Rising insurance costs complicate Nevada marketplace's open enrollment effort

Every year since she's been able to, Jen Gurecki has signed up for health insurance through Nevada's Affordable Care Act marketplace.

Gurecki, 48, a small ski and snowboard manufacturer based in Reno and the founder of a nonprofit providing microloans to women in Kenya, does not have the capacity to provide insurance through her own businesses.

As one of more than 110,000 Nevadans who enroll in health coverage offered on Nevada Health Link, enhanced income-based subsidies created during COVID and extended under the Biden administration have kept her insurance premiums affordable, Gurecki said. But with portions of the subsidies set to expire at the end of the year and overall insurance prices projected to rise, Gurecki is now worried.

"Most people in this country are looking at continued rising costs of just everyday life," Gurecki said. "I don't know where I'm supposed to get the money to pay [for insurance] because I can't work more. I already work all the time."

Fears about increased insurance costs have made national headlines as disagreements about the expiring subsidies culminated in a government shutdown Wednesday.

Meanwhile, as the state's open enrollment period is set to begin Nov. 1, Nevada officials are pushing hard to continue recent momentum — records show that the number of Nevadans who enrolled in plans through the Nevada Health Link marketplace grew by 11.5 percent from 2024 to 2025. But brokers and clients say they are concerned that the loss of enhanced subsidies will drive costs even higher and deter some Nevadans from purchasing plans for 2026. Last year, nearly 95,000 Nevadans, or approximately 86 percent of people enrolled through the state marketplace, received enhanced subsidies. Insurance is vital for Gurecki, who said that access to preventative care is how she found out that she had stage 2 breast cancer in July after a routine MRI.

'Everything is more expensive right now'

The so-called window shopping period for insurance on the marketplace opened Oct. 1, giving Gurecki and other consumers a month to familiarize themselves with new plan offerings and costs before they may begin purchasing them Nov. 1. Enrollment closes two and a half months later, on Jan. 15, 2026. To ensure coverage by the start of the new year, however, state officials said buyers need to sign up for insurance by Dec. 31.

After Jan. 15, open enrollment will close. Getting access to coverage offered through the exchange will then require residents to demonstrate a qualifying life event, such as a marriage, birth or loss of health insurance.

The majority of enrollees are people who do not have access to employer-sponsored insurance coverage but do not qualify for Medicaid or Medicare benefits, said Janel Davis, executive officer at Nevada Health Link. Davis said that this group includes Nevadans who may be self-employed, owners of a small business or those reliant on contract-based work.

This year, the enrollment period includes a brand-new offer for Nevadans: the Battle Born State Plans (BBSP), a public option that provides equivalent health care as other Affordable Care Act (ACA) plans, but aims to limit premium increases. When the Biden administration approved the BBSP plans in January, Senate Majority Leader Nicole Cannizzaro (D-Las Vegas), who sponsored the legislation to establish the public option, touted it as a potential solution to the health insurance affordability crisis.

The plans arrive as health insurance costs are rising across the country and enhanced ACA subsidies (in the form of tax credits) are set to sunset at the end of the year. The enhanced subsidies increased financial assistance for existing marketplace enrollees and expanded eligibility for tax credits to middle-income earners (those making more than 400 percent of federal poverty levels, which for a family of four translates to an annual household income of nearly $130,000).

The expiration of those subsidies could further raise the cost of premiums that are already slated to increase this year. Rates submitted by health insurers in September indicate that premiums for the individual market — which includes the Nevada Health Link marketplace and all non-employer health insurance coverage — will increase by an average of 26 percent, or $147 each month.

State officials did not provide the projected average cost of insurance on the marketplace for the upcoming year because of individual factors that contribute to monthly premium costs. They noted, however, that Nevada Health Link officials are operating under the assumption that the enhanced ACA subsidies will not be renewed before the end of the year. State estimates released to insurance brokers in July indicate that the expiration will lead to an average increase of $76 in monthly premiums for Nevadans who received the subsidies.

Davis cautioned that marketplace insurance prices vary based on individual circumstances such as income, ZIP code and household size, making it difficult to generalize how much more consumers should expect to pay. Nevada Health Link's website offers individuals the option to project estimated costs.

"Everything is more expensive right now," Davis said, acknowledging the rising costs.

Still, she and other Nevada Health Link officials emphasized that the biggest costs could come from not having health insurance.

"It will be more expensive and more costly if you don't have health insurance," Davis said.

All of the plans offered through the exchange fulfill the 10 health benefits that the ACA outlines as critical to one's well-being, including access to emergency services, prescription drugs and preventative care.

Nevada Health Link also provides free enrollment assistance in multiple languages and partners with a network of more than 700 brokers.

At a Thursday open enrollment-focused event, insurance brokers and agents told The Nevada Independent that clients are feeling uncertain about their ability to afford price hikes.

Multiple brokers said they fear that rising rates will cause young, healthy individuals who aren't worried about getting sick to opt out of insurance altogether. Individuals with pre-existing medical conditions, they explained, are more likely to keep their coverage even as costs increase.

"[The insurance community is] really, really afraid," said Melody Mojica, a broker. "And not for ourselves but for our clients, because we know there's going to be a huge drop off in clients that are scared about [not having] health insurance but more scared about [protecting] their own pockets."

Mojica said that she shows clients the value of coverage by focusing on "worst-case scenarios," stressing that insurance will save them thousands of dollars in the case of unexpected emergencies.

Along with the rising costs, there's confusion about what the loss of enhanced subsidies mean.

"We have gotten clients calling saying, is there still Obamacare next year?" said Joy Avendano with the Asian Community Development Council, which receives funding from the state to educate Nevadans on their health care options.

In those instances, Avendano said she reassures clients that the ACA is still in effect and subsidies still exist, even though the expiration of certain subsidies is likely to drive up prices.

Though state officials said that the marketplace offers a variety of cost-saving options to consumers, they acknowledged that the loss of enhanced subsidies will further increase prices.

"I think that there are concerns across the board with the expiration of the premium tax credits," Davis said.

She stressed that the enhanced subsidies had only been in place since the pandemic and that subsidies still remain for many consumers enrolled through the marketplace.