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An Easy to Understand Guide to Nevada Medicaid Enrollment

December 17, 2020

Nevada Medicaid is a joint program run in coordination by the federal government and the state government.


It is designed to provide access to healthcare to people who are low-income and would not be able to afford medical care otherwise. Medicaid can help you pay for doctor’s visits, hospital expenses, medical equipment, and home health care, among many other services.


In this article, we will cover all you need to know about enrolling in Medicaid in Nevada.


We will discuss what Medicaid covers, how you can qualify, how to apply, and answer some of the most common questions on Nevada Medicaid.


What does Medicaid cover for adults in Nevada?


First, let’s take a look at the different benefits that you can expect to receive if you qualify for Medicaid in Nevada (eligibility details below). 


Basic Medicaid services


The following are the basic services that Medicaid covers regardless of what state you live in, as required by federal law.


Inpatient services - Covers hospital stays, surgeries, or any other serious illness or condition that requires prolonged care in a medical facility.


Outpatient services - Routine exams, consultations with your doctor, small procedures like stitches, anything that does not require prolonged care.


EPSDT for children under 21 - The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) is a Medicaid feature that covers full preventative services for those under 21 who are enrolled in Medicaid.


Nursing home - If you have to live in a nursing home because you require long term care due to a disability, your expenses could be covered by Medicaid. 


Home health care - Alternatively, if you’re uncomfortable with the idea of living in a nursing home, and would rather receive care at home, Medicaid covers home health care programs.


Laboratory and X-ray services - Medicaid will cover your lab tests and X-ray expenses.


Quitting tobacco during pregnancy - Counseling is provided for pregnant women who might need help quitting smoking.


Family planning services - Family planning is included in the mandatory coverage by federal law. You will get prescription contraceptives, as well as education to promote healthy family planning. You can also get tests (and treatments if needed) for sexually transmitted diseases. 


Preconception services - Also falling under the family planning umbrella, Medicaid covers services before conception, such as screening for mental illness, obesity, smoking, all issues that could negatively affect a pregnancy. 


These are only some of the basic services that must be covered by each state. For a full list, please visit Medicaid.gov


Another thing to note is that if you’re enrolled in Medicaid, and you want to avail benefits, you have to visit a medical service provider within the Medicaid network. 


Your Medicaid plan provider will have all the necessary details. We will mention some of the best Nevada Medicaid plans below.

Additional Nevada Medicaid services 


In addition to the basic Medicaid services, you will also get additional services in Nevada, depending on the insurance provider. 


Quick note on the insurance providers - as you most likely already know, Medicaid benefits and managed and coordinated by state-approved insurance plans. Medicaid covers the premium, as long as you’re eligible.


When shopping for a plan, you should check all the benefits in detail to learn exactly what your benefits would be. You should pick a plan that provides the most benefits related to services that would benefit you specifically.


If you go with one of the better Medicaid plans in Nevada (listed below), here are some additional benefits you can expect.


Vision care


Under certain plans, you will receive basic vision care once a year. 


Usually, the care has to be medically necessary. For example, it has to be something like you need new glasses due to a change in your vision. 


Your plan would typically cover things like annual eye exams and prescription eyewear, or even credits/rewards towards contact lenses, etc.


Pharmacy benefits


Your provider will have all the details about the pharmacy and prescription drugs coverage. But here’s what you can generally expect your Medicaid plans to cover.


  • Over-the-counter medications (some plans include additional credits for OTC medications)
  • Medications to help you quit smoking
  • Medication prescribed by your doctor
  • Ability to use major pharmacies like CVS, Wal-Mart, Safeway, etc.


24/7 Access to Nurses


One of the major benefits of a Medicaid plan in Nevada is that it might cover 24/7 access to a nurse.


Your provider may provide a hotline number that you can call anytime during the day or night if you need to speak with a nurse.


Some plans also allow you to schedule video chats with doctors in your plan’s network. 


Pregnancy/new baby benefits


Some Medicaid plans will provide you incentives to visit the doctor before and after your baby is born. 


They might provide a cash reward for a prenatal visit, or for a visit within a certain period after the baby is born.


The point of these programs is to encourage you to visit the doctor to make sure that both the mother and the baby remain in good health.


Transportation benefits


Depending on availability, your provider might be able to help you with transportation to and from doctor’s visits, or other qualified medical services.


Behavioral health


Many people struggle with behavioral health during stressful times. Whether it’s mood disorders like anxiety and depression, or alcohol and drug abuse. 


Medicaid plans in Nevada often provide access to therapists and counselors to assist with your behavioral health needs. 


These treatments would be private and you wouldn’t need a referral from your primary care doctor. 

Additional health and wellness benefits


Depending on your plan, you might get additional benefits and incentives to maintain a healthy lifestyle.


Here are only a few examples.


  • Health education classes.
  • Disease management for ongoing conditions like asthma, diabetes, heart health conditions, HIV, and more.
  • Additional rewards for healthy habits like regular check-ups, screenings, mammograms, etc.
  • Memberships to gyms, groups, and weight management programs.


Does Nevada Medicaid cover dental?


Nevada Medicaid only covers care for children up to the age of 21. If your child is under 21, then he or she will get both preventative care and treatment for their teeth. 


For beneficiaries above 21, Nevada Medicaid only covers emergency dental exams and procedures. 


As always, you  should check with your provider to see if they offer more comprehensive dental care on top of Medicaid for an additional fee.

Who qualifies for Medicaid in Nevada? 


As we mentioned before, Medicaid is designed for low-income individuals who would otherwise not be able to afford healthcare in Nevada.


For that reason, there are specific limitations on your income and the assets that you can own, if you want to be eligible for Medicaid. 


We will discuss the income requirements further below, but first, here are some additional requirements for eligibility.


  • You must be a resident in the state of Nevada
  • You must be a U.S. citizen, national, permanent resident, or a legal alien
  • You must be in need of medical care or insurance assistance
  • Your financial situation must be low-income or very low-income (see below)


Additionally, you must fall into one of the following categories to be eligible in Nevada.


  • You’re pregnant
  • You’re responsible for a child 18 years of age or younger
  • You’re 65 years of age or older
  • You (or a family member) have a disability and need help with daily living activities
  • You’re certified blind

What are the income requirements for Nevada Medicaid?


If you qualify for Medicaid according to the requirements mentioned above, then you must meet Medicaid’s definition of low-income or very low-income to be eligible.


We’ll list the income requirements here, but these are current at the time of writing (2020). 


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 income requirement to qualify for Medicaid will depend on the number of people in your household.



Number of people in your household

Maximum annual income (pre-tax)

1

$16,971

2

$22,930

3

$28,888

4

$34,846

5

$40,805



What if I make more than the income limit?


If you make more than the income limits listed above, then you might be able to spend down your excess income on qualified medical expenses.


If you spend your excess income on doctor’s visits, prescription drugs, etc., then you can count those amounts off from your income, bringing the total down, and possibly making you eligible for Medicaid.


The same goes for assets.


You can own some assets, and some others, like your car and home, are exempt from being counted. But if you own more than a certain amount in assets, it could make you ineligible for Medicaid. 


You can also spend down your assets to become eligible for Medicaid. 


But spending down your assets to qualify for Medicaid is a significant financial decision. You should consult with a financial advisor and senior law attorney in Nevada, if you want to explore your options. 

How to apply for Medicaid in Nevada?


If you think you’re eligible for Medicaid based on the criteria listed above, the next step is to get the enrollment process started so you can start receiving benefits as quickly as possible.


Verify eligibility


The first thing you should do is double-check your eligibility with this pre-screening tool from Nevada Medicaid. 


Medicaid applications are handled by the Nevada Division of Welfare and Support Services (DWSS).


You can also call your DWSS to ask questions about your eligibility. 


The number is 1-800-992-0900 (choose option 1)


Otherwise, you can visit a local DWSS office in person. 


Once you have your questions answered, you can fill out the application for Medicaid. 


Note that in the application, you will be asked to choose a plan. In the section below, we’ve listed some of the best Medicaid plans in Nevada. 


Be sure to contact each of them to discuss the benefits in detail to see which one is the best fit for you.


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. 

In person


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

Which Medicaid plan is best in Nevada?


Here are the best Medicaid plans in Nevada. 


These are also known as Managed Care Organizations (MCOs). 


They manage and coordinate your Medicaid benefits, and get reimbursed for their premiums from the Medicaid administration.


These following organizations are the contracted MCOs for Nevada Medicaid.


1. Anthem Blue Cross


Telephone: (702) 228-1308

Email: nv1-providerservices@anthem.com


2. Health Plan of Nevada


Telephone: (702) 242-7088


3. SilverSummit Health Plans


Telephone: (844) 366-2880

Email: NetworkManagement@SilverSummitHealthPlan.com


How long does it take to get Medicaid in Nevada?


States are required to respond to Medicaid applications within 45 days. If your application involves Medicaid for disability, then it might take up to 90 days.


The good news is that if you are approved, then you can retroactively get Medicaid for three months prior to the time you applied, assuming you were eligible the entire time.

Is there a way to speed up the process?


Make sure you submit all the necessary documents, and fill out the application completely and correctly, when you submit the first time.


If DWSS receives complete and thorough information for you, then their job becomes easier, and it is more likely that your approval process may speed up.


Helpful Nevada Medicaid resources


Nevada Medicaid Brochure


Detailed information on asset limits for Medicaid


Access Nevada Benefits


Nevada Aging and Disability Resources Center