As a result of health care reform enacted under the provisions of the 2010 Patient Protection and Affordable Care Act, all states are compelled to re-evaluate their existing insurance regulations to comply with the new federal law. A major change already applies to health insurance for children, who can no longer be excluded due to pre-existing conditions. (In 2014, this same protection will be extended to adults.) Also, insurers must allow children to remain on their parents policies up to age 26. Neither educational nor marital status has any bearing on the coverage.
General Insurance Regulations
Currently insurers in Nevada may exclude for pre-existing conditions for any period of time or permanently, but they must provide a guarantee of renewability so long as premiums are being paid. A policy may not be cancelled due to individual health condition, but insurers are allowed to raise rates.
Health Care Exchange
On June 16, 2011 the governor of Nevada, Brian Sandoval, signed the law creating the Silver State Health Insurance Exchange. The form and logistics of the Exchange are still being worked out.
Pre-Existing Condition Insurance
The U.S. Department of Health and Human Services administers the Pre-Existing Condition Insurance Plan for the State of Nevada which provides coverage for both primary and specialty care, hospital stays, and prescription medications. According to age and option selected, monthly premiums fall in a range of $113 to $487 with deductibles of $1000 to $3000 (and in some cases, a separate drug deductible.) The maximum out-of-pocket expense cap is set at $7000 annually.
Medicaid
Qualification for Medicaid is determined by percentages of the Federal Poverty Level. Children in Nevada age 5 and under are covered at 133% FPL, with those ages 6-19 being eligible at 100%.
Pregnant women are eligible at 185% FPL, parents at 27%, working parents at 200%, and non-elderly disabled Social Security recipients at 75%.
The Nevada Check Up program supplies coverage to families at 200% FPL, while Check Up Plus is available for low income families employed by a qualified small employer. The Women’s Health Connection provides breast cancer and cervical cancer screenings.
Medicare
Approximately 13% of Nevada residents receive Medicare benefits with more than 333,000 accessing prescription drug coverage.