Nevada Health Insurance

Health insurance in Nevada

● Nevada switched to a fully state-run exchange in the fall of 2019, so residents now sign up via Nevada Health Link instead of HealthCare.gov.

● Open enrollment for 2021 coverage will run from November 1, 2020 to January 15, 2020 (one month more than states that use HealthCare.gov).

● Residents with qualifying events can still sign up or make changes to their coverage for 2020. The next open enrollment period, for plans in effect in 2021, will begin on November 1, 2020.

● Short-term health plans can be sold in Nevada with initial plan terms of up to 185 days and cannot be renewed.

● With Anthem's return to the exchange, three couriers offer 2020 coverage through the Nevada exchange.

● The average premium increase in Nevada was about 1.7% in 2020.

● More than 77,000 enrolled in 2020 coverage through the Nevada exchange (the second year-on-year drop in enrollment in a row).

● Nevada implemented the ACA's Medicaid expansion in 2014.

This page provides some basic information about health and health insurance options and helps connect consumers to health insurance resources in the state of Nevada. Here you'll find information about the types of health insurance coverage available, including the basics of Nevada's health insurance market and the next open enrollment period; a brief overview of Medicaid expansion in Nevada; a quick look at the availability of short-term health insurance in the state; statistics on state-specific Medicare rules; as well as a collection of Nevada health insurance resources for residents.

Basics on the health insurance marketplace

The health insurance marketplace, which is also called the health insurance exchange, was an important component of the Affordable Care Act (Obamacare), along with Medicaid expansion provisions. In 2013, exchanges were launched for health/insurance services that first came into force in 2014. States had the opportunity to establish their own marketplace or exploit the federal marketplace.

The marketplace helps people find out if they're eligible for a marketplace plan, see the costs for various plans, and sign up for a health insurance plan. The ACA requires that essential health benefits – such as prescription drugs and maternity care coverage – be included in the health plans offered on the exchange. Plans participating in the exchange in a given state can cover the entire state or a limited service area (i.e. some counties within the state).

You can use the insurance marketplace to enroll in health care and to see if your income level makes you eligible for subsidies or cost-sharing reductions (CSR) to help you pay monthly premiums and other out-of-pocket costs (such as a deductible or copay). The health insurance marketplace is aimed at people who do not have access to group insurance coverage through an employer and are not eligible for Coverage under Medicaid or Medicare. The exchange is useful for individuals or families who own a small business or are employed by an organization that does not provide health insurance coverage.

Coverage options change from year to year. On the exchange side of the equation, health insurance plan options can be added or eliminated, and service areas can change. From a consumer perspective, a change in employment or family status can affect your eligibility for membership through the exchange and your eligibility for subsidies or cost-sharing reductions (RSI). Examples of changes in family status are reaching milestones such as reaching the age of 26 (end of the ACA offer for young adults to be covered by parental policy) or 65 (general medicare eligibility age), marriage or divorce, having or adopting a child, or changing jobs. It's in your interest to visit your status's designated exchange website each year and reevaluate your membership options and associated costs each year.

Nevada's health insurance marketplace

From 2015 to 2019, Nevada Health Link was a state-run exchange that used Healthcare.gov for enrollment. But as of fall 2019, Nevada residents signed up via Nevada Health Link, as the state no longer uses HealthCare.gov.

Open enrollment period and dates in Nevada

The open enrollment period for 2021 health plans has been extended by Nevada Health Link and will extend until January 15, 2021. This is one month more than the registration window that will apply in states that use federally managed exchange and is another example of Nevada's flexibility by establishing its own registration platform. Outside of the open enrollment period in Nevada, state residents with qualified events can sign up or make changes to their coverage.

The loss of other minimum essential coverage is a qualifying event, so people who lose employer-sponsored coverage in the midst of the COVID-19 pandemic are able to enroll in a new plan in the individual market without waiting for open enrollment. Like most other fully state-run exchanges, Nevada Health Link opened a special enrollment period in mid-March for people who weren't insured and didn't have a qualifying event. The sign-up window ended on May 15, 2020, so qualifying events are again needed to register outside the open enrollment period.

Nevada health insurance companies and rate hikes

Three carriers - Silver Summit, Health Plan of Nevada and Anthem Blue Cross Blue Shield (HMO Colorado/HMO Nevada - offer plans for 2020 through Nevada's health insurance market. Anthem had exited the exchange in late 2017, but had reunited in the fall of 2019, for effective plans in 2020.

For Nevada's individual health insurance market, average rates increased by about 1.7% for 2020 (1.6% for plans sold in the exchange). This came on the back of an even smaller 0.4% increase for plans for 2019.

How did Obamacare help Nevada residents?

In 2013, a fifth of Nevada residents (20.7% of the population) were un insured. By 2018, that number had dropped by almost 46%, to 11.2%.

Medicaid enrollment in Nevada increased by 88% from 2013 to early 2020 , the second highest percentage increase in the United States, second only to Kentucky. Clearly, the expansion of Medicaid has played an important role in reducing the number of Nevada residents without health insurance.

Nevada and the Affordable Care Act

In 2010, Nevada's U.S. Senators were split on healthcare reform. Democratic Senate Majority Leader Harry Reid voted yes and was an ardent supporter of the ACA from the get-go. But Republican John Ensign voted against the ACA. In the U.S. House, two Nevada Democrats – Dina Titus and Shelley Berkley – voted yes, while one Republican – Dean Heller – voted no.

Reid did not run for reelection in 2016, and was replaced in the Senate by Democrat Catherine Cortez Masto, who supports the ACA. Jacky Rosen, also a Democrat, is now the Junior Senator from Nevada and is also a strong supporter of the ACA.

In the U.S. House, Nevada's delegation now includes three Democrats and one Republican.

At the state level as of 2020, Nevada has a Democratic governor (who supports the ACA and is working to protect it from being overturned in the Texas v. Azar lawsuit), and a Democratic majority in both the Senate and the Assembly.

Former Governor Brian Sandoval, a Republican, was generally opposed to the ACA because of "the individual mandate it places on citizens, the increased burden on businesses and concerns about access to health care." But in 2012, Sandoval became the first Republican governor to accept federal funding to expand Medicaid starting in 2014, and he continued to urge the Trump Administration to ensure that any changes to the ACA wouldn't pull the rug out from under the hundreds of thousands of people who have gained coverage in Nevada as a result of the ACA — mostly via Medicaid expansion.

Nevada was also the only state with a Republican governor who opted to run its own exchange in 2014. Unfortunately, Nevada Health Link ran into crippling technical problems early in open enrollment and never fully recovered. In May 2014, shortly after the first open enrollment period ended, the Nevada exchange board unanimously agreed to switch to Healthcare.gov's enrollment platform but continued to exist as a supported state-based marketplace. That is the structure Nevada used until the fall of 2019, when they switched back to using the much improved Nevada Health Link platform.

Exchange enrollment hit a record high for 2018, but dropped in 2019 and 2020

During open enrollment for 2020 coverage, 77,410 people enrolled in plans through the Nevada health insurance marketplace. This was about 15 percent lower than enrollment had been two years earlier, when 91,003 people had enrolled in plans through Nevada's exchange for 2018.

Nevada is one of only a handful of states where exchange enrollment increased every year from 2014 through 2018. In that first year, fewer than 36,000 people enrolled, and the exchange struggled with technology problems.

In 2015, after switching to HealthCare.gov's enrollment platform, Nevada's exchange enrollment more than doubled, to above 73,000 enrollees. And the high-water mark came in 2018. Enrollment has declined since then, but the COVID-19 pandemic and Nevada Health Link's decision to open a special enrollment period for uninsured individuals has likely resulted in a substantial increase in enrollment mid-way through 2020.

Medicaid overview

Medicaid is a health insurance option for individuals with disabilities or individuals and/or families with low incomes. Medicaid is a joint program of the federal government and the states. The federal government broad guidelines, and each state defines its own eligibility requirements and income restrictions and administers the program. The ACA offered an option to expand eligibility to adults without dependents. All but 12 states have adopted Medicaid expansion as of August 2020.

Nevada expanded Medicaid in 2014, and as a result, the state estimated that roughly 204,000 people became newly eligible for Medicaid coverage, most of them childless adults who are working but whose employers do not offer health insurance coverage.

Medicaid expansion in Nevada

Nevada's acceptance of federal funding to expand Medicaid eligibility to 138 percent of poverty has played a significant role in reducing the state's uninsured population.

As of early 2020, average monthly enrollment for Nevada Medicaid/CHIP had grown by nearly 300,000 people since late 2013 – an 88 percent increase. (Enrollment in Medicaid plans had plateaued by 2017, and has remained fairly steady since then.)

Short-term health insurance in Nevada

Although the federal government relaxed the rules for short-term health plans in 2018, states may continue to impose tighter regulations. So short-term health plans in Nevada have maximum terms of 185 days, and continue to be nonrenewable, as those are the state's rules.

(In states that don't impose stricter limits, the new federal rules allow short-term plans to have initial terms of up to 364 days, and total duration, including renewals, of up to three years).)

Medicare overview

Medicare covers people who are age 65 or older, certain people with disabilities, and people with end stage renal disease (ESRD). Medicare terminology can be confusing. Here are simple definitions of Medicare options you may have heard about, and visit the Medicare Resources website for detailed information.

● Original Medicare includes both Part A and Part B. Under original Medicare, the federal government pays directly for services you receive. You can also buy a Medicare supplemental (Medigap) policy and/or a standalone Prescription Drug Plan.

● Medicare Part A covers inpatient hospital care, care from a nurse, hospice care, and some home health care; however, it typically does not cover long-term care or custodial care.

● Medicare Part B covers outpatient medical care and services, including some preventive care and vaccines.

● Medicare Part D covers prescription drugs. You can get drug coverage with Original Medicare by enrolling in a Prescription Drug Plan (PDP).

● Medicare Advantage, which is also called Medicare Part C, includes parts A, B, and, D. (You might also see the term "MAPD," which stand for Medicare Advantage Prescription Drug: It's the prescription drug coverage that is rolled into a Medicare Advantage plan). With Medicare Advantage, you can choose from one of several private health plans that provide service in your county, and the federal government pays the plan for the healthcare services you receive.

Medicare coverage and enrollment in Nevada

In Nevada, there were about 540,000 Medicare enrollees as of early 2020. About 40 percent are enrolled in Medicare Advantage plans, while about 60 percent have Original Medicare.