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Nevada health insurance

Two insurers offering 2019 coverage through Nevada exchange. On-exchange open enrollment continues through December 15.

Health insurance in Nevada

Nevada’s health marketplace

Nevada Health Link is a state-run exchange that uses Healthcare.gov for enrollment but the state is working towards having its own enrollment platform in place by the fall of 2019.

Nevada is also the only state in the country where off-exchange plans are available year-round, albeit with a three-month waiting period before coverage begins if you enroll outside of open enrollment and don’t have a qualifying event.

On-exchange open enrollment started November 1 and continues through December 15.

Nevada carriers and rate increases

Two carriers – Silver Summit and Health Plan of Nevada – are offering 2019 plans through the state’s exchange.

For Nevada’s individual market, average rates are increasing by about 0.4 percent for 2019 plans. At ACA Signups, Charles Gaba notes that average rates in Nevada would likely be declining by about 5 percent in 2019 if the individual mandate penalty wasn’t being repealed, and if the Trump Administration hadn’t expanded access to short-term plans and association health plans.

Read more about Nevada’s marketplace, carriers and rate increases.

Exchange enrollment hits record high for 2018

In 2017, 91,003 people enrolled in 2018 coverage through Nevada’s exchange – a 2.2 percent increase over the previous year’s enrollment total (which had also been an increase from 2016).

Nevada is one of only a handful of states where exchange enrollment has increased enrollment every year since 2014. 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.

Medicaid expansion in Nevada

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

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 May 2017, average monthly enrollment for Nevada Medicaid/CHIP had grown by 298,810 people since late 2013 – a 90 percent increase. As of July 2018, the number of Nevadans covered by Medicaid/CHIP has increased by 337,000 since 2013.

Short-term coverage in Nevada

New federal rules for short-term plans clarify that states may continue to impose tighter regulations than the new federal rules. So short-term plans in Nevada have maximum terms of 185 days, and continue to be nonrenewable. (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).

Read more about short-term health plans in Nevada.

How has Obamacare helped Nevada residents

In 2013, a fifth of Nevada residents (20.3 percent of the population) were uninsured. By 2015, that number had fallen by 39 percent, to 12.3 percent.

Medicaid enrollment in Nevada increased by 90 percent from 2013 to May 2017 – the second highest percentage increase in the US, second only to Kentucky. Clearly, the expansion of Medicaid has played a major role in reducing the number of Nevada residents without health insurance.

Nevada continues to see improvements under the ACA. The uninsured rate declined by 39 percent between 2013 and 2015, and Medicaid enrollment increased by 90 percent between 2013 and 2017.

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. Heller has replaced Ensign and is now the Senior Senator from Nevada. He would still rather see the ACA replaced with tort reform and market-based overhauls, although he was one of the Republican Senators who was openly critical of some aspects of the Senate efforts to repeal the ACA in the summer of 2017. Heller has repeatedly said that Republicans need to focus on solutions rather than just calling for the ACA to be repealed, and he voted no on both the Obamacare Repeal Reconciliation Act and the Better Care Reconciliation Act in late July 2017.

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

At the state level, Nevada has a Republican governor, a roughly equally divided Senate (but with a slightly Democratic majority), and a Democratic majority in the Assembly. Governor Brian Sandoval is 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’s also continued to urge the Trump Administration to ensure that any changes to the ACA don’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 that 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 continue to exist as a supported state-based marketplace. That is still the structure Nevada uses as they head into the fifth open enrollment period in the fall of 2017.

Medicare enrollment in Nevada

Nevada Medicare enrollment reached 453,032 in 2015, which is roughly 16 percent of the state’s population. Nationwide, 17 percent of the population is enrolled in Medicare.

Historically, 86 percent of Nevada Medicare recipients qualify for coverage based on age alone – slightly higher than the national average (84 percent) – and 14 percent qualify as the result of a disability.

Medicare spends about $8,763 per Nevada enrollee each year, which is right around the national average. The state ranks 35th in overall spending with $3.3 billion annually.

Nevada Medicare recipients who want additional benefits beyond what original Medicare offers may choose a Medicare Advantage plan instead of traditional coverage. Nearly 34 percent select a Medicare Advantage plan in Nevada, whereas 31 percent of all Medicare recipients are enrolled in a Medicare Advantage plan.

Medicare Part D plans are also an option for Nevada Medicare beneficiaries who want to stand-alone prescription drug coverage. About 60 percent of Nevada Medicare enrollees also have a stand-alone Rx plan compared with 45 percent of all Medicare enrollees.

State-based health reform legislation

Here’s a summary of recent Nevada bills related to health reform: