larger network than an HMO plan but typically do not have the out-of-network benefits of PPO plans. EPO plans do not require you to select a primary care physician (PCP) giving you a broader network of providers. EPO options are a great cost-saving option with more flexibility than a standard HMO plan. What is a PPO Plan? PPO stands for “Preferred Provider Organization.” PPO plans are often more flexible when it comes to choosing a doctor or a hospital. These plans still include a network of providers, but there are fewer restrictions on the providers you choose. PPO plans do not require you to select a primary care physician (PCP), giving you a broader network of providers. So, which plan should you choose? Each plan type has different benefits, so it depends on your health needs when choosing the right plan type. If you are looking for flexibility when choosing providers and locations, a PPO plan may better fit your needs. An EPO plan may be a better option if you want the flexibility of a larger network, but don’t necessarily need out-of-network benefits. If you regularly seek care in a certain geographic area and are looking for a health insurance plan at a lower price point, consider an HMO plan. To keep costs low, insurance carriers contract with providers and partner in plan members’ health to ensure quality care at the lowest cost. Whether you choose an HMO, EPO or PPO option, partnering with your health insurance carrier and your healthcare provider will help you receive the best care while controlling your out-of-pocket costs. Keep in mind that most insurance carriers offer emergency care coverage for all three plan options (HMO, PPO, EPO). Get the most out of your health insurance benefits! Established in 1988, Hometown Health is the insurance division of Renown Health and is northern Nevada’s largest and only locally-owned, not-for-profit insurance company providing wide-ranging medical coverage and great customer service to members.

Read More About Health Insurance Terms Explained: HMO, EPO and PPO Plans

Health insurance is complicated, but you don't have to figure it out alone. Understanding terms and definitions is important when comparing health insurance plans. When you know more about health insurance, it can be much easier to make the right choice for you and your family. A common question when it comes to health insurance is, "Who pays for what?" Health insurance plans are very diverse and depending on your plan, you can have different types of cost-sharing: the cost of a medical visit or procedure an insured person shares with their insurance company. Two common examples of cost-sharing are copayments and coinsurance. You've likely heard both terms, but what are they and how are they different? Copayments Copayments (or copays) are typically a fixed dollar amount the insured person pays for their visit or procedure. They are a standard part of many health insurance plans and are usually collected for services like doctor visits or prescription drugs. For example: You go to the doctor because you are feeling sick. Your insurance policy states that you have a $20 copay for doctor office visits. You pay your $20 copay at the time of service and see the doctor. Coinsurance This is typically a percentage of the total cost of a visit or procedure. Like copays, coinsurance is a standard form of cost-sharing found in many insurance plans. For example: After a fall, you require crutches while you heal. Your coinsurance for durable medical equipment, like crutches, is 20% of the total cost. The crutches cost $50, so your insurance company will pay $40, or 80%, of the total cost. You will be billed $10 for your 20% coinsurance.

Read More About Copays vs. Coinsurance: Know the Difference

When finding a provider to receive your health services, you've probably heard the terms "in-network" and "out-of-network" when it comes to your health plan. But what do these terms mean for a patient? And why should you be aware if a provider is out-of-network? What does it mean when a provider is "in-network" with a health plan? A provider is a person or facility that provides healthcare. When a provider is in-network it means there is a contractual agreement with that health plan regarding the rates for services. The provider will accept negotiated rates for services from the insurance. This means a patient will typically pay less for medical services received and is less likely to receive surprise bills. What does it mean when a provider is "out-of-network" with a health plan? Providers that are out-of-network are those that do not participate in that health plan's network. The provider is not contracted with the health insurance plan to accepted negotiated rates. This mean that patients will typically pay more or the full amount for the service they receive. Why should patients see in-network providers? Seeing an in-network provider for medical services can significantly reduce your medical expenses. Remember that in-network providers have a contractual agreement for negotiated rates with the health plan, so they cannot charge you more than that negotiated rate for a service. Seeing an in-network provider will always ensure any costs you do incur (copays or co-insurance) are applied to your health plan's deductible and out-of-pocket maximum (out-of-network costs don't apply to these amounts). To find the amounts you will pay for specific services, you can check your health insurance plan's Summary of Benefits. What is the best way to find which providers are in-network with a patient's health plan? Most health insurance companies offer multiple ways to find if a provider is in-network. To find the most accurate benefit information from your health plan, you can: Call their Customer Service department Check their website for their online provider directories If offered, check your online member portal.

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© AndreyPopov via Canva.com Becoming a Hometown Health plan member opens you up to the largest provider network in our region. As northern Nevada’s only not-for-profit health insurance company, the hometown advantage goes beyond your health coverage – and you may not be using all the perks available to you. Here are three benefits that Hometown Health is proud to offer all members to enhance wellbeing and connect the dots between healthcare and technology.  MyChart  MyChart is Renown Health's and Hometown Health’s secure online member portal that gives you direct access to your health and benefit information. From 24/7 access to your benefits and important documents to scheduling an appointment with your provider, this free tool is a great way to keep track of your family’s health. If you have a Renown primary care provider, you can use MyChart to:  Securely email your healthcare provider. Get your test results faster and view your After Visit Summaries. Request prescription refills. Schedule and check-in for appointments. Pay your bill. Request your medical records and review immunization records. Manage designated health care agents and upload end-of-life documents, such as advance directives and a living will. View or download your documents: Member ID Card, Summary of Care, Explanation of Benefits, Referrals and Authorizations. Get in touch with our Customer Engagement Center.  Telehealth  Virtual visits have never been easier thanks to Renown Telehealth and Teladoc. These two tools are convenient options that allow members to be seen by a qualified doctor via phone or video chat who can diagnose, recommend treatment and prescribe medication for many non-emergent medical conditions – no matter where you are. Some of the health issues your virtual provider can treat include:   Cold and flu Allergies Sore throat Sinus infection Respiratory infection Stomach bug Ear infection Urinary tract infection  Both Renown Telehealth and Teladoc are also staffed with specialists in behavioral health, where you can speak with a therapist or psychiatrist on a wide variety of issues, including:  Stress and anxiety Depression Trauma Grief Burnout Medication management  Renown is also proud to offer access to top-level specialty care to address your ongoing condition and help guide you through illness maintenance and education. Through Renown Telehealth, Hometown Health members have access to a variety of specialties, including (but not limited to):  Adolescent Medicine Cardiology Hematology, Oncology and Pediatric Oncology Nephrology Pediatric Endocrinology Pediatric Neurology Pulmonary and Pediatric Pulmonary Sleep Medicine  New in recent years, Teladoc is now proud to offer both dermatology and nutrition visits. Teladoc dermatologists can treat conditions like acne, rosacea and rashes, while their registered dieticians can help you manage your nutrition and weight goals.  Booking an appointment with Renown Telehealth is easy by heading over to MyChart and selecting “Schedule an Appointment.” To book an appointment with a Teladoc provider, visit teladoc.com or download the Teladoc app.  Renown Telehealth is available within the state of Nevada, and Teladoc is available in all 50 states. Your copay can be as low as $0 for each visit; check your plan documents for more information.  Doctoroo  The house call has returned – avoid long urgent care waits with Doctoroo. Through Doctoroo, Hometown Health members have access to in-home urgent care services at the same price as your regular urgent care copay. A call to Doctoroo will dispatch a fully equipped medical team consisting of an EMT and either a nurse practitioner or physician assistant to your home within a few hours. Whether you need treatment or testing, each team is ready to provide care in the comfort of your own home with their over 60 medications and antibiotics, EKGs, wound dressings, IVs, catheters and more.  Doctoroo care teams can address and treat many non-emergent care areas and conditions, including (but not limited to): Respiratory Ear, Nose, Throat Eye Wound Care Cardiac Care Musculoskeletal Gastroenterology  Doctoroo is open year-round from 7 a.m. to midnight. Book a house call in minutes in the Doctoroo app or by calling (888) 888-9930.

Read More About 3 Unexpected Perks of Choosing a Hometown Health Plan

Medicaid plays a significant role in our health care system and is the nation’s public health insurance program. In addition, this program is the predominant source of long-term care coverage for Americans. Renown Health is contracted with two Medicaid plans: Molina and Anthem. If you currently have a different plan but want to change to one that Renown accepts, you can request to change plans during the open enrollment period from January 1 to March 31. Request to change your Medicaid plan in one of three ways: Request a change to your plan, or managed care organization (MCO), by reviewing the available MCO plans online at bit.ly/MCOPlansNV and filling out the form on the webpage. Email Nevada Medicaid to ask for a plan change and include your name, Medicaid ID and the names and Medicaid IDs of any dependents in your home: MCORedistribution@dhcfp.nv.gov. Call your local Medicaid district office at 775-687-1900 (northern Nevada) or 702-668-4200 (southern Nevada) to ask about changing your plan.  For more information about the Medicaid plans accepted at Renown Health, please visit: Anthem Molina Healthcare   Renown Health accepts most insurances, but please visit the link below for the full list. Click here for all accepted plans

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