Health Insurance Marketplace in Nevada
If you live in Nevada, the Nevada Health Link is the Health Insurance Marketplace to serve you. Instead of HealthCare.gov, you’ll use the Nevada Health Link website to apply for coverage, compare plans, and enroll. You can apply as early as October 1, 2013. Visit the Nevada Health Link now to learn more.
Choosing the Right Health Insurance Plan
There are a number of different tiers of plans available on the Nevada Health Insurance Exchange. Plans range from bare bones “bronze” plans which cover 60% of pocket medical costs to “platinum” plans which have greater coverage but come with higher premiums. In general higher premiums mean lower out-of-pocket costs and a wider insurer network of doctors and hospitals.The plans are as listed below: NOTE: All cost sharing is of out of pocket costs. Please see ObamaCare health benefits for services that are covered at no out of pocket charge on all plans. The maximum out-of-pocket costs for any Marketplace plan for 2014 are $6,350 for an individual plan and $12,700 for a family plan. Bronze Plan: The bronze plan is the lowest cost plan available. It has the lowest premiums and in exchange has the lowest actuarial value. The actuarial value of a bronze plan is 60%. This means that 60% of medical costs are paid for by the insurance company, leaving the other 40% to be paid by you. Silver Plan: The Silver plan is the second lowest cost plan, it has an actuarial value of 70%. This means that 70% of medical costs are paid for by the insurance company, leaving the other 30% to be paid by you. The Silver plan is the standard choice for most reasonably healthy families who historically use medical services. Gold Plan: The Gold plan is the second most expensive plan, it has an actuarial value of 80%. This means that 80% of medical costs are paid for by the insurance company, leaving the other 20% to be paid by you. Platinum Plan: The Platinum plan is the plan with the highest premiums offered on the Nevada insurance exchange. The Platinum plan as an actuarial value of 90%. This means that 90% of medical costs are paid for by the insurance company, leaving the other 10% to be paid by you. This plan is suggested to those with high incomes and those in poor health. Although coverage is more expensive up front the 90% coverage of costs will help those who use medical services frequently. Nevada health insurers don’t have to offer every tier of plan, but within the Nevada health insurance exchange, all health insurance companies must offer at least one silver plan and one gold plan to consumers. Catastrophic plans – which have very high deductibles and essentially provide protection from worst-case scenarios, like a serious accident or extended illness — are available to people under 30 years old and to people who have hardship exemptions from the fee that most people without health coverage must pay.
Nevada will expand its Medicaid program in 2014 to cover households with incomes up to 133% of the federal poverty level. That works out to about $15,800 a year for 1 person or $32,500 for a family of 4. You can find out whether you qualify for Medicaid in Nevada 2 ways: Contact your state Medicaid agency right now or fill out an application for coverage in the Health Insurance Marketplace.
If you need more detailed analysis, identification of issues, solutions, and implementation of your health insurance plan please let us know with the form below and we’ll get right back to you.
Consumer Operated and Oriented Plan Program
Consumer Operated and Oriented Plan (CO-OP) Program are qualified nonprofit health insurance issuers that offer competitive health plans in the individual and small group markets. CO-OP’s in Nevada:
Accountable Care Organizations in Nevada
ACOs are profit-driven health innovators primarily serving Medicare patients who are financially rewarded by the government and private insurance companies for delivering medical services that lead to better health outcomes for less money.
- Regional Emergency Medical Services NV – Health Care Innovation Award
- St. Luke’s Regional Medical Center, Ltd. NV – Health Care Innovation Award
- University Of North Texas Health Science Center NV – Health Care Innovation Award
Models Run at State Level
Health care facilities where Innovation Models are being tested
- St. Rose Dominican Hospitals – Rose de Lima Campus Henderson, NV – BCPI Initiative: Model 4
- St. Rose Dominican Hospitals – San Martin Campus Las Vegas, NV – BCPI Initiative: Model 4
- St. Rose Dominican Hospitals – Siena Campus Henderson, NV – BCPI Initiative: Model 4
- Renown Pregnancy Center Reno, NV – Strong Start for Mothers and Newborns Initiative
- Women’s Specialty Care Las Vegas, NV – Strong Start for Mothers and Newborns Initiative
The Insurance Exchange/Marketplace
What has been done, not been done, or left up to the federal government to do.
Establishing the Exchange in Nevada
On June 16, 2011, Nevada’s Governor Brian Sandoval (R) signed SB 440 into law establishing the Silver State Health Insurance Exchange.1 In March 2013, the state announced that the online marketplace would be called Nevada Health Link.
Structure: The legislation defines Nevada’s Exchange as a quasi-governmental organization.
Governance: The Exchange is governed by a 10-member board, including three ex officio, non-voting members (or their designees): the Director of the Department of Health and Human Services, the Director of the Department of Business and Industry, and the Director of the Department of Administration. The Governor will appoint five of the voting members, while the Senate Majority Leader and the Speaker of the Assembly will each appoint one voting member. The legislation specifies that voting members should possess subject expertise in areas such as: individual or small employer health insurance markets; health care administration, financing, or information technology; health care delivery system administration; or experience of consumers that would benefit from the Exchange. Voting members cannot be Legislators or hold an elected office in Nevada state government, nor can they be affiliated with, have ownership interest in, or be a representative of a health insurer.
On September 23, 2011, the final board members were appointed.2 The voting members are:
- Lynn Etkins, Legal Aid Center of Southern Nevada
- Dr. Judith Ford, Canyon Gate Medical Group
- Leslie Ann Johnstone, Health Services Coalition
- Marie Martin Kerr, Kerr Intellectual Property Law Group
- Dr. Ronald Kline, Comprehensive Cancer Centers of Nevada
- Elsie Lavonne Lewis, Clark County Urban League
- Barbara Smith Campbell, Consensus
The Exchange Board hired an Executive Director in December 2011.
The Board submitted three reports to the Governor and the Legislature in December 2011, including, a fiscal and operational report, a report for the public summarizing the activities of the Board, and an adopted plan for the implementation and operation of the Exchange.3 The Board is required to submit fiscal and operational reports to the Governor and legislature by June 30 and December 31 of each year.
The Board has established five advisory committees to provide recommendations on Exchange implementation in the following areas: finance and sustainability; plan certification and management; Small Business Health Options Program (SHOP) Exchange; reinsurance and risk adjustment programs; and consumer assistance. The Advisory Committees met regularly starting in March 2012, and the Board approved 35 of their recommendations. As of May 2013, the Advisory Committees will no longer meet.4
The Exchange Board completed a Tribal Interaction and Impact Assessment and is using the information to reach out to the state’s Tribes. The Exchange has also signed a Tribal consultation agreement with the Indian Health Board of Nevada.5
Contracting with Plans: In April 2012, the Exchange Board approved guiding principles recommended by the Plan Certification and Management Advisory Committee, which included adopting a “Free Market Facilitator” model that “ensures the maximum participation by insurers and the widest choice for consumers.”6 In September 2012, the Board approved allowing carriers to offer Qualified Health Plans (QHPs) in either or both the Individual and SHOP Exchanges at their discretion and that QHPs not be required to be identical in each Exchange.7 Carriers are required to offer one silver level plan and one gold level plan in the Exchange, and silver level plans must offer cost-sharing variations of 73%, 87%, and 94% actuarial value. Carriers must also offer a zero cost-sharing version of all plans for American Indians as well as child-only plans at the same level of coverage as any other plan offered through the Exchange. Catastrophic plans may only be offered in the individual market and to individuals under the age of 30 or to individuals with a certification for hardship exemption in effect.8 Also, each licensed carrier may not offer more than five QHPs in each metal tier (including a catastrophic tier) in each Exchange.
Carriers must be accredited by the National Committee for Quality Assurance (NCQA), the Utilization Review Accreditation Commission (URAC), or another recognized accreditation agency in order to submit QHPs for review by the Division of Insurance (DOI). Carriers will use the standard data templates used by the Department of Health and Human Services (HHS) in the federally-facilitated exchange to submit rate and form filing information for QHPs through the System for Electronic Rate and Form Filing (SERFF). QHP submissions must be completed by early July, and the DOI expects to review and certify QHPs by early August.9 Individual market QHPs will be in place for one year and changes to plans may only be made prior to the open enrollment period. The Exchange is hosting a series of eleven carrier onboarding meetings to detail Exchange requirements and to provide carriers with a forum to ask questions about the onboarding process.4
In April 2013, the Board approved network adequacy standards that require carriers to ensure sufficient numbers and types of providers to meet the needs of the enrolled population, to comply with the Affordable Care Act’s Essential Community Provider requirement, and to include at least one community hospital in the provider network, if available. The Board established network adequacy ratios and travel standards according to county and provider specialty. Carriers may employ telemedicine to meet these accessibility requirements.10 Carriers must make their provider directories available to the Exchange for publication online and to enrollees in hard copy, if requested.
Risk Adjustment, Reinsurance, and Risk Corridors: The Board approved plans to conduct an analysis to determine whether Nevada-specific factors should be used in a risk adjustment model and continues to discuss whether the state should administer the reinsurance program or defer to the federal government.11
Dental and Vision Benefits: In March 2013, the Board decided that all QHPs that provide the pediatric dental essential health benefit must submit the dental benefit as a rider for the product. In April, however, the Centers for Medicare and Medicaid Services (CMS) determined it would not recognize riders for the pediatric dental essential health benefit. The Plan Certification and Management Advisory Committee met twice in May and ultimately recommended that the Exchange allow the pediatric dental benefit to be embedded in a QHP, bundled with a QHP, or sold as a stand-alone plan.12 All children enrolled in a QHP through Nevada Health Link must purchase the pediatric EHB. Annual out-of-pocket maximums will be limited to $700 for one child and $1,400 for two or more children enrolled in stand-alone plans.13
Consumer Assistance and Outreach: In December 2012, the Board approved a Navigators, Enrollment Assisters, Certified Application Counselors (CACs), and Producers Plan, detailing how the four entities will work together to enroll eligible individuals through Nevada Health Link. The primary function of Navigators will be to provide enrollment assistance and educational outreach, while Assisters will focus solely on application and enrollment assistance. Certified Application Counselors (CACs) will provide enrollment assistance and will largely work in hospitals.14 CACs will not be compensated by the Marketplace. In June 2013, Nevada Health Link announced the eight organizations that have been selected as Navigator/Enrollment Assister grantees.15 Navigators, Enrollment Assisters, and CACs must receive Exchange Enrollment Facilitator (EEF) Certification from the DOI prior to enrolling individuals or employers in a QHP. Certification requirements include taking a 20 hour training course, passing a test with a score of 70% or better, and undergoing a background check.invalid The first assisters were certified the first week of September. After becoming certified, Navigators, Enrollment Assisters, and CACs must complete a four-hour training course run by the Marketplace.
In order to sell insurance products through the Exchange, producers must register with the Exchange, fulfill training and testing requirements, and satisfy the Exchange’s privacy and security standards. Producers will not be compensated by the Exchange but will continue to receive compensation from carriers, in the same or similar manner as is done today in Nevada. The Board approved a recommendation that web-brokers will not be able to sell QHPs and access Advanced Premium Tax Credit and Cost Sharing reductions through their portals.
The state released an RFP in September 2012 for help planning a marketing and branding campaign in English and Spanish for the Exchange, and in January 2013 entered into a contract with a vendor.16 The campaign is broken out into three phases: Exchange branding, education, and call to action. In March 2013, the Board approved Nevada Health Link as the Exchange’s brand name and in April approved the logo, color palettes, and taglines.17 In June 2013, Nevada Health Link launched a website for consumers, including a subsidy calculator.
The media campaign launched July 1 and uses a mix of mediums to reach target audiences, including television, radio, print, and digital media. Nevada Health Link awareness advertising will run from July 2013 through March 2014, with three distinct waves of messaging. The second phase also includes an outreach component that will have a person-to-person, grassroots focus. Nevada Health Link will partner with non-profit, state-based, and school-based organizations throughout the state to have a presence at 70 events through September 30.18 The objective of the campaign’s second and third phases is to generate 85% awareness of the Exchange among target audiences and facilitate the enrollment of 118,000 Nevadans through Nevada Health Link. Target audiences are Hispanics, families with children, and male young adults with incomes between 138-400% FPL.19 The state has also outsourced the development of an Exchange call center.
Small Business Health Options Program (SHOP) Exchange: In April 2012, the Exchange Board approved guiding principles recommended by the SHOP Advisory Committee. In September 2012, the Board approved keeping the Individual and SHOP markets separate, as well as keeping the market for small groups (1-50) and mid-sized groups (51-100) separate until they have to be merged in 2016. The Exchange’s certification requirements for QHPS in the Individual and SHOP Exchanges will be the same.
The Committee has also begun exploring issues surrounding employer and employee choice in the SHOP Exchange.7 The SHOP Exchange will offer three options to employers. The ‘Open SHOP’ option allows an employee to access all SHOP QHPs. The ‘Open Metal Tier’ option will allow an employer to select a specific metal tier for his/her employees. The ‘Package Option’ will let an employer select a specific package for his/her employees. Employers must contribute at least 50% of premiums for the lowest cost QHP available to employees. The minimum employee participation rate is 75%.17
Information Technology (IT): Through the use of a subcontractor, the Nevada Health Care Reform Unit within the Department of Health and Humans Services completed an IT gap analysis of existing systems that could be used to support the Exchange, as well as completed the preliminary design and requirements for a new eligibility engine. Nevada currently operates two separate eligibility systems for Medicaid and the Children’s Health Insurance Program (CHIP) and the state plans to develop a streamlined single application. A Request for Proposals released by the Nevada Department of Health and Human Services is soliciting subcontractors for the “Health Care Reform Eligibility Engine” to determine eligibility for Medicaid, CHIP, and subsidized coverage through the Exchange. The subcontractor will develop and implement a business rules engine that will store all of the eligibility rules for the State’s publicly-subsidized health coverage programs in a single location and make it accessible to individuals shopping for coverage from multiple entry points.
In July 2012, the Exchange awarded a contract for Business Operations Services that would provide end–to-end business needs for the Exchange through December 31, 2016.20 The subcontractor will be responsible for building the IT infrastructure necessary for the Exchange and for implementing a Call Center to provide assistance to individuals enrolling in coverage. The state expects development and implementation of the IT Solution and a Call Center by October 1, 2013, followed by three years of operations, maintenance, and enhancements. The Board also awarded an Independent Validation and Verification services contract through January 2014.21
Financing: In March 2012, the Finance and Sustainability Committee released financing options for the Exchange that recommended assessing fees on either qualified health plans (QHP) in the Exchange or on all plans offered in the individual and small group market, suggested a gradual increase in the QHP enrollment fee, and recommended charging fees to dental, vision and Medicare products.22 While the Finance and Sustainability Committee continues to work on broader financing options, in May 2012, the Board approved a recommendation by the Committee to raise supplemental revenue for the Exchange by charging user fees to stand-alone vision and dental products and by offering web advertising on the site.23 The following month the Board approved exempting insurers from being taxed on fees charged by the Exchange.24 The Board also rejected a proposal by the Committee to use a General Fund appropriation as a supplementary source of Exchange revenue by subsidizing individuals’ enrollment fees.25 In January 2013, the Board adopted a regulation establishing a monthly fee charged to insurers for each member enrolled in the insurer’s plans.26 The Exchange established separate fees for QHPs that do not include a dental component, QHPs that include dental, and stand-alone dental plans.27
Essential Health Benefits (EHB): The Affordable Care Act requires that all non-grandfathered individual and small-group plans sold in a state, including those offered through the Exchange, cover certain defined health benefits. States must decide whether to benchmark their EHB plan to one of ten plans operating in the state or default to the largest small-group plan in the state. On December 14, 2012, the Insurance Commissioner announced the selection of Health Plan of Nevada POS C-XV-500-HCR as the EHB benchmark plan, the Children’s Health Insurance Plan (CHIP) as the pediatric dental supplement, and the Federal Employee Vision Plan (FEDVIP) as the pediatric vision supplement.28
In September 2010, the Nevada State Department of Health and Human Services received a federal Exchange Planning grant of $1 million. The Department has since received four federal Level One Establishment grants: $4 million in August 2011, $15.3 million in February 2012, $4.4 million in May 2012, and $9 million in July 2013. The grants will be used to develop a rules-based eligibility engine that will serve as the single, streamlined eligibility process for all medical assistance programs in the state, to support information technology security requirements, and to fund training for EEFs. In August 2012, the state received a federal Level Two Establishment grant for $50 million; this will fund Exchange operations through December 2014.29
Expansion of Medicaid
From 2014 to 2017, the federal government will pay for 100% of the difference between a state’s current Medicaid eligibility level and the ACA minimum. Federal contributions to the expansion will drop to 95% in 2017 and remain at 90% after 2020, according to the ACA.
As the ACA was originally written, states would lose all Medicaid funding if they refused to expand their program to the ACA minimum.
However, the Supreme Court in June 2012 ruled that the federal government could not withhold Medicaid funding for states that chose not to expand their programs. The decision effectively allowed state officials to opt out of the expansion, and some have said they will do just that.
Nevada is participating in Medicaid expansion.
On January 3, 2013, Nevada received conditional approval from the U.S. Department of Health and Human Services (HHS) to establish a state-based exchange. Final approval is contingent upon the state demonstrating its ability to perform all required Exchange activities on time, complying with future guidance and regulations, and demonstrating its capacity to administer Exchange plan management functions.30
Additional information about the Silver State Health Insurance Exchange can be found at:
- SB440 (Chapter 439), Nevada’s 2011 Act creating the Silver State Health Insurance Exchange.← Return to text
- “Gov. Sandoval Makes Appointments to Health Insurance Exchange Board.” Nevada News Bureau. September 23, 2011.← Return to text
- Silver State Health Insurance Exchange Fiscal and Operational Report. December 31, 2011; Silver State Health Insurance Exchange Implementation Plan. December 2, 2011; Silver State Health Insurance Exchange: Implementation Plan and Key Milestones. December 8, 2011.← Return to text
- Executive Director’s Report. May 9, 2013.← Return to text
- Blueprint 2.0 Consumer Stakeholder Engagement and Support. October 4, 2012.← Return to text
- Plan Certification and Management. Recommendation 1: Key Principles. Silver State Health Insurance Exchange. Approved April 12, 2012.← Return to text
- Advisory Committee Recommendations Approved by the Board. December 10, 2012.← Return to text
- Qualified Health Plan Certification Checklist. April 18, 2013.← Return to text
- Division of Insurance. Rate and Form Filers Seminar. January 18, 2013.← Return to text
- Network Adequacy Standards for Qualified Health Plans Marketed in the Silver State Health Insurance Exchange.← Return to text
- Summary of Recommendations approved by the Board. June 14, 2012.← Return to text
- Pediatric Dental EHB Requirements. May 16, 2013.← Return to text
- Pediatric Dental Essential Health Benefit on the Silver State Health Insurance Exchange. June 5, 2013.← Return to text
- Exchange Enrollment Facilitator Program. June 12, 2013.← Return to text
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- “State approves $6 million contract to publicize health insurance exchange.” January 8, 2013.← Return to text
- Silver State Health Insurance Exchange Board Meeting Minutes. April 11, 2013.← Return to text
- Nevada Health Link. Marketing & Outreach Update. July 11, 2013.← Return to text
- Nevada Health Link: Media Presentation. May 1, 2013.← Return to text
- Request for Proposal 2023. Business Operations Services. Released March 26, 2012.← Return to text
- Request for Proposal 1956. Independent Verification and Validation Services of the Health Care Reform Eligibility Engine Project. Released January 23, 2012.← Return to text
- Financing Options for the Exchange. Finance and Sustainability Advisory Committee. March 19, 2012.← Return to text
- Financial Sustainability Recommendation 3 Supplemental Revenue. Silver State Health Insurance Exchange. Approved May 10, 2012.← Return to text
- Financial Sustainability Recommendation 4 Tax on Exchange Fees. Silver State Health Insurance Exchange. Approved June 14, 2012.← Return to text
- Whaley, Sean. “State Board Rejects Proposal to Seek State Funding to Subsidize Nevada’s Health Insurance Exchange.” Nevada News Bureau. August 16, 2012.← Return to text
- Adoption of the Silver State Health Insurance Exchange Regulation: EX-01-A. January 10, 2013.← Return to text
- Fees to be Charged to Insurers for Calendar Year 2014 in the Silver State Health Insurance Exchange. January 10, 2013.← Return to text
- Letter from Insurance Commissioner to HHS, December 14, 2012.← Return to text
- Nevada Affordable Insurance Exchange Grants Awards list.← Return to text
- Letter from HHS to Governor Sandoval. January 3, 2013.← Return to text
Provided by the Henry J. Kaiser Family Foundation