Despite widespread fears that rising health insurance costs and expiring federal subsidies could lead to a significant drop in insurance enrollment through Nevada’s Affordable Care Act (ACA) marketplace, state officials say enrollments have actually “remained fairly steady” and only slightly declined.

Following the end of the state’s open enrollment period, which ran from Nov. 1, 2025-Jan. 15, more than 104,200 Nevadans enrolled through the Nevada Health Link marketplace — about a 5.5 percent drop from the previous year.

“That’s a pretty minimal decrease when you look at the big picture of things,” said Janel Davis, executive officer of Nevada Health Link, noting that enrollment has continually crept up since Nevada Health Link started operating in 2013 and became a fully state-based marketplace by 2019. “These plans are still really important, because going without coverage is where it’s problematic.”

In 2025, the state hit record enrollment in the marketplace with more than 110,000 Nevadans enrolled in plans, a growth of 11.5 percent from 2024. About 10 percent of enrollments this year are for the new public option plans referred to as Battle Born State Plans.

Though some state-based marketplaces have open enrollment periods that run through the end of the month, early reports indicate record-high disenrollment rates in certain states, with many of those who disenrolled expected to become uninsured. An analysis from the State Marketplace Network shows that cancellations have increased by 83 percent in Colorado compared to last year, 49 percent in Maryland and 47 percent in Minnesota. Additionally, the report flagged significant reductions in enrollment for states such as California, where enrollments are down 31 percent compared to this time last year.

The State Marketplace Network also noted in the report that state-based marketplace consumers are tending to purchase insurance plans with lower premiums but higher out-of-pocket costs. Enrollment fluctuations are standard throughout the year as individuals’ circumstances change, but the report indicates more people than usual are expected to drop off marketplace plans as bills arrive.

Fears about insurance marketplace enrollment declines arrived late last year as health care costs rose and enhanced subsidies expired at the end of 2025 with little desire by the Republican-controlled Congress and Senate to renew them.

The enhanced subsidies in the form of tax credits 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 at that time for a family of four translated to an annual household income of nearly $130,000).

Concerns about the loss of the subsidies leading to steep premium hikes and doubling costs for enrollees led to the longest federal shutdown in American history as Democrats sought to maintain the funding. The enhanced subsidies ultimately expired, with preliminary data showing average premiums for marketplace plans across the country were double what they were in 2025.

Davis explained that though the subsidies have sunsetted, others are still available.

Estimates indicate at least 8 in 10 enrollees on Nevada Health Link are still receiving some form of subsidy.

Maintaining a high health insurance rate is critical for community health, Davis said, adding that insurance encourages more preventative care, prioritization of health and better outcomes. It’s especially notable in Nevada, where the state’s current uninsured rate of between 10 percent to 12 percent is nearly half of what it was before Nevada implemented Medicaid expansion under the Affordable Care Act.

Davis highlighted that of Nevadans who enrolled in comprehensive health coverage, there was a 32 percent increase from the previous year in active enrollment, or those who evaluated and compared the options available to them on the marketplace when selecting a plan.

Those who actively shopped and changed their plans to something more affordable, Davis said, saved an average of more than $280 a month on their premiums. 

But as the first bills for coverage are expected to land in February with the potential for sticker shock, Davis and others are remaining watchful for further enrollment drops. 

“In the next few months, we’re all kind of on pins and needles to see what happens. I think all of the exchanges are feeling that throughout the nation,” Davis said. “There is a natural attrition that always occurs around this time … with the increases in cost, I think that we expect to see some drop off.”

The new public option plans

Nevada’s new public option plans, referred to as Battle Born State Plans, accounted for 10,762 enrollments or 10 percent of the total enrollments in Nevada’s Affordable Care Act marketplace. The plans are the culmination of legislation passed in 2021 building on the Affordable Care Act by establishing a health insurance plan that covers all ACA-required essential benefits, is required to meet premium reduction targets and is available on the state’s marketplace. 

So far, legal challenges of the plans have not been successful, but a case is pending appeal in state Supreme Court. Nevada is the third state to adopt a public option, after Colorado and Washington.

Though approximately 35,000 people were initially projected to purchase the plans, Nevada Health Authority Director Stacie Weeks said the projections were done more than a year ago, with old data and were a broad estimate that officials knew was likely to fluctuate.

She explained that officials were not projecting the inflation costs and were not expecting a 26 percent average increase in costs across the individual market in 2026 — which includes the Nevada Health Link marketplace and all non-employer health insurance coverage.

Given the changing market factors, Weeks said she considers 10 percent enrollment for the first-time program a success. She added that the public option plans met the state’s premium reduction target to lower costs for consumers and came as the governor also established a reinsurance program that is helping offset market challenges.

“Bringing two very different ideas together to really be beneficial is a unique win that Nevada has,” Weeks said.

Jennifer Krupp, the administrator for the health authority’s consumer health services division, added that new signups for the Battle Born State Plans were from those who actively looked at plan options and were competing with auto-renewals of other exchange plans.

“The 10 percent of consumers who have signed up for coverage through the Battle Born State Plans are even more exciting for us,” Krupp said. “These are consumers who actively chose those plans, they are likely to stay insured, they know what their plan coverage is.”

What’s next

Though the open enrollment period is closed for 2026, Davis said people are still likely to be shopping the marketplace. Individuals who experience a qualifying life event, such as losing health insurance, getting married or having a child may likely qualify for a special enrollment period that can allow for them to get health insurance through the exchange.

If a qualifying life event takes place, she emphasized that there are insurance brokers and navigators available at no cost to help those assessing new coverage options.

About 70 percent of all enrollments during the most recent open enrollment period were assisted by a Nevada Health Link certified broker or navigator, who offer free in-person and virtual support.