Nevada Health Insurance

Nevada Medical Insurance Overview

The state of overall health in Nevada leaves much room for improvement when compared to the nation as a whole.  There are many people living in the state who don’t have insurance coverage, but these numbers are expected to decrease with the addition of the legislation provided under the Patient Protection and Affordable Care Act.  It is estimated that by 2020, over 30 million more people in the United States will have health insurance coverage.

Nevada’s Health Care Issues
According to the United Health Foundation’s website, the state of Nevada is ranked in 38th place compared to the other 49 states in the country.  The state climbed from the 39th spot in 2012, but has been steadily sitting in 38th place ever since.  Below are the strengths and weaknesses of the state as a whole:

Strengths include is low prevalence of smokers, its low infant mortality rate and its low rate of preventable hospitalizations.  Weaknesses include its low per capita health funding, its low rate of people graduating from high school and its high percentage of people who are lacking insurance coverage.

Understanding Nevada’s Uninsured Population
Thirteen percent of the population of Nevada is currently uninsured, with children in the state being the most affected.  Below are statistics regarding the uninsured population of Nevada:

• 13% of people in Nevada don’t have insurance coverage
• Poor adults earning under the Federal Poverty Level make up 55% of the uninsured population of the state.
• 30% of kids from families who earn at or below 100% of the Federal Poverty Level are without insurance coverage.
• 48% of adults who earn 200% or less than the Federal Poverty Level are uninsured.

Group Health Plans
If you are employed in a large company in the state of Nevada, you may be able to get insurance benefits through your employer’s group plan.  For participants of group plans, there are lower premiums because the employer also offers a contribution.  In the state of Nevada, 47 percent of people are covered under a group benefits plan.  Insurers under this plan type are also restricted from denying coverage to enrollees due to a pre-existing condition.  The Division of Insurance regulates group health insurance plans in the state of Nevada.

Signing Up
Signing up for coverage under your employer-sponsored plan is typically done during an open enrollment period.  If you don’t know when this period occurs for your company, ask someone in the Human Resources department for more information.

Securing insurance coverage isn’t a task without its difficulties primarily because of the coverage options available and their associated costs.  Be sure to do a good amount of research into each option before you sign up, but keep the following in the forefront of your mind before making your choice:

• How much will your monthly premiums be?  Are they affordable?
• What options do you have?  Are they comprehensive enough for your medical needs?
• Do you have to cover any dependents under your plan?

Pre-Existing Condition Exclusion Periods
In the event that you have a pre-existing condition, you will have to wait a period of time known as an exclusion period.  This is a time frame that can take up to 12 months in the state of Nevada before you are able to use your insurance benefits.  HIPAA also allows for the insurance company providing the coverage to look back into your medical records for a period of six months to determine your health status.  For people covered under your plan who are 19 and younger, there are no rules making exclusion periods mandatory if they are suffering from a pre-existing medical condition.

Affiliation or Waiting Periods
You could be subject to an affiliation period when you enroll for coverage under your employer-sponsored health plan.  Under an affiliation period, you can be subject to waiting two months, or three if you haven’t enrolled in a timely fashion.

Individual Health Plans
Individual insurance is available to people living in Nevada who aren’t covered under group insurance because they are unemployed, self-employed or working for a firm that doesn’t offer benefits.  Because of the amount of risk placed on a single individual, many insurance companies do not offer this type of coverage.

In Nevada, five percent of the population is covered by individual policies, but there are downsides.  In the event that you are suffering from a pre-existing medical condition, individual plan insurers can reject your application for enrollment.  These plans are usually high in costs of premiums and do not have low deductible amounts.  They are also subject to medical underwriting, making them a less than perfect solution for obtaining insurance coverage in Nevada.  It is estimated that a healthy young person living in Nevada can be covered for $64 per month, but the coverage is not comprehensive and the deductible is high.

Continuation Coverage
In the event that you have lost insurance benefits because of a divorce from a covered spouse or loss of employment status, you might be able to obtain coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA).  This program offers continuing benefits to those who qualify for a period of up to 18 months.  The only qualifying factor is the size of the company that originally offered the benefits package.

You can also convert your group insurance plan to an individual policy through a conversion plan.  You can continue coverage with the same insurance company and keep the same provisions.

Nevada Health Benefit Exchange
In Nevada, the state has created and implemented its health benefits marketplace called the Nevada Health Link.  Through the website, users can compare each of the various options available and consider the plans based on their income level and more.

Under the Affordable Care Act, it was made mandatory that each of the states create and put a health benefits marketplace into action for the benefit of consumers.  Using the website, you can determine when the open enrollment period is and how it works for low-income individuals and families.

Nevada State Insurance Programs
If you can’t get insurance coverage through a group or individual plan, perhaps you should consider applying for one of the many state-funded options that are available in Nevada.  These plans cover 36% of the population in Nevada, which is an increase from 2011.  The following information breaks down each available plan:

Pre-Existing Condition Insurance Plan (PCIP)
People who have been prevented coverage due to a pre-existing condition might be qualified for PCIP.  In any case, before you are qualified for PCIP, you have to have gone without insurance for a time of no less than six months.  Once allowed coverage through the plan, members appreciate an expansive scope of advantages, including hospital stays, medications, and primary and specialty care services.

Medicaid
The Medicaid program is accessible in Nevada to help both low wage earners and families. Medicaid can cover physician’s visits, family planning services, checkups, hearing and speech, home health care, hospitalizations and more.   Retroactive assistance might be accessible through Medicaid for services that were given to new enrollees three months to their enrollment into the program.

Access to Health Care Network (AHN)
This program is intended for low income people and families.  Eligibility is dictated by income level, and people with an income of between 100% to 250% of the federal poverty level can obtain coverage.  Month to month premiums can range from $120 and $770.

Nevada Check UP
Through this program, children who are uninsured can enjoy health benefits that cover inpatient and outpatient services, labs, x-rays, ambulatory services, medications, shots and more.  Eligibility is dictated by level of income and you could pay nothing or between $25 and $80 every three months for coverage under this plan.

Women, Infants, and Children (WIC)
The WIC program tries to furnish moms and kids with nutrition guidance and supplies, and furthermore covers an assortment of prenatal, maternal, and pediatric health care services. Eligibility is subject to salary level and month to month premiums range from $0 and an insignificant share of the expenses.

Nevada Early Intervention Services (NEIS)
Under this program, children who have developmental delays can receive coverage that includes audiology, counseling, home visits, nutrition information, transportation services and more.

Women’s Health Connection (WHC)
Under this plan, women can obtain cancer prevention services and screenings for breast and cervical cancers.  You can be eligible for this program depending on your age and level of income.

Maternal Child Health (MCH) Line
The MCH Line offers who are eligible for Medicaid and have children who are five years of age and younger maternity and prenatal services.

Medicare, the Medicare Prescription Drug Program, and Senior Rx
In the state of Nevada, Medicare is accessible to give health coverage to seniors and the disabled. Medicare incorporates four sections, each covering an alternate health care service or product. Ensured coverage through Medicare is allowed to both the individuals who are older than 65 and have labored for a long time (10 years) at a Medicare-covered occupation (or whose spouse has done so) and the individuals who experience the ill effects of a disability or renal disease.  Senior Rx works as a counseling service to help those looking into their Medicare options.

VA Medical Benefits Package
Veterans, those that have served active duty in one of the branches of the United States military, may exploit coverage under the VA Medical Benefits Package.  This program covers pre-existing conditions and offers comprehensive benefits to veterans who are enrolled.  Qualification depends on whether or not you have received an honorable discharge from the military.

Partnership for Prescription Assistance
Those individuals who don’t have prescription medication coverage could take advantage of the ability to obtain free or low cost prescription medications through the Partnership for Prescription Assistance.  The Partnership for Prescription Assistance can get you connected to an assortment of various prescription medication coverage choices, including 475 programs that offer help in the purchasing of such medications.

National Association of Mental Illness (NAMI) Helpline
Those encountering mental health issues can contact NAMI for help with dealing with their condition.  NAMI connects callers with volunteers who are educated on treatments and resources accessible to those afflicted with mental illnesses.

The Health Insurance Portability and Accountability Act (HIPAA)
Passed in the year 1996, the Health Insurance Portability and Accountability Act (HIPAA) rolled out some critical improvements with regard to the control of private insurance suppliers.  On account of HIPAA, insurers can no more deny coverage to an enrollee on a group health insurance arrangement because of a pre-existing condition.  Extra data can be found on the provisions under HIPAA at this link.

Another element of HIPAA is continuation coverage for people who have lost coverage on a group health insurance contract for an assortment of reasons.  For data on HIPAA continuation coverage, see this particular document.