As open enrollment continues for health insurance, rural Nevadans pay thousands more in premiums each year than their urban counterparts, according to data compiled by the Nevada Department of Insurance (DOI) that allows residents to compare rates.
A 50-year-old Pershing County resident who doesn’t qualify for a federal subsidy would pay a $778 per month premium for a Bronze level health plan, the cheapest and most popular option on the state-based health exchange with the highest deductible.
That same 50-year-old with the same plan would pay $482.42 in Clark County — a difference of $3,557 annually. That’s before co-pays and deductible requirements, which for Bronze plans can be upwards of $7,000, according to KFF, a health policy research organization.
The high cost of premiums for rural Nevadans is a “supply and demand situation where there are fewer providers and hospitals per capita in the rural area” according to the DOI, which regulates rates for individual and small group plans.
But that revenue from those higher premiums is not being transferred to providers, state Sen. Robin Titus (R-Wellington), a family practice physician, said.
“I can assure you, rural providers do not get reimbursed twice the fee for seeing patients,” Titus said, whose district includes Churchill, Douglas, Esmeralda, Lyon, Mineral, and a portion of Nye counties.
Insurance premiums across rural America have historically been more expensive than in urban areas, according to a report by the Urban Institute, a Washington, D.C.–based think tank.
People living in rural areas generally receive more federal subsidies than people living in urban areas, but that only applies to those who make below 250% of the federal poverty line as an individual or $36,450 in Nevada. Nearly three in four people enrolled through the U.S. marketplace receive health care subsidies.
The federal government compares a person’s expected contribution based on their income to the standard premium available in that location, so the discrepancy in subsidies is based on that difference, according to the DOI.
The substantial price difference between rural and urban communities for health insurance premiums is influenced by the older demographics that live there as well as more jobs that don’t offer health employer-sponsored insurance and limited access to providers who can offer low-income or charity-based care, according to a KFF brief in 2014.
The Inflation Reduction Act (IRA) continued to expand eligibility requirements and enhanced marketplace subsidies enacted under the American Rescue Plan Act (ARPA) until 2025 which offset some of these costs in Nevadans get their health insurance through the state-sponsored exchange on Nevada Health Link, which is the only place Nevadans can get federal subsidies.
But even with increased subsidies helping offset the high costs of premiums in rural areas, coverage remains out of reach for many people living with high insurance premiums and older adults with incomes greater than the subsidy cutoff, according to the Urban Institute report.
The state regulates insurance rates based on four geographic areas. Area 1, which includes Clark and Nye counties, frequently has the cheapest insurance premiums regardless of age or insurance plan coverage.
Area 2 comprises Washoe County, and Area 3 is Carson City and Storey, Douglas and Lyon counties. Area 2 and Area 3 have higher premiums than Clark and Nye counties, but lower than the counties in Area 4.
Area 4 represents the bulk of the geographic area and the remaining counties in the state, including Pershing, Humboldt, and Elko counties. In Humboldt County, without any federal subsidies, a 30-year-old would pay $780 for a Bronze level health plan in contrast for residents who are 64 and older, their monthly premium payment would be $1,311.
“The Nevada Division of Insurance has been studying this urban versus rural provider network phenomena through our Network Adequacy Advisory meetings that are conducted throughout the year,” Elizabeth Martins, the PIO for the DOI said in an email to the Current.
The Nevada State Association of Health Underwriters, which represents insurance brokers, agents, and consultants in the state, and the America Health Insurance Plans, a national political advocacy and trade association of health insurance, did not respond to multiple requests for comment on how they price their rates in rural and urban areas.