2015 enrollment – slow but steady growth
As of January 9 – eight weeks into open enrollment – 47,784 people in Nevada had enrolled in private plans for 2015. This was an increase of more than eight thousand people since December 15, when 40,285 people in Nevada had enrolled in 2015 plans – and a dramatic increase since December 10, when the total stood at just 10,198 private plan enrollees.
These numbers come from HHS reports that include data for all the states where HHS is running the exchange. For most of those states, the January 9 number was dramatically higher than the December 15 number, because auto-renewals were included in the January 9 total.
But since Nevada switched to Healthcare.gov for the first time during this open enrollment period, there are no auto-renewals; everyone who enrolled in 2014 in Nevada needed to re-enroll in order to keep their subsidies for 2015, since the state switched from using its own enrollment platform to using Healthcare.gov.
So the growth in Nevada is all due to manual enrollments in the second half of December and the first nine days of January.
Nevada’s exchange struggled significantly in 2014, and enrollment never reached even the modified goals the exchange had set. At its peak last summer, total enrollment in private plans was about 38,000, and it had declined to under 33,000 by fall. So although Nevada is still far below the original enrollment goals it set prior to the first open enrollment period, the January 9 enrollment total is about 26 percent higher than the exchange’s peak enrollment from last summer. And it’s widely expected that there will be an enrollment surge in the days leading up to February 15.
Of the forty thousand people who enrolled by December 15, 90 percent of them are receiving premium subsidies to lower the cost of their coverage. In addition, 13,066 Nevada exchange enrollees were eligible for Medicaid or CHIP between November 15 and December 15.
There were more than 32,000 people enrolled in 2014 plans in the Nevada exchange as of October, although we don’t know what percentage of them successfully re-enrolled and are among the 40 thousand first month enrollees in Nevada (the December HHS enrollment update lists 100 percent of Nevada’s enrollees as “new” but that’s because everyone had to start from scratch on the new enrollment platform – there was no option to just “renew” an existing plan).
Open enrollment continues until February 15. Enrollments submitted now are being processed for a March 1 effective date, and everyone who enrolls by February 15 will have coverage in place on March 1. 2015 coverage through the exchange cannot be purchased after February 15 unless you have a qualifying event. Nevada is the only state in the country however, where coverage can be purchased outside the exchange – albeit without subsidies – year-round (more details below).
Switching to HealthCare.gov
Open enrollment kicked off on November 15, and things are going much better for Nevada Health Link in round two. On May 20, the exchange board unanimously voted to drop Xerox (the company that had been responsible for building the state-run exchange website) and switch to Healthcare.gov instead (this is a permanent change and Nevada is no longer looking for a private vendor to replace Xerox).
The state has retained some responsibilities – certifying private plans and determining Medicaid eligibility – and will legally still be classified as a state-run exchange. But HHS is handling enrollment; applicants are redirected to Healthcare.gov from the Nevada Health Link site.
In-person assistance available
Nevada Health Link is offering in-person enrollment assistance during open enrollment. At the Boulevard Mall at 3528 Maryland Parkway in Las Vegas, you can get help from 10am to 9pm Monday through Saturday, and noon to 7pm on Sundays – no appointment needed. They have numerous brokers and navigators on site to help people enroll, and the assistance is free (this is always the case, in every state – enrollment assistance should never cost you anything, whether you’re using a broker, navigator, or enrollment counselor).
You can also call 702-836-9033 to schedule an appointment with Consumer Assistance and Resource Enterprise navigators.
Nevada Health Link 2015 renewals
Because Nevada has switched to Healthcare.gov for enrollment, 2014 enrollees need to re-enroll during the current open enrollment period that ends on February 15.
People who do not complete the re-enrollment process will be automatically re-enrolled in their current plan, but without premium subsidies. In order to continue to receive subsidies, people who enrolled through Nevada Health Link for 2014 need to make sure that they re-enroll for 2015.
They can do this with the help of a broker, navigator or assister at the exchange call center. In order to have uninterrupted subsidies in January, enrollees must have completed their re-enrollment by December 15. If they missed that deadline, they can still re-enroll anytime until February 15, but should be aware that they will need to pay their full premium up front in January. The Las Vegas Sun is reporting that 2014 enrollees who enroll before the end of open enrollment will be able to recoup the subsidies that they didn’t receive in January (and February, if applicable).
In October, Nevada Health Link began an aggressive outreach campaign to alert enrollees of the need to re-enroll, and they continued the outreach into December.
Oregon is the only other state to switch from running their own enrollment to utilizing Healthcare.gov for 2015. In Oregon, 2014 exchange plans terminated on December 31, and enrollees had no choice but to re-enroll. In Nevada, a state law prohibits insurers from cancelling coverage, which is why the 2014 plans through Nevada Health Link didn’t terminate on December 31 if the insureds took no action to re-enroll, but were instead renewed – albeit without subsidies – into the new year.
2015 rates and carriers
Carriers in Nevada were required to file their 2015 rates by early September. Final approved rates were released by the Division of Insurance in mid-October. The average premium increase is 6.4 percent, although rate changes for 2015 range from a 6.9 percent decrease to a 24 percent increase.
But Las Vegas was one of the 16 metropolitan areas analyzed in a September Kaiser Family Foundation report that examined proposed rates for benchmark (second lowest cost) silver plans. According to the report, the benchmark silver plan – upon which subsidies are based – was proposed to rise by a very modest 1.7 percent for 2015.
Four health insurance carriers are offering policies in Nevada’s exchange: Anthem, Health Plan of Nevada, Nevada Health CO-OP and Saint Mary’s Healthfirst. The lowest-cost bronze plan in Nevada’s exchange averages $227/month in 2014, which is lower than the national average of $249.
Nevada Health CO-OP was created under the ACA’s CO-OP provision, and garnered 37 percent of the exchange’s market share in 2014 – far more than expected, and far more than most other CO-OPs.. Official rates have not yet been released, but Nevada Health CO-OP has said that while they will be keeping rates mostly unchanged in the southern part of the state (including Las Vegas), members in the northern part of the state could see rate decreases of up to 30 percent for 2015.
Improvements for 2015, including a new website
With Nevada Health Link relying on the now very-functional Healthcare.gov site for eligibility and enrollment, the state-run portion of the exchange is able to focus on consumer advocacy and assistance, without being bogged down by the technological problems that hampered the exchange during the 2014 open enrollment. The state launched their new and improved Nevada Health Link website on November 3.
In addition to using Healthcare.gov for enrollment, premium payments are being handled directly by the carriers in 2015, rather than routing through the exchange first. As a result of these changes, Nevada Health Link should have far fewer technological headaches during the 2015 open enrollment and throughout the year.
Nevada Health Link debuted a pre-screener tool for the 2015 open enrollment period; consumers will answer six simple questions and then be routed to the appropriate section of the website.
The exchange is also putting a lot of emphasis on in-person assistance during the current open enrollment period. They’ve upgraded the portion of their site that helps consumers find local navigators, brokers and assisters. You can search by zip code and the results are displayed on a map so you can easily pinpoint the nearest in-person help.
Nevada Health Link also has a community events calendar on its website so that people can easily see when and where enrollment events are taking place.
2014 enrollment numbers
Nevada Health Link extended their 2014 open enrollment period to May 30 for people who experienced technical difficulties during the regular enrollment period. By the end of May, the exchange had enrolled about 35,700 people – short of their goal of 50,000 (which had been modified in early 2014, down from an original goal of 118,000).
Enrollment had climbed to about 38,000 by mid-summer, but had dropped to about 34,000 by early September, and to 32,460 by mid-October. Nevada Health Link’s attrition rate is thus higher than average (possibly the highest in the country – only 71.5% of the Nevada residents who were enrolled in April were still enrolled in mid-October), and the exchange has a lot of work to do to retain its customer base during the 2015 open enrollment period when they will all have to re-enroll.
In addition to the private plan enrollments, as of April 19, Nevada Health Link had also enrolled 182,946 applicants in the state’s Medicaid program, which was expanded under the ACA. Medicaid enrollment continues year-round, so that number is likely growing.
According to a Gallup poll, Nevada’s uninsured rate decreased from 20 percent in 2013 to 16 percent in mid-2014. Nevada Health Link officials hoped to reduce the state’s uninsured rate to 8 percent, so there is still a long way to go during the 2015 open enrollment period.
Xerox has so far been paid about $12 million of the $72 million that had been allocated to build the exchange, and they will only receive a small portion of the remaining funds, since much of the site was never built or was not built correctly. However, Xerox will continue to work with Nevada Health Link until early 2015, running call centers and enrolling applicants who qualify for a special open enrollment period during the rest of this year.
Applicants signing up during the 2015 general open enrollment – that started on November 15 – are directed to the federal call center for Healthcare.gov, while applicants enrolling in Medicaid (year-round) will be utilizing a separate call center. There is certain to be confusion in the transition, but officials decided this approach would be less expensive than completely revamping the existing state-run exchange.
On June 2, the state announced that fixing the Medicaid portion of the exchange will cost $25 million, but the majority ($22.5 million) will be paid by the federal government.
Xerox and Nevada Health Link are settling their contract privately, without litigation. But in early April, a class-action lawsuit was filed against Nevada Health Link, alleging gross negligence in the cases of residents who enrolled through the exchange, claim to have paid their premiums, and yet have applications that are still pending and no insurance coverage in force.
In mid-May, the exchange board indicated that they would “request that Xerox provide defense and indemnify the state of any consequences stemming from the class action lawsuit.” In addition to the consumers whose applications have not been correctly processed, Nevada Health Link has been plagued with problems stemming from a failure to correctly assign and pay broker commissions.
Year-round off-exchange enrollment
Nevada is the only state in the country where carriers selling plans outside of the exchange are required to make those policies available for purchase year-round. The carriers are allowed to impose a waiting period of up to 90 days before coverage become effective, a provision that was included in order to protect against adverse selection.
Residents in Nevada are still required to comply with the individual mandate or face a tax penalty, but they are also allowed to shop for new coverage outside of the exchange year-round, with plans that will go into effect after 90 days.
The availability of off-exchange plans year-round has caused some media confusion, and reports have been published indicating that residents can get policies through the exchange in advance of open enrollment. This is not correct however. The Nevada Health Link website clearly states on the homepage that enrollment is only available outside of open enrollment if you qualify for Medicaid or if you have a qualifying event.
No grandmothered plans in Nevada
Nevada’s Division of Insurance announced in late November that policies scheduled to end on December 31 could not be extended into 2014, and should instead be replaced with ACA compliant plans. Thus there is also no renewal available for pre-2014 plans heading into 2015.
History of the Nevada exchange
Nevada’s blueprint for its state-run health insurance exchange received federal approval on Dec. 3, 2012. Gov. Sandoval and the state legislature created the Silver State Health Insurance Exchange in 2011, and the state moved steadily to get the marketplace up and running.
Nevada’s exchange is overseen by a 10-member board, seven of which are voting members. Five of the voting members were appointed by the governor, and the other two were appointed by the state Senate majority leader. The three nonvoting members lead the state’s departments of Administration, Health & Human Services, and Insurance.
Nevada Health Link operates as a “free market facilitator,” meaning it allows all qualified health insurance companies to sell policies on the exchange. Insurers can participate in both the individual and small-business exchanges.
In July, Nevada Health Link selected Bruce Gilbert to be the new executive director, a position that has been open since mid-March when director Jon Hager resigned.
More Nevada health insurance exchange links
Silver State Health Exchange
Information about exchange planning and start-up operations
State Exchange Profile: Nevada
The Henry J. Kaiser Family Foundation overview of Nevadaʼs progress toward creating a state health insurance exchange.
Nevada Governorʼs Office for Consumer Health Assistance
Serves all residents with health-related issues; benefits, denials, insured, uninsured, worker’s compensation, and hospital billing.
(702) 486-3587 / Toll-Free: 1-888-333-1597 (nationwide)