Things aren’t always as clear-cut as they seem.
We’ve been advising consumers that they can’t buy plans through the state exchange until Nov. 15, unless they have a qualifying life event such as a relocation, birth or marriage.
Although that’s still the case, the state Insurance Division recently asked us to remind Nevadans they can buy off of the state’s Nevada Health Link exchange at any time.
Nevada’s the only state that allows year-round sign-ups outside its exchange.
“We wanted to make sure Nevadans had the opportunity to purchase insurance outside of open enrollment,” division spokesman Jake Sunderland said. “We didn’t want to end up in a place where we were forcing people to be uninsured because of circumstances out of their control when they really wanted to buy coverage.”
Coverage won’t kick in right away, though. Insurers can require a waiting period of up to 90 days before a plan takes effect — a lag designed to prevent people from waiting to buy coverage until after they break a leg or get a cancer diagnosis. Anthem Blue Cross and UnitedHealthcare both have a 90-day waiting period; Nevada Health Co-Op has a 30-day delay.
Beyond the simple fact that you can sign up today, off-exchange plans are no different. Carriers who sell coverage through Nevada Health Link must by law offer the same plans at the same prices off of the exchange, Sunderland said.
There’s also more choice off the exchange at this point, although alternatives through the marketplace are growing. For Nevada’s 2015 individual market, five carriers will offer exchange plans, up from four in 2014. But 11 insurers sell only off exchange, up from nine. There are 61 exchange-based plans for the upcoming enrollment year, compared with 150 outside the marketplace.
The only reason you should wait until you’re eligible to buy through the exchange is if you’re getting a federal premium subsidy.
“We have a competitive market. If you don’t need the premium tax credit, it’s certainly in your interest to look at options off of the exchange,” Sunderland said.
■ We’ve been getting questions about how two federal lawsuits might affect tax credits for Nevadans who buy through the exchange.
At issue in both lawsuits is Affordable Care Act wording that says premium subsidies for consumers who make less than 400 percent of the federal poverty wage should go only to enrollees buying through state-run exchanges. That would exclude consumers in the 36 states with exchanges run through the federal healthcare.gov system.
Two federal appeals courts had differing opinions, but if the U.S. Supreme Court rules that tax credits are just for state-based exchanges, that would mean anyone buying through the federal portal would be ineligible for financial help.
That concerns some Nevadans because the state is switching to healthcare.gov’s enrollment software in November. After the changeover, might Nevadans’ tax credits come to an end? Rep. Joe Heck, R-Nev., told the Clark County Association of Health Underwriters on Aug. 12 that he’s watching how the issue plays out.
It looks as though consumers here have nothing to worry about: The state exchange is merely borrowing the federal government’s eligibility system. It’s not becoming a federally sponsored exchange. And as long as it maintains state control over funding and what plans are sold through the marketplace, it’s not considered federally operated.
“Nevada Health Link’s transition to a supported state-based exchange does not affect our status as a federally recognized state-based exchange,” exchange spokesman Tyler Klimas said. “Customers who purchase insurance through Nevada Health Link remain eligible for tax credits to help lower their insurance costs.”
Nor is the switch to healthcare.gov designed to be permanent: The exchange board will consider software that’s worked in other states to get off healthcare.gov in time for enrollment in November 2015.
■ From the “she’s finally covered!” files: On Aug. 10 we featured Laury Phelps in a story on consumers facing the re-enrollment process in November, when Nevada begins borrowing enrollment functions from healthcare.gov.
Phelps was tearing her hair out over the idea of signing up again when she’d essentially been unable to enroll the first time around. She paid $248 monthly premiums for eight months to Nevada Health Link but never was covered. Nor could anyone with system contractor Xerox tell her why her application wasn’t going through. Meanwhile, Phelps was shelling out $800 a month for medications.
Shortly after we ran her story, the logjam on Phelps’ case broke. The 63-year-old Las Vegan wrote to tell us her insurance ID cards were on the way.
Phelps’ case isn’t totally done: She now has to work through the system to get reimbursed for her out-of-pocket expenses.