Because of the Affordable Care Act, the 78% of Nevadans who have insurance have more choices and stronger coverage than ever before. And for the 22% of Nevadans who don’t have insurance, or Nevada families and small businesses who buy their coverage but aren’t happy with it, a new day is just around the corner.
Soon, the new online Health Insurance Marketplace will provide families and small businesses who currently don’t have insurance, or are looking for a better deal, a new way to find health coverage that fits their needs and their budgets.
Open enrollment in the Marketplace starts Oct 1, with coverage starting as soon as Jan 1, 2014. But Nevada families and small business can visit HealthCare.gov right now to find the information they need prepare for open enrollment.
Key Features of the health care law are already providing better options, better value, better health and a stronger Medicare program for the people of Nevada:
Key Features
Coverage
- Ends Pre-Existing Condition Exclusions for Children: Health plans can no longer limit or deny benefits to children under 19 due to a pre-existing condition.
- Keeps Young Adults Covered: If you are under 26, you may be eligible to be covered under your parent’s health plan.
- Ends Arbitrary Withdrawals of Insurance Coverage: Insurers can no longer cancel your coverage just because you made an honest mistake.
- Guarantees Your Right to Appeal: You now have the right to ask that your plan reconsider its denial of payment.
Costs
- Ends Lifetime Limits on Coverage: Lifetime limits on most benefits are banned for all new health insurance plans.
- Reviews Premium Increases: Insurance companies must now publicly justify any unreasonable rate hikes.
- Helps You Get the Most from Your Premium Dollars: Your premium dollars must be spent primarily on health care – not administrative costs.
Care
- Covers Preventive Care at No Cost to You: You may be eligible for recommended preventive health services. No copayment.
- Protects Your Choice of Doctors: Choose the primary care doctor you want from your plan’s network.
- Removes Insurance Company Barriers to Emergency Services: You can seek emergency care at a hospital outside of your health plan’s network.
Better Options
The Health Insurance Marketplace
Beginning Oct 1, the Health Insurance Marketplace will make it easy for Nevadans to compare qualified health plans, get answers to questions, find out if they are eligible for lower costs for private insurance or health programs like Medicaid and the Children’s Health Insurance Program (CHIP), and enroll in health coverage.
By the Numbers: Uninsured Nevadans who are eligible for coverage through the Marketplace.
- 473,971 (22%) are uninsured and eligible
- 347,244 (73%) have a full-time worker in the family
- 174,840 (37%) are 18-35 years old
- 218,730 (46%) are White
- 44,217 (9%) are African American
- 157,518 (33%) are Latino/Hispanic
- 33,012 (7%) are Asian American or Pacific Islander
- 258,036 (54%) are male
438,826 (93%) of Nevada’s uninsured and eligible population may qualify for lower costs on coverage in the Marketplace, including through Medicaid.
Nevada has received $74,754,285 in grants for research, planning, information technology development, and implementation of its Health Insurance Marketplace.
New coverage options for young adults
Under the health care law, if your plan covers children, you can now add or keep your children on your health insurance policy until they turn 26 years old. Thanks to this provision, over 3 million young people who would otherwise have been uninsured have gained coverage nationwide, including 33,000 young adults in Nevada.
Ending discrimination for pre-existing conditions
As many as 1,157,045 non-elderly Nevadans have some type of pre-existing health condition, including 162,452 children. Today, insurers can no longer deny coverage to children because of a pre-existing condition, like asthma or diabetes, under the health care law. And beginning in 2014, health insurers will no longer be able to charge more or deny coverage to anyone because of a pre-existing condition. The health care law also established a temporary health insurance program for individuals who were denied health insurance coverage because of a pre-existing condition. 1,373 Nevadans with pre-existing conditions have gained coverage through the Pre-Existing Condition Insurance Plan since the program began.
Better Value
Providing better value for your premium dollar through the 80/20 Rule
Health insurance companies now have to spend at least 80 cents of your premium dollar on health care or improvements to care, or provide you a refund. This means that 88,491 Nevada residents with private insurance coverage will benefit from $3,977,544 in refunds from insurance companies this year, for an average refund of $75 per family covered by a policy.
Scrutinizing unreasonable premium increases
In every State and for the first time under Federal law, insurance companies are required to publicly justify their actions if they want to raise rates by 10 percent or more. Nevada has received $4,959,972 under the new law to help fight unreasonable premium increases.
Removing lifetime limits on health benefits
The law bans insurance companies from imposing lifetime dollar limits on health benefits – freeing cancer patients and individuals suffering from other chronic diseases from having to worry about going without treatment because of their lifetime limits. Already, 937,000 people in Nevada, including 329,000 women and 269,000 children, are free from worrying about lifetime limits on coverage. The law also restricts the use of annual limits and bans them completely in 2014.
Better Health
Covering preventive services with no deductible or co-pay
The health care law requires many insurance plans to provide coverage without cost sharing to enrollees for a variety of preventive health services, such as colonoscopy screening for colon cancer, Pap smears and mammograms for women, well-child visits, and flu shots for all children and adults.
In 2011 and 2012, 71 million Americans with private health insurance gained preventive service coverage with no cost-sharing, including 615,000 in Nevada. And for policies renewing on or after August 1, 2012, women can now get coverage without cost-sharing of even more preventive services they need. Approximately 47 million women, including 391,181 in Nevada will now have guaranteed access to additional preventive services without cost-sharing.
Increasing support for community health centers
The health care law increases the funding available to community health centers nationwide. In Nevada, 2 health centers operate 30 sites, providing preventive and primary health care services to 57,987 people. Health Center grantees in Nevada have received $8,264,743 under the health care law to support ongoing health center operations and to establish new health center sites, expand services, and/or support major capital improvement projects.
Community Health Centers in all 50 states have also received a total of $150 million in federal grants to help enroll uninsured Americans in the Health Insurance Marketplace, including $451,674 awarded to Nevada health centers. With these funds, Nevada health centers expect to hire 9 additional workers, who will assist 10,600 Nevadans with enrollment into affordable health insurance coverage.
Investing in the primary care workforce
As a result of historic investments through the health care law and the Recovery Act, the numbers of clinicians in the National Health Service Corps are at all-time highs with nearly 10,000 Corps clinicians providing care to more than 10.4 million people who live in rural, urban, and frontier communities. The National Health Service Corps repays educational loans and provides scholarships to primary care physicians, dentists, nurse practitioners, physician assistants, behavioral health providers, and other primary care providers who practice in areas of the country that have too few health care professionals to serve the people who live there. As of September 30, 2012, there were 36 Corps clinicians providing primary care services in Nevada, compared to 12 in 2008.
Preventing illness and promoting health
As of March 2012, Nevada had received $7,500,000 in grants from the Prevention and Public Health Fund created by the health care law. This new fund was created to support effective policies in Nevada, its communities, and nationwide so that all Americans can lead longer, more productive lives.
A Stronger Medicare Program
Making prescription drugs affordable for seniors
In Nevada, people with Medicare saved nearly $41 million on prescription drugs because of the Affordable Care Act. In 2012 alone, 22,122 individuals in Nevada saved over $14 million, or an average of $611 per beneficiary. In 2012, people with Medicare in the “donut hole” received a 50 percent discount on covered brand name drugs and 14 percent discount on generic drugs. And thanks to the health care law, coverage for both brand name and generic drugs will continue to increase over time until the coverage gap is closed. Nationally, over 6.6 million people with Medicare have saved over $7 billion on drugs since the law’s enactment.
Covering preventive services with no deductible or co-pay
With no deductibles or co-pays, cost is no longer a barrier for seniors and people with disabilities who want to stay healthy by detecting and treating health problems early. In 2012 alone, an estimated 34.1 million people benefited from Medicare’s coverage of preventive services with no cost-sharing. In Nevada, 166,815 individuals with traditional Medicare used one or more free preventive service in 2012.
Protecting Medicare’s solvency
The health care law extends the life of the Medicare Trust Fund by ten years. From 2010 to 2012, Medicare spending per beneficiary grew at 1.7 percent annually, substantially more slowly than the per capita rate of growth in the economy. And the health care law helps stop fraud with tougher screening procedures, stronger penalties, and new technology. Over the last four years, the administration’s fraud enforcement efforts have recovered $14.9 billion from fraudsters. For every dollar spent on health care-related fraud and abuse activities in the last three years the administration has returned $7.90.
Related articles
- The Amazon of health insurance (marketwatch.com)
- Estimates for use of Health Insurance Exchanges higher than expected (blogforarizona.com)
- Young adults want health insurance, poll says (kansascity.com)
- Nevada Employer’s Guide to the Affordable Care Act (doi.nv.gov)
- How the Affordable Care Act Helps Nevada Families (Families USA)
- Nevada & The Affordable Care Act (CBS Las Vegas)
- A Consumer’s Guide to Getting and Keeping Health Insurance in Nevada (doi.nv.gov)