Nebraska Health Insurance

Health Insurance in Nebraska

● Nebraska uses the federally subsidized health insurance market, but the state oversees aspects of the plans available for sale

● Open enrollment for 2021 health plans runs from November 1 to December 15, 2020. Residents with qualifying events can sign up outside that window

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● Short-term health insurance plans can be sold in Nebraska with initial plan terms of up to 364 days.

● Two carriers - Medica and Bright Health - offer coverage through Nebraska's health insurance market.

● Medica's average premiums have fallen by 2020, but are expected to increase by 2021.

● Nebraska will implement the ACA's Medicaid expansion in October 2020 (enrollment began August 1, 2020)

● Nebraska is following new federal rules regarding short-term health insurance plans.

This page is a summary of health insurance information and resources for Nebraska residents. Includes an overview of the status marketplace (exchange) for individual/family health plans and what consumers need to know about the open enrollment period that applies to those policies. We also have details about the Medicaid expansion process in Nebraska, rules and availability of the short-term health plan, and a section dedicated to Enrollment and Medicare resources in Nebraska. You'll also find resources dedicated to helping consumers navigate questions and health insurance issues in the state.

Nebraska's health insurance marketplace

As part of the Affordable Care Act (Obamacare), each state has a health insurance market/exchange. Nebraska uses the federally subsidized health insurance market, but with a market plan management model, which means the state oversees various aspects of plans available for sale in Nebraska's health insurance market, but residents use HealthCare.gov to enroll in plans through exchange.

The market is used by individuals and families who need to purchase their own health plans, including people employed in a small business that offers no health benefits, people who have retired (and lost employer-sponsored coverage) before Medicare eligibility, and people who are self-employed.

Individual/family health plans can also be purchased outside the exchange, directly from health insurance companies. But premium subsidies and cost-sharing reductions are only available when people buy their coverage through exchange. These subsidies keep coverage and health care much more affordable than it would otherwise be. And for 2021 coverage, premium subsidies extend to people with incomes above $51,000 and a family of four earning $104,800.

Nebraska Open Enrollment Period and Dates

Open enrollment for Nebraska 2021 health insurance plans will run out from November 1, 2020 to December 15, 2020. Outside of that window, both on the stock exchange and outside of the exchange, Nebraska residents can only enroll in a single market health plan if they experience a qualifying event.

Medica is no longer the only insurer offering coverage through the Nebraska exchange. Bright Health has become part of the state-round exchange for 2020. Medica has imposed an average rate decrease of nearly 7% for 2020. For 2021, Bright Health documents do not appear on the SERFF or federal government rate review page, but Bright has announced that they are expanding into the small group market in Nebraska and has not indicated that they are planning to withdraw from the individual market. Presumably, their individual market plans will continue to be available in Nebraska by 2021 (they're expanding that market segment even further to other states), but it's possible they won't.

Enrollment in Nebraska's health insurance market reached a record level in 2020, which is quite unusual for states using HealthCare.gov (most have seen a drop in enrollment since 2016, although the COVID-19 pandemic has led to a mid-year increase in trade enrollment nationwide).

Medicaid expansion in Nebraska

In 2018, Nebraska voters approved an election initiative to expand Medicaid. The state then began the process of expanding Medicaid eligibility, with specifications submitted to the federal government for review in late 2019. But enrollment in Nebraska's Medicaid plan didn't begin until August 2020, with actual coverage in October 2020 -- nearly two years after voters approved the ballot initiative to expand Medicaid.

Medicaid expansion will mean coverage for about 86,000 Nebraskans, and the federal government will pay 90% of the costs associated with Medicaid expansion.

Short-term health insurance in Nebraska

Nebraska law limits short-term health insurance plans to conditions of less than 12 months. This is in line with new federal rules on short-term health insurance plans.

The state, however, requires that short-term health insurance plans sold in the state be filed with the Department of Insurance, to cover state benefits or comply with the state's internal and external appeals requirements.

How did Obamacare help Nebraskans?

Although Nebraska did not establish its own exchange and waited until 2020 to accept federal funding to expand Medicaid (and did so only after voters approved an election initiative that requires it), the state was already doing better than most of the nation in terms of pre-ACA uninsured rates, and once the key provisions of the law went into effect , continued to do so.

Prior implementation of the ACA, the uninsured rate in Nebraska was 11.3%, according to U.S. Census data. By 2018, it had dropped to 8.3%, which was slightly below the national average , despite the fact that the state had not expanded Medicaid coverage. The uninsured rate in Nebraska remained at 8.3% in 2019, although it rose again nationally to 9.2%. Nebraska's uninsured rate is expected to fall once Medicaid expansion coverage is in place.

As of December 2020, there are nearly 87,000 people enrolled in private health insurance plans through the market in Nebraska. All have coverage for the ACA's essential health benefits without having to worry about annual or lifetime benefit limits. And 95% of enrollees receive subsidies for premiums that reduce the monthly costs of the premium.

Nebraska and the ACA policy

Nebraska's current senators, Republicans Ben Sasse and Deb Fischer, were not in the Senate in 2010 when the ACA was enacted. But both voted yes on all three ACA repeal measures that the Senate considered in July 2017: the Obamacare Repeal Reconciliation Act, the Better Care Reconciliation Act, and the "skinny" repeal.

In the House, all three Nebraska representatives supported the American Health Care Act (AHCA), an effort to repeal the ACA that passed the House in May 2017 but stalled when the Senate was unable to pass any of their versions of the bill.

Former Gov. Dave Heineman also opposed the ACA, calling it an "inaccessible, unsustainable regulatory nightmare" Heineman ended his term and was replaced in January 2015 by Pete Ricketts.

Governor Ricketts is also opposed to the ACA, and favors many of the GOP's favorite reforms: tort reform, expanded HSAs, and tax credits to help buy health insurance. He opposes expanding Medicaid coverage and promised to continue Governor Heineman's refusal to expand the program, but voters bypassed the state legislature with an election initiative to expand Medicaid. And even though Heineman's administration is implementing a more complicated version of Medicaid expansion, and it takes a long time to do so, the process is moving forward.

Does Nebraska have a high-risk pool?

Prior to the ACA, individual health insurance was taken out in almost all states, which meant that pre-existing conditions could prevent a person from getting a policy or could result in significantly higher premiums or policy exclusions. The Nebraska Comprehensive Health Insurance Pool (NCHIP) was created to offer people an alternative if they were unable to obtain individual health insurance because of their medical history.

Now that the ACA has been implemented, all individual major medical health insurance plans are guaranteed, making high-risk pools largely obsolete and NCHIP closed on December 31, 2013. The program is now only available to people under the age of 65 and to Medicare due to a disability.

Medicare coverage and enrollment in Nebraska

Enrollment in Nebraska Medicare reached 353,755 as of August 2020. About 20% of enrollees had selected a Medicare Advantage plan instead of Original Medicare; there are pros and cons with both choices.

About 59 percent of the state's Medicare beneficiaries are enrolled in autonomous Medicare Part D plans, which provide coverage of prescription drugs.

Nebraska Health Insurance Resources

● Nebraska Department of Insurance's Affordable Care Act page - Includes information on rate review and approval, enrollment assisters, and health plan availability

● HRS Erase/Resolute - The federally funded Navigator organization that can help Nebraska residents sign up for coverage through HealthCare.gov.

● Senior Health (SHIIP) - A local service for Medicare beneficiaries that can provide enrollment advice and help educate Medicare beneficiaries about the resources at their disposal.