The health insurance landscape in Nevada can be perplexing: Despite being ranked sixth in the nation for lowest average premium costs, we’re also among the top 10 states for people without health insurance.
This is the time of year that, in the health insurance industry, brokers and experts attempt to remedy low enrollment rates. Nevada’s open enrollment, which begins on November 1 and lasts until January 15, is the traditional period where people can sign up for new health insurance, adjust their current plan, or even cancel a plan altogether.
The state’s platform to do this is Nevada Health Link, an online insurance marketplace operated by the Silver State Health Insurance Exchange.
Russell Cook is Nevada Health Link’s executive director. He said he frequently fields questions about why open enrollment is only during an 11-week period, once per year, instead of year-round.
“The primary reason has to do with the phenomenon in the health insurance industry known as ‘adverse selection,’” he said. “And what that means, in plain English, is waiting until you actually need health insurance to purchase that health insurance throws off all the calculations that insurance carriers conduct in order to set their rates and compensate for the risk pool. In order to ensure affordable insurance for large populations, such as the state of Nevada, everyone has to sign up at the same time. You have to pay your monthly premiums. You can't wait until you actually need that health insurance to enroll. Otherwise, you're essentially just sending a bill to your insurance carrier.”
Cook acknowledged that the vast majority of people enrolling in Nevada Health Link’s plans are above the threshold for Medicaid, but also struggle to afford typical health insurance plans. In this situation, though, there’s aid available.
“Even if you have a job and even if your employer offers coverage, you can still qualify for premium reduction through Nevada Health Link if that insurance is deemed unaffordable [which is currently 8 ¼ percent of your monthly household income],” he said. “I would recommend starting at nevadahealthlink.com to find an insurance broker near you who can help walk you through the process and help you find the plan that's going to provide you with the lowest out-of-pocket costs at the end of the year.”
For people 65 and older, Gisselle Ochoa is one such independent broker, working with insurance companies around the valley to help consumers determine which Medicare plan is right for them.
She said it often comes down to what she calls The Three D’s: “Doctors, drugs, and dollars. How much you're willing to spend on co-pays; if there's a deductible. Also, the doctors — not all doctors accept the same insurances. They have to be contracted with these carriers. And also drugs, the medications. There's a huge change for 2025 — the donut hole, the coverage gap is gone. So it all comes down to how much your meds are going to be, if your doctors are going to be accepted. And that can be really overwhelming, trying to find that all out by yourself.”
And this decision can come rapidly for people, since you only have three months before and three months after your 65th birthday to enroll, or else Ochoa said you can face penalties.
Medicare’s annual enrollment period is October 15 to December 7, but there are also other periods where people who’ve already selected a plan can make changes to it.
“There is another open enrollment — it is called OEP — and that goes from January 1 to March 31 to change one more time before that's their plan for the rest of the year,” she noted. “Now, there also are other exceptions. For example, people with Medicaid, they're allowed to change every quarter. And then also, for people with chronic conditions, they can also enroll at a different time in the year.”
Guests: Russell Cook, executive director, Nevada Health Link; Gisselle Ochoa, independent Medicare broker
