Your Connection to Quality, Affordable Health Insurance

The Affordable Care Act is helping to ensure that hardworking individuals and families in Nevada have access to quality, affordable health insurance coverage. Click on one of the links in the table of contents below to learn about the basics of health insurance and the health insurance marketplace.  This page now includes information about how your health coverage may affect your 2014 federal income tax return.

For more frequently asked questions about the marketplace and how your health coverage may affect your 2014 federal income tax return, please visit the Kaiser Family Foundation’s Health Reform FAQs page, the Center on Health Insurance Reforms’ Resource Guide, and the IRS’ Health Care Tax Tips page.

NEW: HEALTH INSURANCE COVERAGE AND 2014 FEDERAL INCOME TAXES

How will my health coverage affect my 2014 federal income tax return?

As of January 1, 2014, most residents of the United States are required to obtain health insurance or pay a fee. This shared responsibility provision will apply to a small group of people who can afford health insurance but choose to remain uninsured. Individuals who were enrolled in a health insurance plan that meets minimum essential coverage for each month of 2014 are considered covered and do not have to pay a fee.  Those who did not have health insurance for all or part of 2014 may have to pay a fee when they file their 2014 federal income tax return.  Exemptions are available for some people who were not covered for all or part of 2014.

To learn more about how the Affordable Care Act may affect your 2014 federal income tax return, you may view IRS Publication 5187, Health Care Law: What’s New For Individuals and Families. Nevada Health Link also has a page dedicated to 2014 Tax Information, which is specific to 2014 Nevada Health Link consumers.  The question below entitled, “Where can I go to learn more about health care and 2014 federal income taxes?” provides many helpful resources as well.

I had health insurance coverage through my job, Medicare, Medicaid, TRICARE, or through another source during all of calendar year 2014. Do I need to take additional action when I file my 2014 federal income tax return?

If every member of your household had minimum essential coverage for each month of 2014, you are considered covered and will not have to pay a fee when you file your 2014 federal income tax return.

Most taxpayers will simply need to check a box to indicate they were covered and will not need to take any additional action when they file their tax returns for 2014. You will not have to file any additional forms either. All you have to do is check the box on line 61 on Form 1040, line 38 on form 1040-A, or line 11 on Form 1040-EZ. For more information, click here.

I enrolled in a health insurance plan through Nevada Health Link in 2014. What can I expect when I file my 2014 federal income tax return?

Individuals who enroll in a health insurance plan on the marketplace may be eligible for financial assistance, such as an advanced premium tax credit (APTC). APTCs are paid on your behalf directly from the federal government to the plan you choose to lower the amount you pay monthly for health insurance coverage.

The amount of the APTC one is eligible for is based on their household size and what they estimated their 2014 income would be when they applied for coverage for plan year 2014. Marketplace enrollees are strongly encouraged to go back into their marketplace accounts and update their estimated income throughout the year when they experience changes in income, as the difference between one’s estimated income and actual income will be reconciled during tax time. Individuals who received an excess APTC will have to repay some or all of it. Conversely, individuals who received too little of a tax credit will receive a refund when they file their 2014 federal income taxes.

To assist with the reconciliation process, Nevada Health Link will send enrollees a Form 1095-A, Health Insurance Marketplace Statement, to their last known address by January 31, 2015. Form 1095-A provides information for all household members who were enrolled in a plan through Nevada Health Link, including how many months each enrolled household member had coverage, how much their monthly premium was, and the amount of any APTCs paid to the insurer on their behalf. Everyone who enrolled in a health insurance plan through Nevada Health Link will receive a 1095-A, even if they did not receive an APTC.

Marketplace consumers will use Form 1095-A to fill out another IRS form, Form 8962, Premium Tax Credit. The purpose of Form 8962 is to determine the correct amount of the premium tax credit that you were entitled to in 2014 based on factors like your actual income and household size. Filing this form is especially important if you received an APTC in 2014, as the amount you received was based on your household size and what you estimated your 2014 income would be on your Nevada Health Link application when you applied for coverage for the 2014 plan year. The APTC amount must now be reconciled with your household’s actual income for 2014. You do not have to file Form 8962 if you did not receive an APTC for any month during 2014. However, you may still want to file Form 8962 if you experienced certain life changes, like a change in income or household size, as you may now be eligible to receive the premium tax credit as a refund on your federal income tax return.

Contact the Nevada Health Link Customer Contact Center if the information on your Form 1095-A is incorrect or if you have other questions about the form. You may reach them by dialing 1-855-768-5465. To learn more about Form 1095-A and what you can expect from Nevada Health Link, click here.

How is my advanced premium tax credit impacted if I experienced certain life changes throughout the year, such as a change in family income or household size?

Marketplace consumers are strongly encouraged to report certain life changes on the marketplace soon after they occur so that any financial assistance can be adjusted accordingly. Life events that may affect your tax credit eligibility include: a change in income, a change in household size, a change in address, and getting health coverage through another source like Medicare, Medicaid, or your employer. Click here to learn more about reporting life and income changes to the Marketplace.

If you did not report these changes to the marketplace when they occurred, your estimated premium tax credit for 2014 may differ from the actual premium tax credit you are eligible to claim. For instance, if your household income increased throughout the year and you received advanced premium tax credits, you may have received an excess tax credit, which you may have to repay. Conversely, if your household income decreased, you may be entitled to a refund when you file your 2014 federal income taxes. Form 8962 will help you determine the correct amount of the premium tax credit that you were entitled to in 2014 and if you need to repay some of your advanced premium tax credit or if you are owed a refund.

If I received too much of an advanced premium tax credit during the year, how much will I have to repay?

You can avoid having to repay any excess tax credit by reporting certain life changes to the marketplace during the year, like a change in income and household size.

If you received too much of an advanced premium tax credit for 2014, the amount you will need to repay depends on your final 2014 income. For instance, a single person who earned less than 200 percent of the federal poverty level would have to repay up to $300 of their excess tax credit. Individuals and families with a household income of 400 percent of the poverty level or more would have to pay back their entire excess tax credit. The chart below outlines the repayment limit for individuals and families who received an excess advanced premium tax credit. These repayment limits are based on the 2013 federal poverty level guidelines.

Advance Premium Tax Credit Repayment Limit

Household income as a percentage of the 2013 federal poverty line Single Filers All other Filers
Less than 200 percent $300 $600
200 percent to less than 300 percent $750 $1,500
300 percent to less than 400 percent $1,250 $2,500
400 percent or more N/A N/A


You may be able to participate in an IRS payment plan or installment agreement if you are unable to pay the entire amount of your tax debt immediately. You may also be eligible for an offer in compromise from the IRS, which would allow you to settle your tax debt for less than you owe.

Additionally, on January 26, 2015, the IRS released Notice 2015-9, which will provide limited relief for taxpayers who received an excess advanced premium tax credit (APTC) and therefore have a balance due on their 2014 federal income tax return. Normally, taxpayers who have a balance due on their federal income tax return may owe a penalty for late payments or a penalty for the underpayment of estimated tax. For this year only, the IRS will waive these penalties if a taxpayer meets the following criteria: they have a balance due or an underpayment of estimated tax because they received an excess APTC, they are otherwise current with their filing and payment obligations, and they report the amount of their excess APTC on their 2014 federal income tax return (line 46 on Form 1040 or line 29 on Form 1040-A). Taxpayers who are eligible for this limited relief will still be responsible for paying their balance and for interest accrued on their balance. For more information, including how to request this relief, you may view the entire Notice 2015-9.

Will I receive a refund on my 2014 federal income tax return if I received too little of an advanced premium tax credit throughout the year?

Yes, the premium tax credits offered through the health insurance marketplace are refundable, which means that if the amount of the tax credit you were eligible for exceeds the amount of the tax credit you received, you will receive the difference in the form of a refund on your 2014 federal income tax return.

Please note that you may have received too little of an advanced premium tax credit if you experienced a certain life change, like a decrease in income or an increase in household size. Remember that marketplace consumers are strongly encouraged to report certain life changes on the marketplace soon after they occur so that any financial assistance can be adjusted accordingly during the year. Click here to learn more about reporting life and income changes to the Marketplace.

Can I receive the premium tax credit for 2014 if I enrolled in a health insurance plan outside of Nevada Health Link?

For this year only, some individuals who enrolled in a health insurance plan outside of Nevada Health Link in 2014 may be eligible to receive a tax credit when they file their 2014 federal income tax return. Nevada Health Link recommends that consumers who were enrolled in a health insurance plan outside of the marketplace in 2014 seek assistance from a licensed tax professional to see if they qualify for a premium tax credit. For more information, you may visit Nevada Health Link’s Tax Information page and the Centers for Medicare and Medicaid Services’ Bulletin on retroactive premium tax credits.

What if I received a tax credit for coverage on Nevada Health Link but I don’t make enough money to file a tax return?

You must file your 2014 federal income tax return if you received an advanced premium tax credit in 2014 or if you want to receive your premium tax credit as a refund. This is true even if your income is below the required tax filing threshold.

Individuals who earn less than $60,000 can file their federal taxes for free using Free File Software. For more resources that may help you file your 2014 federal income tax return, view the question below entitled “Where can I find assistance filing my 2014 federal income tax return?”

What if I did not have health insurance coverage for all or part of 2014 and I do not qualify for a coverage exemption?

You will have to pay a fee when you file your 2014 federal income tax return if you did not have health insurance coverage for all or part of 2014 and you do not qualify for a coverage exemption.  The fee for 2014 will be the greater of these two amounts:

A flat rate for the year of $95 per adult and $47.50 per child under 18.  This flat dollar formula is limited to a household yearly maximum of $285.

One percent of your household income that is above the tax filing threshold.  This formula is capped at the national average annual premium for a bronze level plan that was available on the marketplace in 2014, which was $2,448 per individual and $12,240 for a family with five or more members.

If you were uninsured for only part of the year, you will divide the applicable yearly fee by 12 and then multiply the result by the number of months you were uninsured.  You should also note that for any given month, you will be considered covered as long as you had coverage for at least one day of the month.

If you owe a fee for not having health insurance coverage, you will make your payment when you file your 2014 federal income tax return.  Pages 5 and 6 of the Instructions for Form 8965 will help you calculate the amount you owe and you will enter that amount on line 61 on Form 1040, line 38 on Form 1040A, or line 11 on Form 1040EZ.

You may be able to participate in an IRS payment plan or installment agreement if you are unable to pay the entire amount of your tax debt immediately.  You may also be eligible for an offer in compromise from the IRS, which would allow you to settle your tax debt for less than you owe.

To learn more about how your 2014 federal income tax may be affected if you were not covered for all or part of 2014, click here.

Also, please note that the fee for not having health insurance in 2015 will increase to the greater of 2 percent of your annual household income that is above the tax filing threshold or $325 per adult and $162.50 per child for the year.

What are the exemptions from the individual responsibility fee?

There are a number of fee exemptions available for some individuals who did not have health insurance for all or part of 2014.  These include: being uninsured for less than 3 months of the year, belonging to a federally recognized tribe or eligible for health care services through the Indian Health Service, qualifying for one of the hardship exemptions, and being unable to afford the lowest-priced coverage available to you.

Use this tool from HealthCare.gov to see what coverage exemptions may apply to you.  Please note that this tool cannot definitively tell you if you qualify for a coverage exemption. It is simply a resource to determine what exemptions you may qualify for and how to apply for them.

How do I claim an exemption from the individual responsibility fee?

Most exemptions can be claimed by filing Form 8965, Health Coverage Exemptions, along with the rest of your 2014 federal income tax return.  However, some exemptions need to be claimed through the health insurance marketplace, HealthCare.gov.  These include the exemptions based on hardship and on membership in a federally recognized tribe.  Visit this HealthCare.gov page for a list exemptions and how to claim them.  Page 2 of the Instructions for Form 8965 also has a list of types of coverage exemptions, whether they can be claimed on your tax return or granted by the marketplace, and the code for the exemption.

I didn’t have health insurance in 2014 because it was unaffordable for me. Can I get an exemption from the individual responsibility fee?

You may be eligible for an affordability exemption if the least expensive plan available to you on the marketplace in 2014 was more than 8 percent of your household income, after any premium tax credits were applied. You can use the Affordability Worksheets on pages 10 and 11 of the Instructions for Form 8965 to figure out if you can claim the affordability exemption. This exemption can be claimed when you file your tax return.

To claim this affordability exemption, you will need to provide information about the lowest cost bronze plan as well as the second lowest cost silver plan available to you on the marketplace in 2014.

The lowest cost bronze plan available to you in 2014 can be found by using the tool available on the Nevada Division of Insurance page and selecting the county you live in and your age from the drop down menus. Detailed instructions on how to use this tool can be found on Nevada Health Link’s tax information page.  Enter the amount of the lowest cost bronze plan available to you on the Marketplace Coverage Affordability Worksheet on page 10 of the Instructions for Form 8965.

The second lowest cost silver plan (SLCSP) available to you in 2014 can also be found by using the tool on the Nevada Division of Insurance page.  Detailed instructions on how to use this tool are also available on Nevada Health Link’s tax information page. You will enter the amount of the SLCSP available to you on Form 8962 to determine the amount of the premium tax credit you would have been eligible for in 2014.

Should you need additional information about these premium amounts, you may call Nevada Health Link at 1-855-768-5465.

If you have already received an affordability exemption from the marketplace, you can enter your Exemption Certificate Number on Form 8965. For more information about claiming an affordability exemption in this way, click here.

You may also be eligible for the affordability exemption if you were offered employer-sponsored coverage, but your share of the premium for self-only coverage was more than 8 percent of your household income. You can claim this exemption by filling out Part III of Form 8965 and filing the form with the rest of your federal income tax return. For detailed instructions on how to claim the affordability exemption because your employer-sponsored coverage was unaffordable, see page 8 of the Instructions for Form 8965.

What if I didn’t have health insurance and I don’t make enough money to file a 2014 federal income tax return?

If you did not have health insurance coverage in 2014 and your income is below the required tax filing threshold, you do not have to file a 2014 federal income tax return and you will not have to pay a fee for not having health insurance. If you choose this option, you will not have to file any forms.

If your income is below the tax filing threshold but you choose to file your 2014 federal income tax return for any reason, you will need to submit Form 8965 with the rest of your tax return and check box 7a or 7b.

What if I made an error or need to change the information on my 2014 federal income tax return?

You may want to file an amended return if you made an error in reporting your income, deductions, credits, or exemptions.  You may also need to file an amended return if you filed your return before the marketplace made a decision on a pending exemption application, and they later denied the exemption.  Filing an amended return is not necessary to correct other mistakes, such as a math error, as the Internal Revenue Service will correct this information for you.  You can file an amended return by filling out Form 1040X.  This form cannot be filed electronically; it must be mailed in.  For detailed directions about how to file a Form 1040X, including where to mail the form, view the Instructions for Form 1040X.  The IRS also has a tax topic page and a frequently asked questions page for amended returns.

Where can I learn more about health coverage and my 2014 federal income tax return?

For in-depth information about how the Affordable Care Act may affect your 2014 federal income tax return, you may view IRS Publication 5187, Health Care Law: What’s New For Individuals and Families.

Nevada Health Link also has a page dedicated to 2014 Tax Information, which is specific to 2014 Nevada Health Link consumers.

The Internal Revenue Service has a number of resources available for taxpayers, including a Health Care Tax Tips page, a helpful infographic, and a quick chart that provides guidance based on your particular situation.

The Department of Health and Human Services also has a factsheet explaining health coverage federal income taxes.

The Kaiser Family Foundation and the Center on Budget and Policy Priorities have created helpful resources for consumers.

This video from HealthCare.gov gives consumers three tips about marketplace coverage and their taxes in under three minutes.

Where can I find assistance filing my 2014 federal income tax return?

The Internal Revenue Service offers free tax return preparation services for qualifying taxpayers, including the Volunteer Income Tax Assistance (VITA) program and the Tax Counseling for the Elderly (TCE) program. Learn more about these programs here.

The AARP Foundation offers a free Tax-Aide program for low-to-moderate income taxpayers who are age 60 and older.

Many taxpayers seek assistance from a certified tax professional. Click here to learn what to look for when selecting a paid tax return preparer.

Individuals who earn less than $60,000 can file their federal taxes for free using Free File Software.

Health Insurance 101

Why is it important for individuals to have access to quality, affordable health insurance?

Most people will need medical care at some point in their life.  Health insurance protects you when you become unexpectedly sick or injured, and it also helps you get the care you need to prevent many illnesses from developing in the first place.  Without health insurance, you may incur significant medical debt if you do have a medical issue, and you may be less likely to afford and seek important preventive services.  The health reform law makes health insurance and health care more affordable and accessible for Americans.

I keep hearing terms like ‘premium,’ ‘deductible’, ‘co-insurance,’ and ‘co-payment.’ What do these terms mean?

All of these terms describe different kinds of costs that you may be responsible for when you enroll in a health insurance plan.  A premium is the amount of money you pay for your health insurance plan.  Often times, this is a monthly payment that you make to your health insurance company, but it may also be yearly, quarterly, or some other defined interval of time.  A deductible is the amount you must pay in out-of-pocket health care expenses before your insurance kicks in.  For instance, if you enroll in a plan with a $2,000 deductible, you must pay $2,000 before your insurance begins to cover many health care services.  Co-insurance is the percentage of the total cost of a health care service that you are responsible for.  For example, if you go to the doctor and the total charge is $100, and you have an 80/20 coinsurance plan, you must pay the physician $20 for that visit, while your health insurance company pays the remainder of the bill.  A Co-payment is similar to co-insurance, but rather than paying a percentage of the cost, you must pay a fixed dollar amount.  Co-insurance and co-payment both apply to health care costs after you reach your deductible. Additional Resources:

Is financial help available to lower my monthly premium costs?

The Affordable Care Act makes it easier for Nevadans to obtain quality, affordable health insurance.  Through the health insurance marketplaces, Americans can find out if they are eligible for cost-saving programs, such as the advanced premium tax credits (APTCs), to reduce the “sticker price” of coverage.  Last year, 82 percent of Nevadans who enrolled in a plan on Nevada’s state-based health insurance marketplace, Nevada Health Link, were eligible for this financial assistance and used it to lower their monthly premiums payments. These tax credits are based on your household size and income.  Nevadans with household incomes between 100 percent and 400 percent of the federal poverty level (up to approximately $46,680 per year for an individual and $95,400 per year for a family of four) will be eligible for premium tax credits for coverage purchased on the health insurance marketplace. Read the section below entitled, “How is the advanced premium tax credit (APTC) calculated?” for more information. What’s more is that you do not have to wait until tax time to benefit: these tax credits are paid on your behalf directly from the federal government to the plan you choose, to lower the amount you pay monthly.  Coverage through the marketplace is also made more affordable through cost-sharing reductions, which help pay for out-of-pocket costs like deductibles and co-pays. Additionally, many states, including Nevada, decided to expand their Medicaid program as part of the Affordable Care Act.  Because of this expansion, individuals whose household income is less than 138 percent of the federal poverty level ($16,105 per year for an individual and $32,913 per year for a family of four) may be eligible for Medicaid. Additional Resources:

How can I get lower out-of-pocket costs?

In addition to the premium tax credits, a type of financial assistance called cost-sharing reductions (CSRs) are also available to help you lower your health care costs.  CSRs help pay for out-of-pocket costs like deductibles and co-payments.  If you are eligible for the premium tax credit, you may also be eligible for a CSR.  Your household income must be between 100 and 250 percent of the federal poverty level (between $23,850 and $59,625 for a family of four) and you must be enrolled in a “silver plan” on the health insurance marketplace.  Learn more about CSRs here.

Other than cost, what should I look for in a health insurance plan?

All health insurance plans are different, and while cost is an important factor to consider, you should also look at metal tiers, plan types and what doctors are in your plan’s network. If you take prescription medications, you should also consider your plan’s prescription drug formulary. The Affordable Care Act works to ensure that the plans offered on the health insurance marketplace are able to provide enrollees with access to a number of primary care and specialty providers, but your specific doctor may not participate in every plan.  If they don’t, you may have to pay out-of-pocket if you wish to continue seeing them. If you have certain doctors that you want to stay with, you should always call them and ask if they accept the health insurance policy you are planning to enroll in. Plan networks often change, and it can be difficult for plans to maintain an updated website, so even if your doctors are listed on the plan’s webpage, you should call them to be sure they take your plan before you enroll.

Additional Resources:

How do I know if the plan I have meets the Affordable Care Act’s coverage requirement?

A health insurance plan that qualifies as “minimum essential coverage” will qualify as coverage under the Affordable Care Act. This includes Qualified Health Plans (QHPs) sold on the health insurance marketplace. Every plan sold on the health insurance marketplaces must be a QHP, so if you purchased a plan on Nevada Health Link last year, you have met the ACA’s coverage requirement. Similarly, if you purchase a plan on the health insurance marketplace during this year’s open enrollment period, you will meet the ACA’s coverage requirement and will not be fined during next year’s tax season. Other plans, including Medicaid, Medicare and many employer-sponsored and individual plans also meet the coverage requirement. If you do not have health insurance or your plan does not meet the coverage requirement, you may have to pay a fine during tax time. Exemptions are available in certain situations. Learn more about the types of plans that qualify as coverage under the Affordable Care Act here.

Medicare, Medicaid, and CHIP

Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP) are all government-sponsored health insurance programs. Medicare provides health insurance for Americans age 65 and older, as well as many individuals with disabilities. Medicaid provides coverage for low-income individuals.  In Nevada, individuals may be eligible for Medicaid if they earn less than 138 percent of the federal poverty level ($16,105 per year for an individual and $32,913 per year for a family of four). CHIP, known in the Silver State as Nevada Check Up, covers children whose parents earn too much money to be eligible for Medicaid, but not enough to afford private health insurance coverage. Nevadans can apply year-round for Medicaid and Nevada Check Up on the health insurance marketplaces or through the Nevada Division of Welfare and Supportive Services.  Learn more about Medicaid and Nevada Check Up here. Medicare is not part of the health insurance marketplace. Medicare beneficiaries are already considered covered and do not have to take any additional action.

Additional Resources:

Where can I go to learn more about health insurance?

For in-depth information about a variety of marketplace topics, please visit the Kaiser Family Foundation’s Health Reform FAQ site. You can also view webinars and explore health reform topics at Health Reform: Beyond the Basics. This document from Families USA explains the basics of health insurance. Nevada Health Link also provides a glossary of important health insurance terms for consumers to review. HealthCare.gov has many resources to answer your health insurance questions as well.

Health Insurance Marketplaces

GENERAL MARKETPLACE INFORMATION

What is a health insurance marketplace?

The Affordable Care Act created health insurance marketplaces – websites where individuals and small businesses can compare and purchase different private health insurance plans based on their individual needs. On the health insurance marketplaces, people can directly compare plans on the basis of price, benefits, quality, and other factors.  Health insurance marketplaces are also the only place you can enroll in coverage that offers financial assistance, such as premium tax credits and cost-sharing reductions.

Is Nevada Health Link a health insurance marketplace?

Yes, the health reform law gave states the option to set up their own health insurance marketplace.  Nevada decided to operate its own state-based health insurance marketplace, called Nevada Health Link. This year, there is a brand new Nevada Health Link that makes enrolling in coverage easier than ever because it utilizes the federal government’s health insurance marketplace, HealthCare.gov, which enrolled more millions of Americans in coverage last year.  Nevada Health Link will still have authority over certain aspects of the marketplace, such as the premium rate review and the plan certification.  This year, you can go directly to HealthCare.gov to begin the enrollment process, or, if you choose, you can start at Nevada Health Link.

What kind of health insurance can I enroll in on the marketplace?

Nevada Health Link and HealthCare.gov can connect you to a private Qualified Health Plan (QHP), Medicaid, or the Children’s Health Insurance Plan (CHIP) – known in the Silver State as Nevada Check Up.  Your household size and income will be used to determine what kind of plan you may be eligible for.

What kinds of services are covered under the health plans offered in the marketplace?

Under the Affordable Care Act, many health insurance plans must now cover a set of essential health benefits (EHBs).  The required EHBs include diabetes screenings, colonoscopies, mammograms, prescription drugs, behavioral health screenings, and more.  Click here to review a list of EHBs. Every state also has their own set of EHBs that is required of all individual and small group plans.  Click here to see the Silver State’s EHB benchmark plan.

Can I purchase dental coverage on the health insurance marketplace?

You may purchase a stand-alone dental plan through the health insurance marketplace.  Click here to see a list of certified dental plans in the state of Nevada.

What do the different metal levels mean?

Health insurance plans sold on the marketplaces are categorized by “metal level” – platinum, gold, silver, and bronze.  Generally speaking, the plan pays more for the total cost of your care as you move from a bronze plan to a platinum plan.  Learn more about the marketplace insurance categories here.

How is the advanced premium tax credit (APTC) calculated?

The amount of the tax credit that you may be eligible for depends on your annual income, household size, and the cost of the “benchmark plan” available to you.  If your yearly household income is up to approximately $46,680 for an individual or up to $95,400 for a family of four, you may be eligible to receive a premium tax credit for coverage purchased through the health insurance marketplace. Additionally, tax credit amounts are based on the cost of the “benchmark” plan, which is the second-lowest cost silver plan available in the marketplace.  HealthCare.gov will determine if the benchmark plan is more expensive than a certain maximum percentage of your income that you can spend on your premium payments, which is based on your household size and income.  If the benchmark plan is more expensive, then the federal government will pay the difference, giving you a tax credit. Additional Resources:

  • Find detailed information about calculating the premium tax credit here
  • Find health insurance premiums in Nevada, including your “benchmark” plan here
  • Access premium tax credit information from the IRS here
  • Learn how to estimate your income here

My employer offers health insurance. Can I still purchase a plan on the marketplace?

Yes, you can buy a plan on the health insurance marketplace, but you may not be eligible for financial assistance.  You can shop for a plan on the health insurance marketplace, but if your employer offers affordable health insurance coverage, you will not be able to receive financial assistance for a plan purchased on the marketplace.  If the insurance plan your employer offers is not affordable, then, depending on your household size and income, you may be eligible for a premium tax credit.  Learn more about changing from an employer-sponsored plan to a marketplace plan here.

I am enrolled in Medicare. Do I need to enroll on the health insurance marketplace?

No.  If you are already enrolled in Medicare, then you do not have to take any additional action.

What does the marketplace mean for people on Medicaid and Nevada Check Up?

Nevadans who earn less than 138 percent of the federal poverty level ($16,105 per year for an individual and $32,913 per year for a family of four) may be eligible for Medicaid.  Nevada Check Up covers children whose parents earn too much money to be eligible for Medicaid, but not enough to afford private health insurance coverage. You can visit Nevada Health Link or HealthCare.gov during the open enrollment period of November 15, 2014, to February 15, 2015, to see if you are eligible for Medicaid or Nevada Check Up, but you should also note that individuals eligible for these programs can apply year-round; there is no enrollment period for Medicaid or Nevada Check Up.  Additionally, while health insurance marketplaces like Nevada Health Link and HealthCare.gov assess initial eligibility for Medicaid and Nevada Check Up, the state’s Division of Welfare and Supportive Services (DWSS) makes the final eligibility determination. If you are currently enrolled in one of these programs, you do not have to re-enroll on Nevada Health Link or HealthCare.gov.  However, DWSS requires that Medicaid and Nevada Check Up enrollees undergo an annual redetermination process, which is based on your initial determination date.  DWSS is responsible for this process and contacts beneficiaries by mail when their redetermination is approaching.  Please contact DWSS directly with questions about Medicaid and Nevada Check Up applications and redetermination process.  You may reach DWSS toll free by dialing 1-800-992-0900 or by calling 702-486-1646 (Southern Nevada) or 775-684-7200 (Northern Nevada). Additional Resources:

I currently have COBRA coverage. Can I still shop on the health insurance exchange?

Yes, you may shop for a health insurance plan on the health insurance marketplace if you currently have COBRA coverage.  Depending on your household income and family size, you may be eligible for less expensive coverage on the health insurance marketplaces.  Click here to learn more about COBRA coverage and your options on the marketplace.

INFORMATION FOR THIS YEAR;S OPEN ENROLLMENT PERIOD: NOVEMBER 15, 2014 – FEBRUARY 15, 2015

When can I enroll in a health insurance plan on the health insurance marketplace?

Marketplaces have an open enrollment season, or a specific period of time designated for purchasing health insurance coverage for the following plan year. This year’s open enrollment period is scheduled to begin on November 15, 2014, and conclude on February 15, 2015.  Plans purchased during this period can begin as early as January 1, 2015.

I enrolled in a health insurance plan on Nevada Health Link last year. Do I have to re-enroll this year?

Yes, if you enrolled in a health insurance plan on Nevada Health Link during plan year 2014, you will need to re-enroll in a plan during this year’s open enrollment period. For those that enrolled in a private health insurance plan on Nevada Health Link last year: if you do not re-enroll by December 15, 2014, Nevada Health Link has decided to automatically re-enroll you in a similar plan outside of the health insurance marketplace, where you will not be eligible for any financial assistance on your premium payments. Eighty-two percent of Nevadans who enrolled in a private health insurance plan on Nevada Health Link last year received financial assistance in the form of a premium tax credit.  If you want your tax credit and any cost-sharing reductions you have been receiving to continue into 2015, you must take steps to re-enroll in coverage by December 15, 2014, by logging on to HealthCare.gov or Nevada Health Link and filling out a new application. If you miss the December 15th deadline, you will still be able to enroll in a plan on the marketplace during the remainder of the open enrollment period.  However, you should note that you may be held responsible for paying the full amount of the premium for the plan that you were automatically enrolled in, during the month(s) in 2015 you were enrolled. Those who are re-enrolling should also take this opportunity to make sure their personal information (such as income and household size) is up-to-date to ensure they get the correct amount of financial assistance and to avoid having to pay back any excess during tax time. Read about re-enrollment from Nevada Health Link here.

What will happen if I do not enroll in a health insurance plan during the open enrollment period?

If you enrolled in a health insurance plan on Nevada Health Link during plan year 2014, and you do not take action to re-enroll by December 15, 2014, you will be automatically re-enrolled in a health insurance plan outside of the health insurance marketplace.  You will not be eligible for any financial assistance to help you with your premium payments.  Read more about re-enrolling in a health insurance plan if you were a Nevada Health Link customer last year by clicking here. If you are new to the health insurance marketplace, you will have the full open enrollment period of November 15, 2014, until February 15, 2015, to enroll for coverage that begins as early as January 1, 2015.  If you do not apply by February 15, 2015, you may not be eligible to apply for coverage on the health insurance marketplace until the following year’s open enrollment period. There are a number of specific circumstances that allow you to enroll in coverage outside of the annual open enrollment period.  If you experience a qualifying life event you may be eligible for a Special Enrollment Period.  Examples of a qualifying life event include having a baby, getting married or divorced, and losing your employer-based health coverage.  To learn more about the Special Enrollment Period and qualifying life events, click here. Nevadans can also purchase a private health insurance plan outside of the marketplace year-round, but those who do will not be eligible for financial assistance.  Aside from this important distinction, health insurance plans sold on and off the marketplace in Nevada are no different from each other, but consumers who choose this option may have to wait 90 days for their coverage to begin. Individuals who are eligible for Medicaid and Nevada Check Up can also apply for the program year-round; there is no enrollment period for these programs.  Please contact DWSS directly with questions about Medicaid applications and redetermination process.  You may reach DWSS toll free by dialing 1-800-992-0900 or by calling 702-486-1646 (Southern Nevada) or 775-684-7200 (Northern Nevada).

I experienced difficulty enrolling in a health plan during last year’s open enrollment period. What will be different about this year?

Nevada Health Link will now use the federal government’s HealthCare.gov infrastructure to determine eligibility and enroll consumers. Last year, millions of Americans successfully enrolled in coverage using this very same federal infrastructure that Nevada Health Link will use in the upcoming open enrollment period. There is also a new, shorter application, with fewer pages and fewer questions, which will make this year’s enrollment easier for most Nevadans. If you still need help with a plan purchased during the 2014 enrollment period, contact Nevada Health Link at 855-768-5465 or CustomerSupport@nevadahealthlink.com. For help with a 2015 plan, contact HealthCare.gov at 1-800-318-2596. Read more about the changes to this year’s enrollment process in Nevada.

What materials do I need to apply for coverage?

Some of the documents you will need to apply for coverage on the health insurance marketplace include your social security number, income verification for every member of your household, and your plan identification number if you had coverage during plan year 2014.  You will also need to provide an estimate of your household income for 2015.  For a full list of materials, click here.

How can I get help enrolling in coverage?

HealthCare.gov is available to assist you with questions you have about enrolling in a 2015 plan.  You may reach them by calling 1-800-318-2596. You can also receive free in-person assistance from one of the following navigator organizations staffed by certified assisters:

  • Ramirez Group (Statewide; 702-530-5249)
  • Nevada Primary Care Association (Northern Nevada; 775-887-0417)
  • Consumer Assistance and Resource Enterprise (Southern Nevada; 702-836-9033)

New enrollment stores are also available for individuals to receive in-person assistance from a licensed broker or certified assister.  The store locations and hours of operation are provided below.  You may click here to learn more about the enrollment stores. Reno 3937 South McCarran Boulevard Reno, NV 89502 Open 7 Days a Week: 10:00 a.m. to 7:00 p.m. 15th of every month: 9:00 a.m. to 9:00 p.m. Las Vegas The Boulevard Mall 3528 South Maryland Parkway #384 Las Vegas, NV 89169 Monday – Saturday: 10:00 a.m. to 9:00 p.m. Sunday: 12:00 p.m. to 7:00 p.m. 15th of every month: 9:00 a.m. to 9:00 p.m. Or, you can use Nevada Health Link’s in-person assistance search tool to search for assisters by zip code.  On the Nevada Health Link website you can also access the community events calendar to see what enrollment events are happening in the area.

I successfully enrolled in a health insurance plan on the health insurance marketplace. Do I need to do anything else throughout the year?

There are certain life changes that you must report on HealthCare.gov, including having a child, experiencing a change in income, and changing your address.  Changes like these can impact the amount of your premium tax credit, if you are receiving one.  It is important to report these changes to avoid having to pay back any excess tax credit you receive during tax time. To report a change, you may call the Marketplace Call Center at 1-800-318-2596.