When the state Division of Insurance recently announced which insurers will be participating in the Silver State Health Insurance Exchange

Thomas Mitchell

When the state Division of Insurance recently announced which insurers will be participating in the Silver State Health Insurance Exchange (SSHIX in the vernacular) under ObamaCare, only four companies signed on, all HMOs, and only two of those are offering insurance in all the rural counties — but at considerably higher premiums in most cases, as much as 75 percent higher.

Additionally, those rates are just the preliminary figures and may change after the Division of Insurance reviews all rate filings to ensure they are adequate, not excessive and non discriminatory. Final figures are not expected to be released until Sept. 1.

SSHIX breaks insurance coverage into four geographic areas: Southern NV: Clark & Nye counties; Northern NV1: Washoe County; Northern NV2: Carson City, Douglas, Lyon and Storey counties; Rural NV: All other counties.

Enrollment begins Oct. 1 and coverage starts Jan. 1, 2014.

While most of the rates published online are higher than current rates for individuals, the exchange explains ObamaCare premiums may only be based on age, geographic location, family composition, and tobacco use. The law prohibits setting rates based on gender, health history, current health status, and history of being insured. There also are no annual or lifetime limits on expenditures.

“As a result, it is difficult to accurately compare the premiums shown to plans in the Nevada market prior to Jan. 1, 2014,” state officials explain. Additionally, individuals making less than $45,960 a year and families of four with income less than $94,200 are eligible for tax credits to help defray cost.

Asked why rural rates are so much higher than in more urban parts of the state, Jon Hager, executive director of the SSHIX, explained, “Health insurance premiums in rural Nevada have always been higher than those available in the more competitive urban areas. The greater access to health care providers in Southern Nevada creates competition that decreases the overall cost of health care in Las Vegas and the surrounding cities.  The proposed premiums show that this is still the case in the insurance market in 2014 — both on and off of the Exchange.”

Insurance Commissioner Scott Kipper agreed, “Not unlike plans outside of the Exchange, premiums in rural counties will be higher because it is simply more expensive to deliver care in those areas.”

If you choose to forgo health coverage, in 2014 you’ll have to pay a fine (Or is that a tax under the Supreme Court ruling?) of $95 a year or 1 percent of income, which ever is more. It jumps to $325 or 2 percent in 2015 and $695 or 2.5 percent in 2016, still far cheaper than most premiums.

As for smokers, expect to pay 50 percent higher premiums, and that 50 percent penalty cannot be defrayed by tax credits. Apparently there is no penalty for mainlining heroin or snorting cocaine.

Here are a few examples for how residents in those “all other counties” will be affected if purchasing the so-called Silver Plan, which requires the insured to cover 30 percent of costs, under the Anthem HMO:
—A 60-year old Las Vegas resident would pay $580 in premiums, while a resident of Ely or Elko, for example, would pay $1,010.
— A 40-year-old in Southern Nevada would pay $275, compared to $475 in Ely or Elko and $300 to $390 in other counties.
— A 25-year-old rural resident would pay $370, compared to $215 to $306 in more urban counties.

Under the Silver Plan submitted by Nevada Health Co-op HMO:
— A 60-year-old living in Carson City, Douglas, Lyon and Storey counties would pay slightly more than someone of the same age in the rural counties —  $973 compared to $967 — though a Las Vegan would pay only $515.
— A 40-year-old Las Vegan would pay about $250, while those in most other counties would have to pay about $450.
— A 25-year-old in Southern Nevada would pay $190 for coverage, compared to more than $350 in the remainder of the state.

The Gold Plan for both companies has higher premiums but only requires the insured to pay 20 percent out of pocket for health care expenses.

If you go to eHealth.com and plug in an Ely zip code for a 60-year-old male, you find Anthem lists a plan for $361 a month with $1,000 deductible and 30 percent co-pay, which makes the $1,010 under Anthem’s Silver Plan on the exchange 180 percent higher. Other companies had comparable rates, but mandatory ObamaCare coverage is far more generous and covers pre-existing conditions.

Our federal government generously gave our state $75 million of our tax money to set up the exchange. Rates can be viewed at: http://exchange.nv.gov/Resources/Proposed_2014_Rates/

Thomas Mitchell is a longtime Nevada newspaper columnist. You may email thomasmnv@yahoo.com. Read additional musings on his blog at http://4thst8.wordpress.com/.