By Thomas Mitchell

When the state Division of Insurance (DOI) a month ago released preliminary cost figures for health insurance plans participating in the Silver State Health Insurance Exchange (SSHIX) under ObamaCare, it turned out that only two HMOs were willing to offer insurance in the rural counties — but at considerably higher premiums, as much as 75 percent higher.

This past week DOI released approved 2014 rates for all health insurers, both those participating in the exchange and those who are not. Though the rates in more urban counties appear relatively competitive, in the rural counties the cheapest rate in the exchange is more than 50 percent higher than the cheapest non-exchange rate.

Which means all us will be paying more for ObamaCare insurance, because the only way to get the Advanced Premium Tax Credit — which basically is a tax refund to cover a portion of insurance premiums, even if you pay no income tax — is to buy through the exchange. When you subsidize something, it invariably costs more.

Insurance Commissioner Scott Kipper explained during a conference call with the press, “The advantage of going through an exchange is, if you are an individual whose income is under 400 percent of the federal poverty level, then you would be eligible for a subsidy on your premiums.”

In general, those making 133 percent of the federal poverty level (currently $11,500 for one person, $15,500 for a couple and $23,500 for a family of four) are eligible for Medicaid. Those making 133 to 150 percent of poverty would pay 3 to 4 percent of income for insurance. As income increases, the percentage of income required increases to 9.5 percent at 400 percent of the federal poverty level. This means a family of four making $94,000 is eligible for premium subsides. A family of eight could earn a tax credit if its income is less than $158,000. With higher incomes you have to pay the market rate.

John Hager, executive director of SSHIX, explained how residents may enroll as of Oct. 1 for insurance coverage to start on Jan. 1, “You go to, you have to create a profile, so we can make sure we have the right person. You’ll have to answer a series of questions. If you don’t think you are subsidy eligible, you can basically go straight to shop and compare. If you would like to enroll in the Advance Premium Tax Credit or Medicaid … you can go through a series of questions to make that determination, then you go to shop and compare. The application process will take about 15 minutes for the individual, a little bit longer for families.”

Though the national exchange — which is being set up to cover people in states that opted to not create their own exchanges as Nevada did — has waived requirements for proof of income and will take an applicant’s word on it, Hager said Nevada will verify income through a federal data hub that is supposed to be operational by Oct. 1.

For those who find navigating the website too daunting, Kipper said there is a program to train individuals who will be able to assist Nevadans in navigating through it all. “Actually, it is called the navigator program. The navigators, or exchange enrollment facilitators, will be going through some specialized training to assist the consumers.”

He said the navigators must have a minimum level of education, must take a test and — again unlike the federal exchange — must pass a criminal background check.

“Yes, we are requiring background checks,” Kipper said. “We’re doing this process almost exactly like we would perform the processing of an individual who wants to become an insurance agent. We believe that it is very important that if these folks are dealing with Nevadans that they have a large level of credibility. We think that an opportunity for fraudulent activity exists and we want to minimize that as much as possible.”

Though the state will need more than 110 or 120 such navigators, the state only certified its first navigator at the first of the month. The state is providing $2.5 million in grants to a half dozen organizations to provide the training. Additionally, about 1,200 insurance brokers have expressed interest in assisting people in enrolling.

Insurance rates for 2014 are posted at: To calculate your maximum premium based on income and family size go to:

Thomas Mitchell is a longtime Nevada newspaper columnist. You may share your views with him by Read additional musings on his blog at

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