Nevada is nicknamed as The Silver State because silver plays a vital role in the state’s history as well as economy. The state is also popular for its 24-hour casinos and the great expanses of desert among the Americans and it comes to 7th largest state in terms of areas. However, residents of this Silver State are among the least healthy as the state ranks number 45 in the health ranking and rank number 6 for heart disease. There is certainly room for improvement in health for Nevada like many other states of the U.S. Since 2015, it has been a state-run exchange that uses Healthcare.gov for enrollment. But from the fall of this year 2019, residents of this state enrolled through Nevada Health Link, as the state is no longer using HealthCare.gov. This is the only state in the U.S, where off-exchange health insurance plans are available all through the year. Residents who enroll outside the open enrollment period without having a qualifying event have a three month waiting period for the coverage to start. During the open enrollment for 2019 coverage around 83, 647 people enrolled in health plans through the Nevada exchange which was 9% lower than the previous year enrollment. For 2020 coverage, on-exchange open enrollment run from November 1 to December 15, 2019 and outside this window enrollment will only be available for residents with qualifying events.
Highlights and Updates
- November 1 to December 15, 2019 is the open enrollment date for the 2020 coverage in Nevada.
- Earlier Nevada has a state-run exchange and HealthCare.gov was used for enrollment but in the fall of 2019 the state transitioned into completely state-run exchange.
- In Nevada short-term health plans are available with initial plan terms of up to 185 days and the plans cannot be renewed.
- For 2019 coverage, only two insurers were offering the coverage through Nevada exchange but in 2020 Anthem will be joining the exchange.
- In 2019, first time the enrollment dropped year over year, as only 84,000 residents enrolled for 2019 coverage.
- Insurers have proposed an average premium rate increase of just 0.5% for 2020 in Nevada, and it was 0.4% in 2019.
Individual and Family Health Plans in Nevada
Nevada residents have the option to choose from a wide array of health insurance plans designed especially for individuals and families. These health insurance plans can be obtain either from the private insurance companies or providers participating in Nevada through the state run exchange. All the qualifying Individual and family health plans in Nevada offered by private insurers should offer the ten standardized essential benefits that are mandated under Affordable Care Act. All these plans will include essential benefits like emergency services, hospitalization, prescription drugs, ambulatory patient service, maternity and newborn care, preventive care, rehabilitative and habilitative services as well as devices, mental health, and pediatric service along with oral and vision care. Individual and families health insurance plans available in Nevada include:
Preferred Provider Organization Plans – PPO plans are among the most popular plans in the Individual and Family segment that allow members to visit their preferred in-network physician or healthcare provider without requiring a referral from their primary care physician. PPO plan is right for individuals who wish to have freedom to choose healthcare provider of their choice. The other benefit of this plan is that a portion of out-of-network claims are covered by the insurance company and members of this plan do not have to obtain referral before visiting a specialist. However, PPO plan members are encouraged to use the insurance company’s network of doctors, though they don’t need to choose a primary care physician. In-network healthcare services are covered with greater benefit compared to out-of-network services. Thus, while availing the PPO plan, enrollees should cross-check that their healthcare provider accepts their health plan so that they can receive highest level of benefit coverage.
Health Maintenance Organization – HMO plans offer healthcare services through a network of providers who agree to provide healthcare services to members of the plan. The members of HMO plans receive coverage for a broader range of preventive healthcare services than they would receive through another type of plan. Members are required to choose a primary care physician who take care of their healthcare needs and also provide a referral to see a specialist. Members may not require to pay deductible before the start of the coverage and they also have minimal co-payments, so members have lower out-of-pocket costs with the HMP plans. Members don’t have to submit their claims to the insurance company, so no or less paper work with these plans. However, members need to keep in mind that they will likely have no coverage for services rendered by out-of-network providers for healthcare services received without a proper referral from their primary care physician.
HSA Plans – Health Saving Account Plans are the least understood plans in Nevada, as most of the people of this state do not have clarity on these plans. People who do understand these plans and the tax savings that come along with the plans simply prefer HSA plans. HSA is tax-advantaged saving accounts in which people can set aside money on a pre-tax basis that can be used to pay for the qualified healthcare expenses. The untaxed amount in the HSA can be used to pay for deductibles, co-payments, co-insurance, and some other healthcare expenses. This allows people to lower their overall health costs. HSA can only be used in conjunction with a High Deductible Health Plan.
Flexible Spending Accounts – Flexible Spending Account is an effective way of managing money to pay for out-of-pocket medical expenses. The money saved in the FSA is not taxable, thereby resulting in taxes reduction. In the Flexible Spending Account the employees contribute in the account over the year in regular installments. As per the Affordable Care Act provisions, individuals can contribute up to $2,500 per year to their FSA, which can be used for out-of-pocket expenses not covered by the insurance plans. Out-of-pocket expenses may include over-the-counter preparations, devices and equipment allowed by law. Individuals should obtain a prescription for OTC items and need to submit an itemized receipt to avail tax deduction.
Short-term Plans in Nevada
As per Nevada regulations, short-term health insurance is a plan that lasts not more than 185 days and its coverage cannot be renewed. The short-term coverage can be extended in case if the insured is hospitalized on the day on which the plan would have terminated. The extended period of the plan would cover the period for which the patient stays in hospital. The health insurance exchange of the state has been active in educating consumers about the short-term plans. Currently five insurers are offering short-term plans in Nevada. Short-term plans are great solution for Nevada residents who are between jobs, waiting for their group coverage to start or require an affordable solution to traditional health insurance for some time. The benefits covered under short-term plans are related to emergency care and these plans work well for people who don’t require regular medical care like frequent visit to the doctor or expensive prescriptions. Though, short-term plans do not come with many benefits like major medical health insurance but still these plans provide some coverage that is affordable for many people.
Dental Insurance Plans in Nevada
Dental insurance plans and discount dental plans in Nevada are an excellent options for individuals and families who wish to save substantially on dental care costs while their visit to the dentist. The dental plans in Nevada can be availed through private insurance carriers and these plans come with no waiting periods. Dental insurance plans in Nevada are categorized into indemnity and managed-care plans.
Indemnity Plans – Indemnity plans provide a broader selection of dentists and in this plan the insurance carrier pay for the covered dental services only after receiving the bill. This means that the insured have to pay up front and then they ca reimburse the amount from their insurance carrier.
Managed Care Dental Plans – Managed care dental plans maintain a network of dental care providers. Dentists participating in the network agree to provide dental care services at pre-negotiated rates and submit the claim to the insurance company. The members of this plan have less paperwork and lower out-of-pocket costs with this plan.
Insurance Carriers in Nevada
In Nevada two insurance carriers Silver Summit and Health Plan of Nevada were offering health insurance plans in 2019 through the state’s exchange. In addition to them, Anthem Blue Cross Blue Shield will be rejoining the exchange statewide in 2020 after exiting in 2017. So, overall there will be three insurance companies offering plans in the Nevada exchange in 2020.