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Health Care Reform

What is Health Care Reform?

On March 23, 2010, President Obama signed the Affordable Care Act (ACA) also known as health care reform into law. The law puts in place a significant number of health insurance reforms that have rolled out over the last three years. Some of the final and most notable changes of the law took effect on January 1, 2014.

The best way to summarize the impact of the ACA is to say that it will make insurance more accessible to you. There are a number of provisions throughout the law that help you afford coverage, as well as guarantee you access to insurance with a minimum level of benefits.

Primary among these reforms is assistance for individuals and families to purchase health insurance through federal subsidies and expanded eligibility for Medicaid; as well guaranteed access to health insurance regardless of your age or health status.

Since January 1, 2014, you could no longer be declined coverage or be charged extra for health insurance because of a health issue you have now or in the past. You will also be guaranteed a minimum set of health benefits known as “Essential Health Benefits

Other notable market reforms include:

  • Extending dependent coverage to age 26.
  • Coverage with no expense to the consumer of most preventive services and immunizations.
  • Insurers in the individual and small group market but spend at least 80 cents of every dollar collected from consumers on medical care and services.
  • Annual and lifetime dollar limits are prohibited on essential health benefits.

Help Affording Health Insurance

Many Nevadans who do not receive health insurance coverage from their employer are potentially eligible for premium assistance under the Affordable Care Act or enrollment in the Medicaid program.  For individuals and / or families that earn up to 400 percent of the Federal Poverty Level (FPL) subsidies are available for purchases through Healthcare.gov.  Nevadans can determine the amount of assistance available toward premium or if they might qualify for Medicaid on the NevadaHealthLink.com. The below chart illustrates the levels of assistance available.

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Individual Mandate

It’s also important to know that since January 1, 2014, most people will have had health insurance or will pay a fine. For individuals, the penalty for the entire year will be $95 per adult and $47.50 per child, up to a family maximum of $285 or 1 percent of the family’s income, whichever is greater.

In 2015, these amounts increase to $325 per adult, $162.50 per child, and a family maximum of $975 or 2 percent of the family’s income.

For 2016 and subsequent years, the full penalties will be $695 per adult, $347.50 per child, and a family maximum of $2,085 or 2.5 percent of the family’s income.

The requirement to have coverage can be waived for several reasons, including financial hardship or religious beliefs.

The IRS intends to send letters to taxpayers notifying them that they owe the penalty, and it will also have the power to withhold future tax refunds.

Health Insurance Rates

One result of the ACA is that Nevada expanded its review of health insurance rates. Nevada continues to review all health insurance rate changes in the individual and small group insurance markets, however now that review can includes additional staffing, greater reliance on technology and outside actuarial consulting analysis of submitted data.

The law also requires insurance companies to spend the majority of your premium dollars on health care. This means that insurers selling policies to individuals or small groups must spend at least 80% of premiums on direct medical care and efforts to improve the quality of care or provide a premium rebate to their customers.

A similar requirement applies to large group health insurance; insurers selling to large groups (usually 50 or more employees) must spend 85% of premiums on care and quality improvement.

The Nevada Division of Insurance is committed to consumer protection and transparency in regards to the cost of your health insurance, read more about health insurance rates in Nevada here.

More Information

Read more about how Health Care Reform affects you and your family.