Nevada Public Option: Premiums, Enrollment, and Legal Fights

The Nevada public option is a state-mandated health insurance program, branded as the Battle Born State Plans, that launched for the 2026 plan year and is sold only through Nevada Health Link. Three insurers offer the plans, which must come in at least one silver and one gold tier, cover all ten essential health benefits required by the Affordable Care Act, and price below standard marketplace plans by set margins. About 10,762 Nevadans had enrolled by mid-January 2026, roughly 10% of marketplace signups.

What You’re Buying

Battle Born State Plans are qualified health plans. That means the same essential coverage categories as any other ACA marketplace plan: hospitalization, prescriptions, maternity, mental health, preventive care, and the rest. Every participating carrier has to offer at least one silver-level and one gold-level plan, and you can only buy them on Nevada Health Link.¹

For 2026, three of the eight insurers on Nevada Health Link offer Battle Born State Plans:

Anthem, under the Community Care Health Plan of Nevada name
SilverSummit Health Plan, sold as Ambetter
Health Plan of Nevada

Those are the same kinds of carriers already running Nevada’s Medicaid managed care, which is not an accident. State law requires any carrier holding a Medicaid or CHIP managed care contract to submit a good-faith bid to offer a Battle Born State Plan. A carrier that refuses becomes ineligible for Medicaid managed care work in Nevada, which is why participation exists at all.²³

How Much Cheaper the Plans Are Supposed to Be

The law sets two separate price mandates. In each zip code, a Battle Born State Plan’s premium has to run at least 5% below a reference premium (the second-lowest-cost silver plan from the previous year, adjusted for medical inflation) through 2029. Statewide, the plans as a group have to average at least 15% below the statewide reference premium over the first four years. Annual increases are capped at the growth rate of the Medicare Economic Index.⁴¹

State officials say the 2026 plans hit the premium targets.⁵ Whether the full 15% average reduction holds up through 2029 is contested. An actuarial analysis submitted by Wakely Consulting Group during the federal waiver comment period concluded a 15% reduction by 2030 was unlikely and projected 13.2% instead, noting that Nevada physician rates are already near 100% of Medicare and leave little room to cut.⁶ For the immediate question of what you pay in 2026, the per-zip-code 5% floor is the number that actually governs the price on your screen.

Networks, Doctors, and Brokers: What to Watch

Lower premiums come from somewhere. In this program, they come partly from provider reimbursement rules and partly from squeezed broker commissions, and both have practical consequences for shoppers.

On the provider side, any doctor or hospital that participates in Medicaid, the state employee health plan, or workers’ compensation must enroll in at least one Battle Born State Plan network and accept new patients on the same terms as other patients. Reimbursement in aggregate has to be comparable to or better than Medicare rates, with specific floors for federally qualified health centers, rural health clinics, and community behavioral health clinics.¹ A provider only has to join one public option network, though, not all of them. Analysts warned during the federal waiver review that this could produce narrower networks than standard marketplace or Medicaid plans.⁶ Before enrolling, check whether your current doctors and preferred hospitals are in the specific plan you’re considering.

Brokers are the other thing to know about. To hit the premium targets, participating carriers cut broker commissions rather than reduce provider payments or administrative costs. Brokers responded accordingly. One agent told The Nevada Independent, “I’m simply not going to offer them… we’re not going to actively represent these plans to our clients.”⁷ If you work with a broker, you may not hear about Battle Born State Plans unless you ask. In January 2026, state marketplace officials told lawmakers they would move to a flat-fee reimbursement for brokers to address the problem, though specific amounts weren’t publicly disclosed.⁸ Regulators have also warned that brokers who steer consumers away from the plans without disclosing their financial interest can lose their Nevada Health Link certification.

Who Can Buy a Battle Born State Plan

Battle Born State Plans are individual-market plans on Nevada Health Link, so the same marketplace eligibility rules apply. If you qualify to shop on the exchange, you can shop these plans. If you don’t, you can’t: this is not a Medicaid expansion or a government-run insurer open to anyone who walks up.

The federal rules shaping marketplace eligibility shifted sharply in 2025 and 2026, and those shifts affect who’s enrolling in the public option. Enhanced federal premium tax credits expired at the end of 2025, sending average Nevada individual market premiums up roughly 26% for 2026 and pulling total marketplace enrollment down 5.5%, from a record 110,000 to about 104,200.⁵ The One Big Beautiful Bill Act, signed in 2025, shortened the open enrollment window, ended automatic reenrollment, added more frequent income verification, and barred lawfully present immigrants, including DACA recipients and people with Temporary Protected Status, from buying marketplace coverage.⁹ An estimated 100,000 Nevadans are expected to lose coverage as a result.⁸ The public option doesn’t address these losses; it exists alongside them.

How Enrollment Is Going

Open enrollment for 2026 coverage began in November 2025. By late December, Battle Born State Plans accounted for 8% to 9% of total Nevada Health Link enrollment, and one in five consumers who actively shopped and selected a plan (rather than auto-renewing an existing one) picked a public option plan.¹⁰ By mid-January, enrollment reached 10,762, about 10% of the roughly 104,200 marketplace enrollees.⁵

State officials called the 10% share a successful first year. Critics pointed to the gap between that figure and the 35,000-person projection state officials had previously offered publicly.⁸

Legal and Political Fights That Could Change the Program

Two things could still move. The first is a court case. In 2024, the National Taxpayers Union and State Senator Robin Titus sued in Nevada’s First Judicial District Court in National Taxpayers Union et al. v. Lombardo et al., arguing SB 420 violated three provisions of the Nevada Constitution: the two-thirds supermajority requirement for revenue-generating bills, the appropriations clause, and the separation of powers.¹¹¹²¹³

The second is political. Republican Governor Joe Lombardo has called the program “political theater” and urged lawmakers to repeal or substantially revise the law. His 2023–25 budget proposal stripped more than $2 million in implementation funding; the Legislature restored it and raised the total to nearly $5 million over two years.¹⁴ The program remains in place, but its administrative framing has shifted toward a “Market Stabilization Program” emphasizing reinsurance for all individual-market carriers alongside the public option mandates themselves.¹⁵

How Nevada Stacks Up Against Other State Public Options

Nevada is the third state to launch a public option, following Washington’s Cascade Select in 2021 and the Colorado Option in 2023. All three use a public-private model, where private carriers run the plans under state rules on pricing, networks, and benefits.

Washington started slowly. Roughly half the state’s counties lacked a public option plan in year one because hospitals refused to participate, and the state later passed a law requiring certain hospitals to contract with at least one public option plan. By 2025, Cascade Select plans held 30% of marketplace enrollment, with about 94,000 customers, and were the lowest-premium silver plans in 31 of 39 counties.¹⁶

Colorado requires every ACA carrier in the state to offer a Colorado Option plan. By 2025, 47% of marketplace customers were in one, growing to about 50% in 2026.¹⁷ Colorado has missed some of its original premium reduction targets, and one analysis found that for unsubsidized enrollees, Colorado Option plans were actually more expensive than alternatives in most cases.¹⁶ That’s a useful warning for Nevada shoppers: run the numbers on your specific situation, including whether you qualify for subsidies, before assuming a public option plan is the cheapest option for you.

1
Nevada Legislature. NRS Chapter 695K – Public Option
2
CMS. Nevada 1332 Waiver Application Addendum
3
Nevada Health Link. Plan Preview PY26
4
NASHP. Nevada Enacts a Public Option
5
The Nevada Independent. Nevada Health Insurance Marketplace Enrollment Dips Nearly 6% but Remained Fairly Steady
6
CMS. Nevada 1332 Federal Public Comments Received
7
The Nevada Independent. Nevada’s New Public Option Health Plans Face a Hurdle: Insurance Brokers
8
NPR. Nevada Public Option Health Plan ACA
9
The Nevada Independent. GOP Bill Biggest Health Care Shakeup Since Obamacare: Here’s What It Means in Nevada
10
Nevada Current. With Health Insurance Premiums Rising, Nevada’s New Public Option Is Proving Popular
11
National Taxpayers Union. National Taxpayers Union v. Lombardo
12
Georgetown Law Litigation Tracker. National Taxpayers Union et al. v. Lombardo
13
Nevada Business. NTU, State Sen. Titus File Appeal in Nevada Health Care Case
14
The Nevada Independent. Despite Lombardo Opposition, Nevada’s Public Option Moves Forward
15
KOLO TV. Lombardo Moves Forward With Changes to Nevada’s Public Option
16
KFF Health News. Nevada Public Option Health Insurance ACA Obamacare Enrollment
17
Becker’s Payer. Where Public Options Stand in 3 States