Looking ahead to 2016
There were five carriers that offered individual plans in the Nevada exchange in 2015, and three of them (Anthem BCBS, Time, and Nevada Health CO-OP) have requested double-digit rate increases for 2016. The proposed rate hikes for 2016 are:
- Health Plan of Nevada: 8.3 percent increase,
- Nevada Health CO-OP: 12.56 percent increase
- HMO Colorado (Anthem BCBS): 14.69 percent increase
- Saint Mary’s HealthFirst (Prominence): 2.9 percent increase
- Time (Assurant): 73 percent increase. But after the 2016 rates were filed, Assurant announced that they would be exiting the individual market nationwide, and will not participate in the 2016 open enrollment.
Humana is joining the Nevada exchange for 2016, and Anthem will start to offer PPO options in the exchange (currently, they only have HMO options). Nevada has a user-friendly rate search tool, and rates for 2016 are currently under review. Final approved rates will be published on the Nevada Division of Insurance website on October 2. Open enrollment begins November 1.
Penalty exemptions for tech glitches
Because Nevada’s health insurance exchange was so technologically flawed in 2014, the IRS allowed an exemption for residents who were unable to complete the enrollment process. Bruce Gilbert, the executive director of the exchange, noted that “any Nevadan prevented from obtaining coverage due to a technology failure is eligible for an exemption from the individual-responsibility penalty.”
But in order to get that exemption, tax filers in Nevada needed to file form 8965 with the code “G” in the “exemption type” column. Requesting a “general hardship” exemption doesn’t work, and Nevada residents started to get rejections from the IRS in June if they had filed that way. If you were unable to obtain coverage in 2014 because of the technological problems with Nevada Health Link, you can resubmit form 8965 to the IRS with the correct exemption code.
2015 enrollment – slow but steady growth
As of February 22 – at the end of the 2015 open enrollment period – 73,596 people in Nevada had enrolled in private plans for 2015. This was an increase of more than twenty five thousand people since January 9, and was more than double the number of people who had enrolled by the end of the 2014 open enrollment period last year.
But not all of them paid their initial premiums, and some people cancelled their coverage early in the year. By the end of March, 62,944 had in-force private plan coverage through the Nevada exchange. 84 percent of them are receiving premium subsidies – slightly lower than the national average of 85 percent.
In addition to the private plan enrollments, there were 28,290 Nevada exchange enrollees who qualified for Medicaid between November 15 and February 22. Medicaid enrollment continues year-round, but tends to increase during the general open enrollment.
Since Nevada switched to Healthcare.gov for the 2015 enrollment period (after running their own exchange last year), everyone who enrolled in 2014 in Nevada needed to re-enroll in order to keep their subsidies for 2015. Thus the enrollment report shows that 100 percent of the 2015 enrollees are new to the exchange (as opposed to renewing plans from 2014).
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 2015’s numbers represented strong enrollment growth, even after accounting for the attrition due to the fact that not all enrollees pay their premiums.
Open enrollment for 2015 has ended, and to purchase coverage now must people need a qualifying event (Native Americans can enroll year-round in the exchange, and Medicaid enrollment is also year-round). 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
Things went much better for Nevada Health Link during the second open enrollment period. On May 20, 2014, 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.
Nevada Health Link 2015 renewals
Because Nevada switched to Healthcare.gov for enrollment, 2014 enrollees needed to re-enroll during the 2015 open enrollment period.
People who did not complete the re-enrollment process were automatically re-enrolled in their 2014 plan, but without premium subsidies. In order to continue to receive subsidies, people who enrolled through Nevada Health Link for 2014 needed to make sure that they re-enrolled for 2015.
In order to have had uninterrupted subsidies in January, enrollees must have completed their re-enrollment by December 15. If they missed that deadline, they were able to re-enroll anytime until February 15 (February 22 with the extension that was added), but in that case, they needed to pay their full premium up front in January. The Las Vegas Sun reported that 2014 enrollees who enrolled before the end of open enrollment would 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 was 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.
Five health insurance carriers are offering policies in Nevada’s exchange in 2015: Anthem, Assurant, Health Plan of Nevada, Nevada Health CO-OP and Prominence Health Plan (formerly Saint Mary’s Healthfirst).
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.
The lowest-cost bronze plan in Nevada’s exchange averages $227/month in 2014, which is lower than the national average of $249.
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 2013 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)