There is currently a Nevada Medicaid transition happening across the state. For decades, rural Nevadans on Medicaid could simply show their state ID card to see a doctor. However, starting on January 1, 2026, your ID won’t be enough. You must now be enrolled in a private insurance plan — also called “Managed Care.” If you’re currently on Medicaid and live in a rural county, here’s what you need to know to prepare for the rural Nevada Medicaid transition.
What Is the Nevada Medicaid Transition?
The Nevada Medicaid system is changing from a fee-for-service system to a managed care system. That means anyone on Medicaid won’t be able to simply show their state ID to get care. Instead, they must be enrolled in a private insurance plan.
This change is set to take effect on January 1, 2026. However, there is a 90-day grace period (January 1 – March 31, 2026) to switch plans if you don’t like the one assigned to you by the state.
Who Is Affected?
Currently, there are around 75,000 residents in rural Nevada counties — like Nye, Elko, Lyon, Douglas, and Carson City — who depend on Medicare for their healthcare needs. Most of whom will be affected by the Nevada Medicaid transition and have to switch to a private insurance plan starting next year.
Exemptions to the Nevada Medicaid transition include:
- Seniors (65+)
- Foster children
- Individuals on Disability (SSI) or Waiver programs
Unless you fall into one of these categories, you’ll need to enroll in a private healthcare insurance plan beginning in 2026.
If you have not chosen a plan by December 26, 2025, the state will automatically enroll you in one of the available private carrier options.
The Nevada Medicare transition also creates something called the “split family” complication. Because Medicaid income limits are higher for children (CHIP) than for adults, it could mean the children still qualify for Medicaid, while the adults may earn too much to qualify for Medicaid, forcing them to find a plan on the Exchange. Your family will then have two different insurance carriers on two different networks.
If you fall into this situation, make sure your family doctor accepts both the adults’ Exchange plan AND the kids’ new Medicaid Managed Care plan — and if not, start looking for a new doctor who does.
Private Carrier Options for Rural Nevadans
While there are multiple private carrier options in a major city like Las Vegas, rural Nevada counties only have two choices when it comes to the Nevada Medicare transition:
- SilverSummit Healthplan (Centene)
- CareSource (a new non-profit)
Both plans offer similar coverage to original Medicare. However, since they’re private, they also come with a few extra benefits. For example, SilverSummit offers free gym memberships, Costco memberships, and boys/girls club memberships. CareSource also offers free Sam’s Club memberships, $100 gym vouchers, and free cellphone plans with unlimited data.
While they offer similar benefits, it’s still crucial that you research the options to choose the one that’s right for your family.
What to Do to if You’re Affected by the Nevada Medicaid Transition
The push to state Medicaid managed care will affect thousands of people across rural counties. If you’re one of them, here are a few steps to prepare for the Nevada Medicaid transition:
- Check your email. You should have received a letter in October and another in December.
- If you dislike your assigned plan, you have until March 31, 2026, to switch.
- Call your doctor immediately and ask if they’re in network with SilverSummit or CareSource. If they aren’t you’ll need to switch plans during the grace period to continue seeing them.
If you have questions about the Nevada Medicare transition or would like to discuss your options, contact us at Health Benefits Associates. Our team of knowledgeable agents can walk you through the choices to help you choose the one that works best for your family’s needs. Schedule an appointment by calling 775-828-1216 today.