Picture of health

The open enrollment period for people to sign up for qualified health care plans that meet the 10 essential benefits mandated by the Affordable Care Act closed in Nevada on Dec. 15. But the folks at the Silver State Health Insurance Exchange, the agency that operates Nevada Health Link—the state’s public health insurance marketplace—aren’t quite ready to release enrollment numbers.

The agency is holding off on this until Dec. 23 for several reasons—the most important of which is that people who started their applications before the Dec. 15 deadline still have time to enroll.

“If people started an application on or before that Sunday, then they have until December 20th to complete enrollment,” explained Silver State Health Insurance exchange communications officer Janel Davis. “We will be letting people know that, ’Hey, guess what? Good news. You still have time because insurance is confusing, and we want to make sure that you get the coverage you need.’”

People have until midnight on Dec. 20 to complete applications. To facilitate this, the Nevada Health Link call center will have extended hours. On Dec. 19, those hours will be 9 a.m. to 5 p.m. On Dec. 20, they’ll be 9 a.m. to 10 p.m.

“So the open enrollment period is very similar to tax season, and people tend to procrastinate and wait,” Davis said. “So, typically, we see quite a big surge during these last couple of days. And we’ve already noticed it in just the last 10 days after the Thanksgiving holiday.”

It remains to be seen what Nevada’s enrollment numbers will be for this year, though the state was recently ranked as having the sixth highest uninsured rate in the nation. And the fact that the Trump administration removed the individual mandate requiring people to have insurance at the beginning of this year may also affect numbers.

“And, unfortunately, we think that that has some influence on why younger people are not purchasing plans—and why, you know, our numbers are turning a little bit down this year,” Davis said. “So we think that’s in part due to the individual mandate going away. And the reason it was there is, you know, is that you get more people on an insurance plan and you create a more competitive marketplace and cheaper premiums.”

Parting ways

This year’s enrollees will have noticed other changes specific to Nevada, including a new online platform with fewer problems than the Federally run one—healthcare.gov—that the state relied on in the past.

“Something different is we’re not using healthcare.gov to enroll people anymore,” Davis said. “So this year, people are just going to NevadaHealthLink.com. And relatively, the soft launch—the actual launch of the platform—was really smooth. Overall, a successful ride it’s been. There have been isolated issues, and we’re dealing with those as soon as we’re notified of them. But the user experience has been much better. And we haven’t had downtime like we did on healthcare.gov—or maintenance time. The first day of open enrollment, healthcare.gov was actually blacked out for the first six hours. And that didn’t happen on our exchange website.”

The decision to switch to a state-run platform wasn’t just about convenience, though. It was motivated mostly by a need to save costs. That’s because, in 2017, the federal government began charging a fee to Nevada and the other state-run exchanges that used the healthcare.gov platform. In order to pay for this and operational costs, Nevada Health Link began collecting a percentage of the premiums charged by insurance carriers in the state. Soon, nearly two-thirds of the money Nevada’s exchange collected was being used to pay the leasing fee for the federal platform. And, in 2019, that fee was set to increase to three percent, a figure that represents nearly all of the revenue Nevada currently collects.

According to Heather Korbulic, the executive director of the Silver State Health Insurance Exchange, the new, state-based platform that was unveiled in time for open enrollment this year is considerably more cost effective.

“They were going to charge us almost the entire amount of revenue that we generate at the exchange,” she said. “For instance, we are projected to pay about 12 million dollars for calendar year 2019, and our contracted rate for maintenance and operations for the next year is 5 million dollars, for each year. So we know right away that we’ll have a significant savings.”

Korbulic said there are other benefits to not relying on the healthcare.gov platform, too, including real-time access to data about who the exchange’s consumers are, which gives the agency the “ability to do direct and targeted outreach” to its existing consumers to see where there are gaps and who can be targeted for enrollment in the future.

A third reason, she said, is “the ability to implement policies that are specific to Nevada and more in line with Nevadans’ needs.”

“So on healthcare.gov, we’re working with a pretty archaic and rigid service or platform that really did not allow states any kind of unique flexibility,” Korbulic said. “And with our own exchange, we have the ability to implement policies—you know, within compliance of the federal and state laws—that allow for flexibility that’s necessary.”

An example of this is the exchange’s flexibility to coordinate more closely with the Department of Health and Human Services on issues surrounding Medicaid.

“So, when people apply for Medicaid and get denied because they’re over assets, meaning they don’t have a low enough income to be eligible for Medicaid, then what happens is we get a transfer from the Division of Welfare and Supportive Services, and we can invite those people to come over and claim their application and enroll in a qualified health plan,” Korbulic said. “So what we’ve seen throughout this open enrollment period is 21,000 individuals who applied for Medicaid and were denied that we now have 60 days from their denial to get in touch with them and connect them to a qualified health plan.”

And this year, people who are eligible to complete applications they started before the deadline—as well as those who’ve been denied Medicaid—still have time choose from plans and coverage carriers that are more diverse than in recent years.

“We had Anthem join us back,” Davis said. “They were not part of last year’s enrollment or the year before. So that was really exciting and created some more stability and increased competition for Nevadans. So Washoe, Clark and Nye counties have access to all 27 qualified health plans.”

Residents of Nevada’s 14 rural counties have access 17 plan options. And for the first time, Nevadans have also been able to get dental care without purchasing health care, too.

“So a lot of people were interested in that, and you could find some really good deals this year for just purchasing a dental plan,” Davis said.

There are also more plans in the work for next year’s enrollment period—spurred on by the increased freedom of Nevada no longer using the federal enrollment platform.

“So one thing we’ll be talking about next year is the extension of our open enrollment period and whether or not our carriers and our stakeholders are interested and whether that’d be a benefit to Nevadans,” Korbulic said. “And that’s not something we could do if we’re on healthcare.gov.”