With most of the Affordable Care Act’s major provisions now in effect, the nation’s health insurance marketplace has undergone a significant transformation. Obamacare impacts individuals, families and small business owners alike. Most Americans are required to have minimum essential coverage unless they qualify for an exemption; however, the law is designed to make health insurance more accessible and affordable with income-based financial assistance and one-stop shopping via state-based and federally facilitated exchanges. Meanwhile, the private marketplace remains a place to shop for quality, affordable health insurance plans that meet ACA requirements.
The following guide offers a glimpse at the various types of ACA-compliant health insurance in Nevada, including individual and family health plans, small group health plans, coverage for high-risk applicants, mini-COBRA continuation coverage, Medicaid, and CHIP.
Health and healthcare in Nevada
Nevada ranked 39th in United Health Foundation’s 2014 America’s Health Rankings.1 Its strengths include a low prevalence of binge drinking, a moderate prevalence of diabetes, and a low incidence of infectious diseases. The state’s biggest challenges include a low high school graduation rate, a high violent crime rate, and low per capita public health funding. While 52.1 percent of Nevadans age 25 and older with at least a high school education report their health is “very good” or “excellent,” only 21.9 percent of those with less than a high school education report the same.
Nevada individual and family health insurance
For 2014 Obamacare open enrollment, Nevada opted for a state-based exchange. Individuals, families and small businesses shopped and applied for coverage through the Silver State Exchange’s Nevada Health Link portal. However, effective at the start of 2015 open enrollment, the state moved toward a partnership model, and operates as a state-based marketplace with healthcare.gov technology to complete enrollments.4
Nevada residents can also buy qualified health insurance plans in the private marketplace through websites such as HealthCare.com. Check out HealthCare.com’s tax subsidy calculator to see if you qualify for a tax credit. If you do, visit Nevada’s Health Insurance Marketplace to apply for health insurance coverage.
The U.S. Department of Health and Human Services reported that 45,390 individuals in Nevada selected a marketplace plan through the exchange from Oct. 1, 2013, through April 19, 2014.2 In 2015, the number of individuals in Nevada enrolled in a marketplace plan increased to 73,596 during the open enrollment period.3
|Nevada’s health insurance exchange:||nevadahealthlink.com|
|Nevada department of insurance:||doi.nv.gov|
Nevada small group health insurance plans
Small business owners with 50 or fewer employees may purchase group health insurance plans through Nevada’s Health Insurance Marketplace, as well as in the private marketplace. Small businesses that use SHOP and have 25 or fewer employees may qualify for a Small Business Healthcare Tax Credit.
Self-employed individuals with no employees must apply for an individual health insurance plan on or away from Nevada’s exchange.
Nevada state COBRA variations for small groups
The Consolidated Omnibus Reconciliation Act (COBRA) allows those employed by businesses with 20 or more employees to continue their group health insurance plan for a limited time should they lose coverage due to qualifying events such as termination of employment due to reasons other than gross misconduct, a reduction in work hours, divorce or legal separation, and loss of dependency status. To learn more about the federal COBRA program, visit dol.gov/ebsa/cobra.html.
Nevada high-risk pools
It used to be that health insurance companies could deny applicants or charge them more based on health history and preexisting conditions. When the Affordable Care Act was passed in 2010, many states created federally funded preexisting condition insurance programs or accepted federal funding to assist with similar high-risk pool programs they already operated. 5
The Affordable Care Act prohibits this practice for health insurance plans considered minimum essential coverage with effective dates beginning Jan. 1, 2014, and later. As such, the PCIPs and state high-risk pools created to provide health insurance for those once considered uninsurable are being phased out.
Medicaid is a state health insurance program for low-income individuals under age 65, pregnant women, children, disabled individuals, and seniors over age 65; it is partially funded by the federal government. In 2014, states were given the option to accept additional federal funding and expand their Medicaid program eligibility to those who make up to 133 percent of the federal poverty level (effectively 138 percent due to how it is calculated, according to HealthCare.gov).6
Nevada expanded Medicaid to low-income adults without dependents in 2014.7 Medicaid/CHIP open enrollment takes place year-round.
The information below is specific to Nevada’s Medicaid program:
|Governing agency||Centers for Medicare & Medicaid|
|Administrator||Nevada Department of Health and Human Services|
|Where to apply||nevadahealthlink.com / dwss.nv.gov|
|Open-enrollment period||Year-round in all states|
The Children’s Health Insurance Program is a partnership between the states and federal government. CHIP provides health insurance to uninsured children who meet certain eligibility guidelines.
The information below is specific to Nevada Check Up, Nevada’s health insurance program for low-income children:
|Program name||Nevada Check Up|
|Where to apply||nevadahealthlink.com In-Person at Division of Welfare and Supportive Service offices—find locations at dwss.nv.gov under “contact us”|
|Eligibility8||Low-income, uninsured children, birth through age 18|
1 United Health Foundation. 2014 America’s Health Rankings Annual Edition. “Annual State Health Rankings.” http://www.americashealthrankings.org
2 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2014/.
3 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2015/.
4 U.S. Department of Health & Human Services, Office of the Assistant Secretary for Planning and Evaluation. “Health Insurance Issuer Participation and New Entrants in the Health Insurance Marketplace.” Sept. 23, 2014. http://aspe.hhs.gov/health/reports/2014/NewEntrants/ib_NewEntrants.pdf.
5 National Conference of State Legislators. Coverage of Uninsurable Pre-Existing Conditions: State and Federal High-Risk Pools. Updated April 2014. http://www.ncsl.org/research/health/high-risk-pools-for-health-coverage.aspx.
6 Centers for Medicare & Medicaid Services. “Medicaid Expansion & What It Means for You.” HealthCare.gov. N.D. https://www.healthcare.gov/what-if-my-state-is-not-expanding-medicaid/.
7 Centers for Medicare & Medicaid Services. “Nevada.” http://www.medicaid.gov/medicaid-chip-program-information/by-state/nevada.html.
8 Nevada Department of Health and Human Services. Division of Health Care Finance and Policy. “Nevada Check Up.” https://nevadacheckup.nv.gov.