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The Best Medicaid Health Plans in Nevada

January 1, 2021

If you’re looking to enroll in Nevada Medicaid to access a variety of medical or wellness benefits, then you’ll need to sign for a Medicaid health insurance plan in NV.


Medicaid offers various benefits to eligible Nevada residents including the following, among many more.


  • Inpatient services 
  • Outpatient services
  • Long term care at a nursing home
  • Home health services
  • Lab/X-rays and screening services


But the services are managed and distributed through state-approved health insurance plans known as Managed Care Organizations (MCOs).


In this article, we will discuss how to choose the best MCO for you in Nevada. We will cover all the necessary information to help you understand which Medicaid insurance is a best fit for you, so you can maximize the services and benefits that might be available for you.


Before we delve into the various MCOs, let’s take a quick look at Medicaid eligibility in Nevada, and how to apply if you qualify.


Who qualifies for Medicaid in Nevada?


Medicaid is designed for low-income individuals who would otherwise not be able to afford medical care. 


For that reason there are specific limits to how much you can earn, and the resources you can own, if you want to qualify for Medicaid. 


We’ll briefly discuss the income requirements below, but there are also additional requirements for Medicaid eligibility in Nevada.


  • You have to be a U.S. citizen, permanent resident, or a legal alien
  • You must be a Nevada state resident
  • You must be have a need for medical or long-term care due to an illness or disability
  • Your financial situation must considered low-income or very low-income


In addition to the basic requirements, you must also fall under one of the following categories to qualify for Medicaid in NV.


  • You’re 65 years of age or older
  • You’re the guardian for a child 18 or younger
  • You’re pregnant
  • You’ve been certified blind
  • Either you or someone in your family need help with daily living tasks due to an ongoing disability.

Income limits for Nevada Medicaid


As a single individual, your annual pre-tax income can’t exceed $16,971. For couples, the amount is $22,930. 


The income limits are tied to the federal poverty level (FPL). Typically, your income has to be under 138 percent of the FPL. So, the limits may change in the future if the FPL is revised.


For the most up-to-date information, be sure to check Benefits.gov. The American Council on Aging also provides detailed information about income and assets for Nevada Medicaid.


You can also check out our article on Nevada Medicaid enrollment for more details on income and asset requirements. 

How to apply for Medicaid in Nevada?


There are three primary steps to applying for Medicaid in Nevada.


  1. Verifying your eligibility
  2. Picking the right MCO/health plan
  3. Filling out the application


Let’s look at each step in further detail.

Step1: Make sure you’re eligible for NV Medicaid


You can get a general idea about if you’re eligible for Medicaid from the requirements listed above. 


But to be sure about your qualification, you need to go through this pre-screening tool from Nevada Division of Welfare and Support Services (DWSS).


The DWSS is the state agency that handles the Medicaid applications and approval process. So, by completing their eligibility questionnaire, you’ll know about your eligibility with a greater degree of certainty.


The pre-screening tool will ask you some basic questions about your household, income, disability, current access to insurance, etc.


It’s a quick process and you will see your results right away. 


If you have trouble with the online tool, you can call DWSS directly at 1-800-992-0900 (choose option 1).


If you’d rather ask questions in person, you can visit your local DWSS office.

Step 2: Pick the Medicaid plan that best suits you


Once you’ve confirmed your eligibility, the next step is to pick an insurance plan that best suits you. 


As we mentioned previously, in the state of Nevada, Medicaid benefits are delivered and distributed through state-approved insurance plans known as Managed Care Organizations (MCOs).


Let’s say you need to visit the doctor for a check-up, screening, or an X-ray. Or perhaps you need to visit the pharmacy to fill your prescription.


You’d visit a doctor or pharmacy within your state-approved MCOs network. They’d provide you the necessary services, and for the most part, you wouldn’t pay anything out-of-pocket if you have Medicaid.


The service provider gets paid through the MCO, and the MCO gets reimbursed from the state.


But depending on your specific needs, location, and other factors, specific MCOs might be better for you than others.


And below, we’ll cover each Nevada Medicaid plan in detail to help you understand which plan is right for you.


But before, let’s quickly cover how to apply for Medicaid in Nevada, which is the next step.



Step 3: Fill out the application


Remember to do the research and pick your ideal provider before coming back to this step. When filling out the form, you’ll be asked about your preferred Medicaid plan.

Online


Create an account with DWSS and complete the online application

By Mail


Download the paper application. Fill it out and mail it to the address on the form.


As you’ll see, the application is quite long, and you may feel like you need help. 


You can contact the DWSS with any questions and they’ll help you complete the application. Also, you can ask them about any supporting documents that you might need to send in.


Otherwise, if you’ve already picked a Medicaid plan, you can call them as well. They’ll be willing to help you as it is also in their best interest to get you approved as quickly as possible.

In person


Similar to the mail option, complete the paper application. Then bring it to your local DWSS office for submission. 

Which health insurance company is the best for Medicaid recipients in Nevada?


In this section, we’ll cover the three Nevada MCOs in detail so you can get a better understanding of which plan would suit you best.


Before we talk about each plan separately, we should note that regardless of which MCO you choose, you will be able to access the basic Medicaid benefits.


There are some services that Medicaid health plans must cover in each state, according to federal law.


The basic benefits include a wide range of medical and wellness services, including the following.


  • Hospital stays, surgeries (inpatient services)
  • Doctor’s visits, routine exams, minor procedures (outpatient services)
  • Laboratory services, X-rays, screenings like mammograms, etc.
  • Pharmacy benefits
  • Home health care due to disability or illness
  • Nursing home stays
  • Family planning services


For a full list of basic Medicaid services, please visit Medicaid.gov


But beyond the basic services, there are additional benefits that might be covered by Nevada Medicaid plans, or the MCOs. 


Let’s take a look at each MCO and discuss their additional coverage features.


Each MCO listed below will cover the following, in addition to the basic Medicaid services listed above:


  • Medical benefits
  • Obstetrical provider access (for pregnancy)
  • Additional value-added benefits
  • Pharmacy benefits (with home delivery)
  • Urgent Care access
  • Mental health services

1. Anthem Blue Cross and Blue Shield


Website: https://mss.anthem.com/nevada-medicaid/home.html 


Telephone: (844) 396-2329


Medical services covered


For a full list of benefits from Anthem, visit their website, or this comparison chart from the Nevada Department of Health and Human Services. 


If you sign up with Anthem, here are some of the key benefits you’ll receive. 


  • Unlimited visits and consultation with your primary care physicians (PCP)
  • The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) for children under 21
  • Childhood immunizations
  • Emergency care including transportation
  • Circumcision services
  • Physical therapy
  • Occupational therapy
  • Speech therapy
  • Medical equipment
  • Chronic disease management and education

Additional benefits


  • Free yearly eye exams
  • Medically necessary contacts or glasses
  • CareMore Care Centers - personalized care from doctors to help manage chronic illness
  • Nutrition therapy for medical reasons
  • Diabetic care and education
  • Podiatry services
  • Weight-loss surgery
  • Help quitting smoking
  • Transgender health services
  • Peak flow meter for asthma management


Value-added benefits


  • One free Costco Gold membership per household
  • Free Boys & Girls Club memberships for children
  • Free phone with 350 minutes, data, and text included each month
  • Electric breast pump
  • Books for Babies program
  • Adult dental hygiene kit





Pregnancy benefits


  • Large network of OB-GYN
  • Option to get care from out-of-network OB-GYN in third trimester 
  • Nurse case managers to support optimal pregnancy
  • New baby education program
  • Financial rewards for regular doctor’s visits during pregnancy
  • Financial incentives for remaining tobacco free during pregnancy


Areas covered


Look for Anthem providers in your area.

Co pays


There are no co-pays for covered services.

Customer Service


  • Available both in English and Spanish
  • 24/7 access to a NurseLine
  • LiveHealth Online - online doctor’s visits any time day or night
  • Helpful member handbook to better understand and make use of benefits

Who is Anthem best for


Anthem is a great option for all Nevada Medicaid beneficiaries, but it can be especially helpful for those living with a chronic illness like diabetes, because of their CareMore Care Centers feature.


According to some discussions on online forums, Anthem could also be a great option for those living in and around Las Vegas.

2. Health Plan of Nevada (HPN)


Website: https://myhpnmedicaid.com/Member 


Telephone: (800) 962-8074


Medical services covered


For a full list of benefits from HPN, visit their website, or this comparison chart from the Nevada Department of Health and Human Services. 


If you sign up with HPN, here are some of the key benefits you’ll receive. 


  • Unlimited primary care physician (PCP) visits
  • Wellness screening for children (EPSDT)
  • Immunizations/shots
  • Personal care services (help with daily activities for disabled individuals)
  • Physical therapy
  • Occupational therapy
  • Speech therapy
  • Medical equipment


Additional benefits


  • Mobile medical center with two exam rooms
  • Medically required glasses and lenses
  • Yearly sports physical for children
  • Maternity care and breast pumps
  • ABA services for autism
  • Medications and counseling to help quit smoking
  • Diabetes management
  • Peak flow meter for asthma
  • Weight loss surgery
  • Environmental assessments


Value-added benefits


  • VISA gift cards for wellness services
  • VISA gift card to promote healthy pregnancy
  • Breast pumps
  • Transportation and housing assistance (help moving from hospital to home)
  • Test prep
  • ID card assistance
  • Free cell phone with data



Pregnancy benefits


  • Large network of OB-GYN
  • Option to get care from out-of-network OB-GYN in third trimester 
  • Nurse case manager during pregnancy 
  • Breastfeeding counselling and assistance


Clinical coordinators and Community health workers (CHW) provides help with the following:


  • Food
  • Jobs
  • Clothing 
  • Transportation
  • Housing assistance


Areas covered


Look for HPN providers in your area.

Co pays


According to HPN’s coverage and benefits page, you receive all covered services at no extra cost to you.

Customer Service


  • 24/7 virtual visits using NowClinic
  • Helpful member handbook

Who is HPN best for


HPN is another great option for most Nevada residents, and also popular with those living in the Las Vegas area.


HPN provides additional support and assistance to pregnant women through gift cards, maternity care and community health workers. There’s also a pregnancy and new baby support mobile app. 


The plan also covers personal care services and transportation services to those with disabilities.


So, HPN could be a good option for pregnant women or those living with disabilities. 

3. SilverSummit Health Plan


Website: https://www.silversummithealthplan.com/members/medicaid.html 


Telephone: (844) 366-2880


Medical services covered


For a full list of benefits from SilverSummit, visit their website, or this comparison chart from the Nevada Department of Health and Human Services. 


If you sign up with HPN, here are some of the key benefits you’ll receive. 


  • Unlimited visits to PCP
  • Preventative eye exams
  • Medically required contacts and glasses
  • Hearing tests
  • Immunizations
  • Occupational Therapy 
  • Physical Therapy 
  • Orthotics
  • Prosthetics
  • Native American Access to Care


Additional benefits


  • Chiropractic services for children under 21
  •  Durable Medical Equipment
  •  Maternity Care
  •  Midwife Services
  •  Private Duty Nursing


Value-added benefits


  • Earn up to $765 in VISA gift cards for wellness and preventative visits, immunizations, and more
  • Amazon Prime membership with Alexa-enabled Amazon Echo for qualified diabetics
  • Dental benefits for qualified beneficiaries
  • Annual baby showers including
  • Baby necessities
  • Immunizations
  • Parenting education and resources



Pregnancy benefits


Start Smart For Your Baby Program


  • Educational material from a personalized case manager
  • Prenatal screenings
  • Postpartum follow-up,
  • Breastfeeding support
  • Free breast pump


Additional pregnancy resources:


  • Large network of OB-GYN
  • Option to get care from out-of-network OB-GYN in third trimester 



Areas covered


Look for SilverSummit providers in your area.

Co pays


There are no co-pays for covered services.

Customer Service


  • 24/7 Nurse Advice Line

Who is SilverSummit best for


SilverSummit might be ideal for those looking to maximize wellness. They heavily incentivize a healthy lifestyle and preventative measures. It is also a great plan for pregnant women because of the additional services like Start Smart, annual baby showers, and more.


Which is the best Nevada MCO?


Since all the MCOs are state-approved, they have to maintain a certain level of service and standard to maintain their approved MCO status.


So, regardless of which one you choose, you can expect high quality service.


What it comes down to then, is how easily you can access their services based on their networks. In other words, look for service providers (doctors, nurses, hospitals, pharmacies) in your area, or ones that you want to visit, and find out if they are covered under an MCO.


You can use the links listed above to find providers under each plan.


The other things to consider can be the additional medical services and perks offered by each MCO, and to see if any of those benefits meet a specific need for you or your family members.


What about Dental?


Dental coverage through Medicaid is relatively straightforward in Nevada.


Regardless of which MCO you choose (Anthem, HPN, or SilverSummit) you will automatically get enrolled with a Dental Benefit Administration (DBA).


Currently, all Medicaid dental benefits in Nevada are managed by Liberty Dental Plan.


You can go to Liberty’s website, or call them at (866) 609-0418 to find a dentist/service provider within the network.


But only children under 21 are fully covered for dental through Medicaid in Nevada. 


If you’re under 21 (or have a child under 21), and have Medicaid, here are the benefits available to you.


  • Regular dental checkups
  • Cleanings and X-rays
  • Root canals, crowns, and dentures
  • Space maintainers
  • Extractions
  • Anesthesia
  • Sealants, fluoride treatments, fillings
  • Dental emergencies


For Medicaid-eligible adults above 21, Medicaid only covers emergency dental exams and procedures. If you’re a pregnant woman above 21, there are some expanded dental benefits covered as well.


But you can avail more comprehensive coverage through Liberty Dental Plan through optional services.


For more detailed information about dental coverage, call Liberty at (866) 609-0418, or check out the dental benefits chart.


Final thoughts on Nevada Medicaid plans


Hopefully by now you have a better idea about the different Medicaid plans in Nevada, and also about how the application process works.


Just to recap, here’s what we recommend you do.


Look through the requirement criteria we’ve listed to get a general idea about your eligibility.


If you think you may qualify, go through the DWSS pre-screening tool to verify your eligibility.


The next step would be to carefully consider your needs, location, and other factors to determine which is the best Medicaid plan for you in Nevada. Look through all the factors that we’ve listed, but also feel free to contact the providers directly with any questions.


Finally, it’s time to apply. You can apply by mail, online, or in-person. Simply follow the links and instructions above, or contact your preferred provider for further assistance.