Health insurance in Nevada
- Nevada has a state-run exchange that uses HealthCare.gov for enrollment, but will be transitioning to a fully state-run exchange by the fall of 2019.
- Open enrollment for 2020 coverage in Nevada will run from November 1 to December 15, 2019.
- Short-term health plans can be sold in Nevada with initial plan terms up to 185 days, and cannot be renewed.
- Two carriers are offering 2019 coverage through the Nevada exchange, but that will grow to three in 2020 with Anthem’s return.
- The average premium increase in Nevada was about 0.4% in 2019; insurers have proposed an average increase of just 0.5% for 2020 .
- Nearly 84,000 enrolled in 2019 coverage through the Nevada exchange (the first time enrollment has dropped year-over-year).
- Nevada implemented the ACA’s Medicaid expansion in 2014.
Nevada’s health marketplace
Since 2015, Nevada Health Link has been a state-run exchange that uses Healthcare.gov for enrollment. But starting in the fall of 2019, Nevada residents will enroll through Nevada Health Link, as the state will no longer be using HealthCare.gov.
Nevada is 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 (premium subsidies and cost-sharing reductions are not available outside the exchange, so enrollees pay full price if they enroll off-exchange).
On-exchange open enrollment for 2020 coverage will run from November 1 to December 15, 2019; outside of that window, enrollment will only be available through the exchange for residents who have qualifying events.
Nevada carriers and rate increases
Two carriers – Silver Summit and Health Plan of Nevada – are offering 2019 plans through the state’s exchange. But for 2020, Anthem Blue Cross Blue Shield (HMO Colorado/HMO Nevada) is rejoining the exchange statewide, after exiting at the end of 2017. So there will be three insurers offering plans in the exchange in 2020.
For Nevada’s individual market, average rates increased by about 0.4 percent for 2019 plans. Although that’s a very modest rate change, Charles Gaba of ACA Signups noted that average rates in Nevada would likely have declined by about 5 percent in 2019 if the individual mandate penalty hadn’t been repealed, and if the Trump administration hadn’t expanded access to short-term plans and association health plans.
For 2020, average rate increases are expected to once again be very modest, with insurers proposing an average increase of about half a percent.
Read more about Nevada’s marketplace, carriers and rate increases.
Exchange enrollment hit a record high for 2018, but dropped in 2019
83,647 people enrolled in plans through the Nevada exchange during open enrollment for 2019 coverage. This was 9 percent lower than enrollment had been the year before, when 91,003 people had enrolled in plans through Nevada’s exchange for 2018. That had been a 2.2 percent increase over the 2017 enrollment total, which had also been an increase from 2016.
Nevada is one of only a handful of states where exchange enrollment increased every year from 2014 through 2018. 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. And the high-water mark came in 2018.
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 2019, average monthly enrollment for Nevada Medicaid/CHIP had grown by more than 300,000 people since late 2013 – a 90 percent increase (enrollment had plateaued by 2017, and has remained at about the same level since then).
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, as those are the state’s rules. (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 (20.7 percent of the population) were uninsured. By 2017, that number had fallen by nearly 46 percent, to 11.2 percent.
Medicaid enrollment in Nevada increased by 90 percent from 2013 to May 2019 – 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 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
In Nevada, there were about 516,000 Medicare enrollees as of late 2018 – less than 17 percent of the state’s population. Nationwide, 18 percent of the population is enrolled in Medicare.
Of Nevada beneficiaries, about 86 percent were eligible by virtue of their age in 2016 (the remainder eligible due to disability.) Nationally, about 16 percent of Medicare beneficiaries were eligible due to disability.
In 2016, Medicare’s per-beneficiary spending in Nevada was $9,347 – slightly lower than the national average.
As of 2017, about 85,000 Nevadans were enrolled in Medicare Advantage plans – about 36 percent of the state’s Medicare population. That compares to about 33 percent nationwide.
As of 2018, about 178,000 Medicare beneficiaries in Nevada had Part D stand-alone plans, while another 180,000 had prescription drug coverage integrated through their Advantage plans.
State-based health reform legislation
Here’s a summary of recent Nevada bills related to health reform: