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How Health Benefits Work

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    How Health Benefits Work

    Frequently Asked Questions

    How you sign up depends on the type of coverage you get:

    You can qualify for Medicaid if your family’s income qualifies, even if your job offers insurance. Also, if you qualify for Medicaid and you can get employer-sponsored coverage, Medicaid may pay the costs of your employer-sponsored coverage for you and your family, if it is determined to be cost-effective for the state of Nevada. Learn more about when Medicaid may pay for your employer-sponsored coverage.

    You cannot get subsidies for buying an individual health plan through Nevada Health Link if your job offers you affordable insurance.

    In most cases, it doesn't matter how you qualify for Medicaid, because the actual medical coverage you get is the same no matter how you qualify. Generally speaking, the big difference is that people with disabilities get extra ways to qualify and, if you have a disability and start working, you can earn more while still getting Medicaid coverage through Health Insurance for Work Advancement (HIWA).

    For Medicaid based on having low to moderate income, the main income rules are:

    1. If your family’s income is at or under 138% of the Federal Poverty Guidelines (FPG) ($1,835 per month or less for a person, $3,795 or less for a family of four), you may qualify.
    2. If you are 18 or younger and your family’s income is at or under 205% of FPG ($5,638 per month for a family of four), you may qualify for Nevada Check Up (NCU).
    3. If you are pregnant and your family’s income is at or under 205% of FPG ($5,638 per month for a family of four), you may qualify. The unborn baby is counted as a family member.

    This way of getting Medicaid, sometimes called "Medicaid expansion," is based on your Modified Adjusted Gross Income (MAGI), which includes most of your earned and unearned income. MAGI doesn't include some types of income, like Supplemental Security Income (SSI) benefits and some contributions to retirement accounts. Learn more about what types of income affect income-based Medicaid eligibility.

    If you have a disability, you may be able to get Medicaid coverage if your income is a lot higher than this, thanks to Health Insurance for Work Advancement (HIWA). Learn more about HIWA.

    Health Coverage Income Limits for Your Family

    It depends on your situation:

    There are different health coverage options as your income goes up:

    The bottom line: There is a coverage option for almost everybody. Do not worry that getting a job will leave you without health coverage.

    To qualify for Health Insurance for Work Advancement (HIWA), you must:

    • Be 16 – 64 years old
    • Live in Nevada
    • Be a U.S. citizen or a qualified immigrant
    • Be working
    • Have a disability that meets Social Security’s medical standards.
      • For HIWA, SSA’s disability rules related to income do not apply.
      • If you don't have a disability determination from Social Security, a disability determination will be done when you apply for HIWA.
    • Have $15,000 or less in resources. Money in an ABLE account, the house you live in, and a car are not counted.
    • Have unearned income of less than $699 a month
    • Have gross earned income of less than 450% of the Federal Poverty Guidelines (FPG) ($5,985 a month), and
    • Have total countable income of less than 250% of FPG ($3,325 a month).
      • HIWA calculates your countable income the same way that SSI does: almost all of your unearned income is counted, but less than half of your earned income is counted. Also, you can subtract the cost of some things you need to work, like transportation, personal care services, work equipment, and medical equipment. Your HIWA countable income may be much lower than you think!
    Your Countable Income:

    To get HIWA coverage, you need to pay a monthly premium. Your premium amount depends on your total countable income.

    Learn more about HIWA.

    Medicare has three main parts:

    • Medicare Part A helps pay for medical care you get while you’re in a hospital.
    • Medicare Part B helps pay for medical care you get outside of a hospital.
    • Medicare Part D helps pay for prescription drugs.

    Medicare Advantage (also called Medicare Part C) is a way to get a single combined plan including Parts A, B, and D through a private company. With Medicare Advantage plans, you may have less flexibility, but your costs could be lower.

    If you or your spouse worked enough time while paying Medicare taxes, you qualify for Medicare Parts A and B:

    • When you turn 65
    • When you’ve been getting Social Security Disability Insurance (SSDI) benefits for two years, or
    • If you have Lou Gehrig’s disease (amyotrophic lateral sclerosis, or ALS) or end-stage kidney disease (ESRD).

    Note: If your disability began before you turned 22 years old and you get Childhood Disability Benefits (CDB) benefits for two years based on a parent’s work record, you start getting Medicare.

    No, Medicare only helps pay for care that it considers reasonable and necessary. If you need a service that Medicare doesn’t cover, you have to pay for it yourself, unless you have other coverage, such as Medicaid, employer-sponsored coverage, or a Medicare supplement (Medigap) policy.

    For certain services, you pay a deductible, copayment, or co-insurance before Medicare begins to help pay for that service. For Medicare Part B or Part D, or for Medicare Advantage, you may have to pay a monthly premium.

    You may qualify to get help paying for your Medicare premiums, copayments, and deductibles if you have low income. Medicare Savings Programs (MSPs), also called Medicare Beneficiaries programs, help pay for Part B coverage and the Low Income Subsidy (LIS) helps pay for Part D coverage. Note: If you don't qualify for an MSP, but do qualify for Medicaid through Supplemental Security Income (SSI) or SSI's 1619(b) rule, you may not have to pay a Part B premium.

    Learn more about getting help paying for Medicare.

    Yes. Other types of coverage that you can have with Medicare include:

    Learn more about how Medicare interacts with other types of coverage.

    The employer may pay all or part of the premium; you'll pay the rest of the premium, plus any copayments, co-insurance, and deductible.

    Employers are supposed to offer plans that cost the employee, for the employee’s policy alone, less than 9.96% of the employee’s family income for the monthly premium. Also, that plan must either be at least at the bronze coverage level or meet the "minimum value" standard (which is about equivalent to a bronze-level plan) for copayment, co-insurance, and deductible expenses.

    If your employer offers a plan that does not meet these standards, you may qualify for government help through tax subsidies to reduce the premium on an individual plan.

    The coverage your employer offers must meet affordability standards for the employee, but not for the family. It may be very expensive for family members to join an employer-sponsored health plan, and they may be better off buying an individual plan on Nevada Health Link.

    Note: Before 2023, the spouse or children of an employee would not qualify for subsidies on Nevada Health Link if the employer offered coverage that was affordable for the employee's policy alone, even if the cost to add the rest of the family wasn't affordable. This was called the "family glitch." Learn more about affordability rules for family members and how it affects eligibility for tax credits on Nevada Health Link.

    Yes, if you are under 26, you can be covered under your parent's insurance plan. Employers who offer coverage to their employees must also offer it to their children under the age of 26.

    Dependent children with disabilities can continue to be covered under their parent’s plan past age 25. To qualify as a dependent child, you must be dependent on your parents for support and your disability must limit your ability to support yourself through work.

    Employers do not have to offer coverage to the spouses of employees.

    Yes—plans cannot deny people coverage. When you apply for insurance, they cannot reject your application and they cannot say that they won’t cover medical needs related to your disability. They also cannot charge you more because you have a disability.

    Depending on your situation, you may qualify to have the government help pay for your individual health plan through tax credits. Here's how it works:

    1. When you sign up at Nevada Health Link, you give details about your family's situation. Nevada Health Link reviews that information instantly. If your family qualifies for government help to pay for individual coverage, Nevada Health Link tells you and lists insurance options for you.
    2. Your insurance options list the full cost of the monthly premium, how much of that premium the government pays each month, and how much you pay each month. The government helps pay for the premium by giving you a tax credit every month, so you don't have to think about it during the year. All you have to do is make sure you keep paying your part of the premium.
    3. In January or February, the government sends you a form listing your total health coverage tax credits for the previous year. You need this form at tax time, because it is possible the government paid more or less than it should have for your health coverage. If so, this is sorted out when you file your taxes.

    No, but depending on your income, you may get more help from the government if you get a silver-level plan:

    Note: From 2021 through 2025, there was no income limit for getting subsidies that help pay individual coverage premiums. However, a 400% of FPG income limit is set to return for 2026. DB101 will be updated if there are any changes.

    When Nevada Health Link looks at your income, they count most of your earned and unearned income. However, some income is not counted, including Supplemental Security Income (SSI) benefits and some contributions to retirement accounts. Learn more about what types of income affect whether you get help paying for individual coverage.

    Health Coverage Income Limits for Your Family

    Usually, when you sign up for a plan through Nevada Health Link, you need to stay on the plan for the entire calendar year. So, if you are signed up for 2026, then you can’t leave that plan until 2027.

    However, in certain situations you may be able to change plans mid-year:

    • If your income changes and you gain or lose eligibility for government help paying for your coverage
    • If you move, or
    • In other life-changing circumstances, such as having a child or getting married.

    The first one is the key. If your income goes down and you can’t afford your plan anymore, report your change in income to Nevada Health Link. You may qualify to get Medicaid or to have the government increase how much it pays for your current insurance (meaning that you have to pay less).

    Note: American Indians do not have these restrictions and can change up to once a month.

    Learn more

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