People will no longer face a tax penalty if they choose not to purchase health insurance starting next year, but those who do will find slightly lower rates on Nevada’s Obamacare exchange.
The Silver State Health Insurance Exchange is readying for the start of open enrollment Nov. 1 amid several federal changes. Individual mandate repeal in the new GOP tax law goes into effect, the newly raised federal cap on junk plans will not lift Nevada’s limit on them, and a new federal policy has spurred business chambers to offer association health plans, said Executive Director Heather Korbulic.
Rates are going to be down by 0.4 percent with basically the same exchange options in each county for 2019, with open enrollment running through Dec. 15, Korbulic said. There will still be 14 counties with only one carrier option, just like in the 2018 plan year, when rural counties almost had no exchange options. Korbulic said the exchange did attempt to bring in more choices.
“That’s big,” Korbulic said of the rate decrease and plan options. “That means for consumers that they’re going to see low-cost, no-cost options again, that there is stability, they’re not going to have to be switching between carriers unless they choose to because the plans will still exist.”
The individual mandate penalizing those who do not have insurance has been nixed, and Korbulic said the exchange expects people between ages 26 and 40 to be the most likely to forgo coverage as a result. These healthier individuals help lower risk levels for insurance companies and stabilize prices. Korbulic said the exchange is continuing to advertise its message that people cannot afford not to be insured if they get injured.
“We built on that, and it’s more targeted for that age group, millennials,” Korbulic said, noting that one ad shows a woman texting and falling into a fountain, and another features a man playing basketball with his kids and getting a concussion. “We’re demonstrating the high costs of medical care if you forgo insurance and how devastating that can be for a family.”
Korbulic said the exchange is also upping its outreach, an area where the federal government has also made cuts. She said that instead of three $10,000 grants for brokers, the exchange gave out five this year. Those funds help with education and outreach.
Another concern this year has been association health plans, which were created through federal action under President Donald Trump, Korbulic said. The Henderson Chamber of Commerce and others are working together to offer health plans to members. Scott Muelrath, president and CEO of the Henderson chamber, said in a statement that the plans would be ACA-compliant.
Korbulic said these networks are not fully regulated by the Division of Insurance and don’t have to use the ACA’s system of community ratings, which prevent price hikes in a particular area over health status and gender, among others.
Employees of a business in Fallon, for example, may pay more due to the rural area even though they live in Reno, Korbulic said.
“It’s more navigation that consumers need to cut through the noise and find what’s right for their individual needs,” Korbulic said.
Korbulic also said she’s concerned about the federal government’s moves on short-term health plans that do not cover the 10 essential health benefits spelled out in the Affordable Care Act. She said state law caps these plans at 185 days rather than the federal government’s 364 days, renewable for three years. Nevada law says these plans are not supposed to be renewable, Korbulic said, but a consumer could just sign up for the same plan with another company once it expires.
This short-term coverage lacks Obamacare’s essential health benefits, she said, allows discrimination based on preexisting conditions, and doesn’t come with community rating for prices. Also known as “junk” plans, Korbulic said these options also mean consumers could see their coverage canceled if the company determines a health condition existed before the plan went into effect and wasn’t disclosed.
“If that’s the case, they can retroactively terminate you, leaving you with this pile of medical bills that they’re not going to pay,” Korbulic said. “What’s more concerning there is that those plans aren’t minimum essential coverage, so because of that you would not be eligible for special enrollment on the exchange.”
People can buy exchange plans during open enrollment, and can only purchase outside of that period if there is a qualifying life event, such as losing a job that had provided coverage for employees. Patients whose junk plans cancel them will be ineligible to shop for another plan on the exchange.
“You are left way high and way dry,” Korbulic said.
Consumers need to educate themselves about their options and decide whether association or short-term plans serve their needs at an affordable rate, Korbulic said. She encouraged consumers to meet with an enrollment professional to decide their options.
The exchange is switching from the federal platform that Nevada residents currently use to determine eligibility for subsidies and coverage options. The state approved a five-year, nearly $25 million contract with GetInsured in August.
Korbulic said all deadlines have been met so far. The exchange is working to have a final plan by the end of November laying out the execution of the project. Nevada’s platform, NevadaHealthLink.com, will take over for healthcare.gov for plan year 2020 in a move that is expected to save the state nearly $19 million in federal payments.
The exchange will continue to pay to use the federal platform even though NevadaHealthLink.com is going to be enrolling customers in 2019 for plans that start in 2020. The exchange, congressional delegation and Gov. Brian Sandoval all worked to get the Centers for Medicare and Medicaid Services to reduce Nevada’s costs while it transitioned, but Korbulic said requests were denied twice.
“They’d have to do a whole rulemaking just for Nevada and they don’t see that as being beneficial,” Korbulic said. “It’s very frustrating, but I’ll give them the credit of at least trying to work with us on making that happen and also, CMS has been incredibly helpful and encouraging to us with this transition. We haven’t hit any snags as a result of them spinning their wheels or not being responsive.”