In Nevada, you have several options when it comes to health insurance. If your employer offers health insurance, you can get it through your work, or you can buy it through the Nevada insurance exchange, from individual insurers, or obtain Medicaid.

This guide describes your Nevada health insurance options in detail.

What to know about insurance in Nevada

  • Open Enrollment: Open enrollment dates for the Nevada health insurance marketplace are from November 1 through to January 15. This is a month longer than the open enrollment period for states without their own exchange and applies for 2021 and 2022. You must buy health insurance during this period unless you qualify for a special enrollment period.
  • Changes to plans: Rates and changes to insurance plans in Nevada are posted on the Nevada Division of Insurance website on October 2 every year in time for the open enrollment period.
  • Special Enrollment Period: You may qualify for a special enrollment period for certain life events like getting married, having a baby, changing employment, moving, getting divorced, or losing health insurance. You can sign up for new insurance during the enrollment period, which usually runs for 60 days from the qualifying event.
  • Nevada Health Link: Nevada has a health insurance exchange called Nevada Health Link, where you can buy ACA-approved pans. You must buy through the exchange if you’re eligible for the Advanced Tax Credit subsidy that effectively lowers your monthly payments.
  • Off-exchange insurers: If you don’t qualify for the tax credit, you may also purchase ACA-compliant health insurance off the exchange from approved insurers.
  • Coverage types: Half of Nevada residents (49.5%) have employer-sponsored health insurance, 17.8% are on Medicaid, 14% are on Medicare, 5.5% have individual insurance, and 11.5% don’t have any health insurance coverage.

How do I enroll in the Nevada Health Insurance Marketplace?

If you don’t use the HealthCare.gov website but register on the Nevada Health Link website, you will be redirected to Nevada Health Link.

When shopping for insurance on the Nevada exchange, your first step is to find out how much insurance will cost by clicking on the “I’m ready to get started” link. Next, you need to supply basic information such as:

  • Birthdates of yourself and insured household members
  • Household income
  • Zip code

Nevada Health Link determines whether you qualify for health insurance, advanced tax credits, or Medicaid. If you are eligible for Medicaid, you should contact the Nevada Department of Health and Human Services. If you qualify for health insurance and/or advanced tax credit, you’ll be asked further questions regarding doctor’s visits and prescriptions. Once this step is complete, you will be able to view and compare different health plans available to you. Once you’ve selected a plan, you can create an account and apply for the plan you’ve selected.

The following companies offer individual health insurance in Nevada:

  • Anthem (HMO Colorado DBA HMO Nevada)
  • Friday Health Plans of NevadaHealth Plan of Nevada, Inc.
  • Hometown Health Providers Insurance Company
  • SelectHealth Inc.
  • Sierra Life & Health Insurance Co, Inc.
  • SilverSummit Healthplan, Inc.

How do I enroll in Nevada individual and family insurance?

The health plan enrollment process is the same whether you’re applying for individual or family insurance. If you’re shopping for a family, evaluate the pros and cons of individual versus family health plans. These include factors such as:

  • Age of each family member
  • Deductibles,
  • Health needs
  • Preferred plan types
  • Monthly premiums

Insurance for individuals in Nevada

There are several different types of health insurance plans in Nevada.

  • One option is a Health Maintenance Organization plan. HMO plans limit your coverage to physicians contracted to the HMO. You may need to live in a town or county serviced by the particular plan. Out-of-network care isn’t covered except in an emergency. HMO deductibles are low, but you need to choose a primary care doctor. You need a referral from your primary care provider to see a specialist.
  • If you need flexibility,Preferred Provider Organization (PPO) plans allow you to go to doctors of your choice. Still, you’ll pay less if you stick with providers within the plan’s network. If you’re on a PPO plan, you don’t need a referral to see a specialist. However, premiums and deductibles may be higher.
  • A Point of Service (POS) plan combines features of an HMO and PPO plan. You must have a primary care provider, and you need a referral to see a specialist, but you can see doctors and specialists outside the provider’s network.

Insurance for families in Nevada

Family health insurance requirements are more complex than individual insurance requirements. Family health insurance plans in Nevada should accommodate the different medical needs of each family member. Balance anticipated out-of-pocket costs against higher premiums for health plans that offer adequate coverage for all family members.

If family members need regular medication and treatment for chronic conditions, it may be best to choose a plan with good coverage, low deductibles, but higher premiums. If all family members are in good health, a low-cost plan with high deductibles may be adequate. Other factors include the ages of those insured because premiums increase with age.

Another factor is the type of plan. Although HMO plans are often cheaper, if you need extended coverage for family members studying, living, or working elsewhere, it may be better to go with a PPO plan that allows the use of out-of-network providers.

How much does health insurance cost in Nevada?

Nevada health plans fall under four metal tiers: bronze, silver, gold, and platinum. All tiers provide the same set of essential benefits, but the value of the cover supplied depends on the tier. Tiers reflect the amount you pay for medical services (coinsurance), monthly premiums, and annual deductibles. Choose a plan based on your total coverage cost rather than a plan with the lowest monthly premium.

Average premiums in Nevada 2018 2019 2020 2021
Most affordable bronze plan $329 $327 $307 $280
Most affordable silver plan $415 $397 $372 $383
Most affordable gold plan $472 $450 $482 $472

  • Bronze plans are the cheapest but have high deductibles. In terms of actuarial value, you pay, on average, 40% of your total medical costs. Bronze plans are a good choice if you’re in good health and are only looking to cover medical emergencies. In 2021, the most affordable bronze plan in Nevada costs $280 per month.
  • Offering lower deductibles and slightly higher premiums, silver plans are the next tier. They offer a higher level of coverage and reduce annual medical costs. Based on the actuarial value you pay 30% of annual medical expenses. Although premiums are higher, silver plans may be more economical if you qualify for Cost Sharing Reduction savings. These may apply if your gross family income falls between 138% and 250% of the Federal Poverty Level (FPL). To receive benefits, you must choose a silver plan from the Nevada health insurance exchange (Nevada Health Link). Average premiums for most affordable silver plans start at $383.
  • Gold and platinum plans have low deductibles and a cost structure that further reduces your share of medical expenses. The average actuarial share of total medical costs for gold plans is 20% and for platinum 10%. These plans offer excellent coverage if you need lots of medical care or are suffering from a chronic medical condition. The most affordable premiums in 2021 for gold plan premiums in Nevada are $472 per month.

What kind of low-income health insurance is available in Nevada?

Nevada operates two forms of low-income health coverage, Medicaid and Nevada Check Up. Medicaid is a joint program funded by the Federal Government and Nevada providing basic health coverage for qualifying low-income individuals. Nevada Check Up is the state’s version of the Children’s Health Insurance Program (CHIP) providing health insurance for qualifying children up to and including the age of 18.

Medicaid in Nevada

Medicaid provides health insurance for certain categories of low-income people. To qualify for Nevada Medicaid, your household income must be less than 138% of Federal Poverty Level (FPL) and you must meet one of the following criteria:

  • Be 65 years old or older
  • Be a pregnant woman
  • Be blind
  • Be disabled or have a disabled family member.
  • Have responsibility for an infant or child under the age of 19

To apply for Nevada Medicaid, contact your local Division of Welfare and Supportive Services (DWSS) office. Once accepted, you won’t need to pay a premium for Nevada Medicaid. Benefits include doctor and emergency room visits, hospital care, dental care, birth control, eyeglasses, immunizations, and prescription medication. You must use registered Nevada Medicaid providers, and some procedures, examinations, and medicines require prior authorization.

Nevada Check Up (SCHIP)

Nevada Check Up provides low-cost, comprehensive health care for children up to age 19. To qualify for Nevada Check Up, your child can’t be eligible for Medicaid or have individual insurance. For eligibility, complete a qualification assessment on Access Nevada, open an account, and make a formal application.

Nevada Check Up targets those who earn too much to qualify for Medicaid, but less than Nevada’s state income limits for the program. Nevada Check Up benefits are similar to those for Medicaid. The program has a quarterly premium of between $25 and $80 per quarter depending upon gross income. The premium is charged per family, not per child, and nonpayment or late payment may result in loss of coverage.

What are Nevada’s Medicare options for seniors and people with disabilities?

Nevada Medicare provides health insurance for adults aged 65 and over and includes certain disabled people and those suffering from certain diseases.

There are two options: Original Medicare and Medicare Advantage.

  • Original Medicare covers hospital stays (Part A) and medical expenses (Part B). You first pay a deductible, then Medicare pays a share of your medical costs. With Original Medicare, there’s no annual limit to your out-of-pocket expenses. You must take Part A, while Part B is optional. Medicare Part D drug plan covers prescription expenses.
  • Medigap, also known as Medicare supplement insurance, covers expenses like deductibles not covered in Part A or B, such as prescription drugs, copays, and deductibles.
  • Alternatively, Medicare Advantage Plans provide the same benefits as Medicare Part A and B. Sold by approved individual companies, most include prescription drug coverage and additional benefits.

Eligibility

You’re eligible for Medicare if you are aged 65 or over and a U.S. citizen or permanent resident. You are entitled to Medicare if you have a qualifying disability and have been receiving Social Security or Railroad Retirement Board disability benefits for two years. You can also qualify if you’re in need of a kidney transplant, have end-stage renal failure, or Lou Gehrig’s disease (amyotrophic lateral sclerosis). Part A is free if you’ve paid Medicare taxes for 10 years. Part B premiums depend on your income.

Enrollment

The initial enrollment period for Medicare is a seven-month period starting three months before you turn 65. Alternatively, you can join during the general enrollment period between January 1st and March 31st.

Medicare Resources

If you need help or advice regarding Medicare eligibility, benefits, and enrollment, contact your local Nevada SCHIP counselor. You can also find help at the Nevada Division of Insurance.

Are there short-term health insurance plan options in Nevada?

Short-term health insurance plans provide emergency health cover for short periods when you don’t have an ACA-approved insurance plan. Short-term health policies don’t meet the minimum standards required by the ACA. In most instances, short-term health insurance won’t cover pre-existing conditions. Should you get sick, the insurer may investigate whether the illness is linked to a pre-existing condition and may deny claims.

Nevada Insurance FAQs

Does Nevada require health insurance?

No. Coverage is mandated in the Affordable Care Act, but there is currently no federal tax penalty for not having ACA-compliant health insurance coverage.

Do I have to use the Health Insurance Marketplace in Nevada?

No, you can purchase ACA-compliant health insurance from several individual insurers approved to sell policies in Nevada. If you want to take advantage of the Advanced Premium Tax Credit or Cost Sharing Reduction, you must buy your health plan on Nevada Health Link.

What types of alternative health insurance plans (like cost-sharing plans) are available in Nevada?

The most popular form of cost-sharing plans are faith-based plans. In a faith-based plan, members share health care costs with other members. You don’t need to be a member of a particular denomination (or even religious), to participate in a plan. While these plans can be relatively low-cost, most faith-based plans don’t cover pre-existing conditions, mental health care, or pregnancy. Since the federal government and Nevada don’t consider them health care plans, these plans are unregulated. If you would like to join a faith-based plan, make sure you ask lots of questions before enrolling.

Do I need health insurance if I have HSA/FSA?

The purpose of HSA and FSA accounts is to save pre-tax money to provide for health plan deductibles. These accounts are not a substitute for health insurance.

Do I need short-term disability coverage in Nevada if I have health insurance?

Health insurance covers medical expenses arising from a disability but does not provide disability coverage. Nevada workers’ compensation laws require employers to offer no-fault disability insurance for workplace accidents. These and individual short-term disability policies provide coverage for day-to-day expenses should you be temporarily disabled.

Do I need long-term disability coverage in Nevada if I have health insurance?

No, but health insurance only pays medical expenses. It won’t replace income lost because of long-term disability. For example, long-term disability coverage in Nevada usually pays out 60% of pre-disability income.

What does Nevada Check Up cover?

Nevada Check Up is the state’s Children’s Health Insurance Program (CHIP), providing health care coverage for children in low-income uninsured households up to the age of 19. All approved medical costs are covered and no copays are required. However, there is a small quarterly premium.

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Tammy Burns
Insurance and health care consultant

Tammy Burns is an experienced health insurance advisor. She is ACA-certified for health insurance and other ancillary, life, and annuity products.

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