Switching to HealthCare.gov
Open enrollment kicks off on November 15, and Nevada Health Link is prepared for a much better second round. 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 will retain some responsibilities – certifying private plans and determining Medicaid eligibility – and will legally still be classified as a state-run exchange. But HHS will handle enrollment; applicants will be redirected to Healthcare.gov from the Nevada Health Link site.
On October 9, the Nevada Health Link Board provided a progress update and schedule for the various aspects of the exchange’s transition to a Supported State Based Marketplace (SSBM). Carriers began testing the new system on October 7, and so far, everything appears to be on track.
Nevada Health Link 2015 renewals
Because Nevada will be using Healthcare.gov for enrollment, current enrollees need to re-enroll during the 2015 open enrollment that runs from November 15 to 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, and they must finalize their re-enrollment by December 15 in order to have seamless subsidies going into 2015.
2015 rates and carriers
Carriers in Nevada were required to file their 2015 rates by early September, and state regulators have been reviewing them ever since. 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 will be 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, and officials are optimistic that things will be much better during the second round of open enrollment.
In addition to using Healthcare.gov for enrollment, premium payments will be handled directly by the carriers for 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 next year.
Nevada Health Link is debuting 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 for the upcoming open enrollment period. They will be upgrading the portion of their site that helps consumers find local navigators, brokers and assisters (currently it just displays all of the names in a PDF style document. But the new “find an assister” tool will let people search by name or zip code and will display results in a Google maps format).
Nevada Health Link will also have 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 – starting on November 15 – will be 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 believe this will 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)