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Heath Care Reform

Small business tax credits.  30,300 small businesses in Nevada could be helped by a new small business tax credit that makes it easier for businesses to provide coverage to their workers and makes premiums more affordable.1  Small businesses pay, on average, 18 percent more than large businesses for the same coverage, and health insurance premiums have gone up three times faster than wages in the past 10 years.  This tax credit is just the first step towards bringing those costs down and making coverage affordable for small businesses.

Closing the Medicare Part D donut hole. Last year, roughly 28,000 Medicare beneficiaries in Nevada hit the donut hole, or gap in Medicare Part D drug coverage, and received no extra help to defray the cost of their prescription drugs.2 Medicare beneficiaries in Nevada who hit the gap this year will automatically be mailed a one-time $250 rebate check. These checks will begin to be mailed to beneficiaries in mid-June and will be mailed monthly throughout the year as new beneficiaries hit the donut hole. The new law continues to provide additional discounts for seniors on Medicare in the years ahead and completely closes the donut hole by 2020. 

Support for health coverage for early retirees. An estimated 38,600 people from Nevada retired before they were eligible for Medicare and have health coverage through their former employers. Unfortunately, the number of firms that provide health coverage to their retirees has decreased over time.3  Beginning June 1, 2010, a $5 billion temporary early retiree reinsurance program will help stabilize early retiree coverage and help ensure that firms continue to provide health coverage to their early retirees. Companies, unions, and state and local governments are eligible for these benefits.

New consumer protections in the insurance market beginning on or after September 23, 2010.

Insurance companies will no longer be able to place lifetime limits on the coverage they provide, ensuring that the 1.5 million Nevada residents with private insurance coverage never have to worry about their coverage running out and facing catastrophic out-of-pocket costs.

Insurance companies will be banned from dropping people from coverage when they get sick, protecting the 132,000 individuals who purchase insurance in the individual market from dishonest insurance practices.

Insurance companies will not be able to exclude children from coverage because of a pre-existing condition, giving parents across Nevada peace of mind.

Insurance plans’ use of annual limits will be tightly regulated to ensure access to needed care.  This will protect the 1.4 million residents of Nevada with health insurance from their employer, along with anyone who signs up with a new insurance plan in Nevada.

Health insurers offering new plans will have to develop an appeals process to make it easy for enrollees to dispute the denial of a medical claim.

Patients’ choice of doctors will be protected by allowing plan members in new plans to pick any participating primary care provider, prohibiting insurers from requiring prior authorization before a woman sees an ob-gyn, and ensuring access to emergency care.

Extending coverage to young adults. Beginning on or after September 23, 2010, plans and issuers that offer coverage to children on their parents’ policy must allow children to remain on their parents’ policy until they turn 26, unless the adult child has another offer of job-based coverage in some cases. This provision will bring relief to roughly 9,470 individuals in Nevada who could now have quality affordable coverage through their parents.4  Some employers and the vast majority of insurers have agreed to cover adult children immediately.

Affordable insurance for uninsured with pre-existing conditions. $61.1 million federal dollars are available to Nevada starting July 1 to provide coverage for uninsured residents with pre-existing medical conditions through a new transitional high-risk pool program, funded entirely by the Federal government. The program is a bridge to 2014 when Americans will have access to affordable coverage options in the new health insurance exchanges and insurance companies will be prohibited from denying coverage to Americans with pre-existing conditions. If states choose not to run the program, the Federal government will administer the program for those residents.

Strengthening community health centers. Beginning October 1, 2010, increased funding for Community Health Centers will help nearly double the number of patients seen by the centers over the next five years. The funding could not only help the 33 Community Health Centers in Nevada but also support the construction of new centers.

More doctors where people need them. Beginning October 1, 2010, the Act will provide funding for the National Health Service Corps ($1.5 billion over five years) for scholarships and loan repayments for doctors, nurses and other health care providers who work in areas with a shortage of health professionals. This will help the 13% of Nevada’s population who live in an underserved area.

New Medicaid options for states. For the first time, Nevada has the option of Federal Medicaid funding for coverage for all low-income populations, irrespective of age, disability, or family status. 

State Government Insurance Programs Offered

Pre- existing Condition Insurance Plan (PCIP) Run by U.S. Department of Health and Human Services www.PCIP.gov


Covers broad range of benefits, including primary and specialty care, hospital care, and prescription drugs. Pre-Existing Health Conditions Covered Eligibility: Must have been uninsured for at least 6 months prior to applying. Must prove being a U.S. citizen or legal U.S. resident, a Nevada resident, and having problems getting insurance due to a pre- existing condition.

Medicaid dwss.nv.gov To find address and phone number of welfare office near you: dwss.nv.gov (Under: DWSS Offices Telephone and Fax Numbers) Access to Health Care Network (AHN) 877-385-2345 775-284-8989 www.accesstohealthcare.org


Coverage: Medicaid: Diagnosis (services to find out what is wrong), Physician services, Check-ups (medical and dental), Family planning, Maternity, Prenatal and newborn care, Prescriptions, Hospital services, Comfort care, Hospice, Dental services, Drug and alcohol treatment, Mental health services. AHN: Hospitals, Family doctors, Cancer care, care from Specialists, X-ray & labs, Diagnostics, Children’s health services, Maternity care, Women’s health services, Prescription drug assistance Eligibility: Medicaid: Must be a U.S. citizen or qualified alien and live in Nevada. Income limits: Pregnant women: 185% FPL. Infants ages 0–1: 133% FPL. Children ages 1–5: 133% FPL. Children ages 6–18: 100% FPL Aged, blind, and disabled singles: Asset limit of $2,000 for all; aged, living independently up to 86% FPL; blind, living independently up to 87% FPL; disabled, up to 75% FPL. Aged, blind, and disabled couples: Aged, living independently, up to 89% FPL; blind, living independently, up to 114% FPL; disabled up to 83% FPL. Parents/caretakers living with children ages 0–18: Non-working, 25% FPL; working, 86% FPL. AHN: Must be uninsured and live in Nevada. Must have income between 100% to 200% FPL. Be able to show picture ID, proof of residency, and proof of income.

Nevada Check Up www.nevadacheckup.state.nv.us


Coverage: NV Check Up: Physician, Chiropractor, Dental, Vision, Medical Equipment, Hospital Inpatient and Outpatient hospital, Laboratory and X-Ray, Prescription Drugs, Ambulance, Non-Emergency Transportation, Mental Health, Home Health, Well-Child, Well-Baby Visits, and Immunizations. Eligibility: NV Check Up: Must be a Nevada resident and a U.S. citizen or “qualified alien” (legal residents need to have 5 years residency). Must be a child age 0–18. Income limit of 100% to 200% FPL. Must not be insured within the last 6 months before enrolling or lost insurance beyond parents’ control, and must not be eligible for Medicaid. Eligibility is determined for one year unless child moves out of state, is enrolled in Medicaid, has other coverage, or becomes financially ineligible.

Nevada Early Intervention Services (NEIS) health.nv.gov/BEIS.htm


Covers audiology (hearing) services Family training, Counseling and home visits, Health services, Medical services for diagnostic or evaluation purposes, Nutrition counseling, Occupational therapy, Physical therapy, Psychological services, Service coordination, Social work services, Special instruction, Speech and language services, Transportation services, Vision and more. Eligibilty: Must be a child 0–3 years old of a Nevada resident. Patient must have been diagnosed with a condition such as Down syndrome, spina bifida, autism, blindness, deafness, or other diagnosed condition that has a high probability of resulting in a developmental delay, or shows significant delays in development such as talking or walking.

Women’s Health Connection (WHC) health.nv.gov (Search: Women’s Health Connection) Maternal Child Health (MCH) Line 800-429-2669 health.nv.gov (Search: MCH)


Coverage: WHC: Breast and cervical cancer screening services. Pelvic exams, Pap smears, clinical breast exams, mammograms. MCH: Provides prenatal care and other maternity services. Eligibility: WHC: Nevada women 40 years or older who do not have health insurance, Medicaid, Medicare Part B, HMO coverage, or whose health insurance does not pay for the program’s services. Income limit of 250% FPL. Women ages 40 or older get annual pelvic exams and annual clinical breast exams, and Pap tests. Those age 50 or older get the above benefits plus annual mammograms. MCH: Must be parents of children up to age 5 who are Medicaid-eligible.

Medicare www.medicare.gov


Coverage: Medicare offers Part A, inpatient care in hospitals and rehabilitative centers; Part B, doctor and some preventive services and outpatient care; Part C allows Medicare benefits through private insurance (Medicare Advantage); Part C includes Parts A, B, and C not covered by Medicare. Part D covers prescription drugs. Senior RX offers extra coverage for medication. There are plans for seniors with Medicare Part D and for seniors without Medicare Part D. Eligibility: Medicare: Must be U.S. citizen or permanent U.S. resident, and: 1) If 65 years or older, you or your spouse worked for at least 10 years in Medicare-covered employment, or 2) You have a disability or end-stage renal disease (permanent kidney failure requiring dialysis or transplant) at any age. Senior RX: Must be age 62 or older Income limit of $25,477 if you are single and $33,963 if you are a married couple.

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