As of December 15, a total of 32,213 people in Nebraska had enrolled in private plans through the exchange, but this doesn’t include people whose 2014 plans were auto-renewed through Healthcare.gov. It does include people who had a 2014 plan and went back to the exchange during the first month of open enrollment to manually renew it or select a new plan. 52 percent of Nebraska’s first month enrollees were new to the exchange for 2015, while the other 48 percent had a plan in 2014 and manually renewed or changed it by December 15.
88 percent of Nebraska’s exchange enrollees are receiving premium subsidies in 2015.
In addition, 3,315 Nebraska residents enrolled in Medicaid or CHIP through Healthcare.gov between November 15 and December 15.
Auto-renewals likely added tens of thousands of people to the total number of Nebraska residents who have exchange coverage in force in January, although the next state-by-state breakdown won’t be released by HHS for another few weeks.
Nebraska exchange enrollments submitted by January 15 will have coverage effective February 1. Enrollments submitted between January 16 and February 15 will have coverage that begins on March 1. If your Nebraska plan was auto-renewed and you’d rather shop around for a different plan, you can still get a new plan with a February or March effective date. After February 15, you cannot enroll in a private plan for 2015 (including off-exchange plans) unless you have a qualifying event during the year.
CoOportunity taken over by state regulators
CoOportunity is an Iowa-based ACA-created CO-OP that was one of four carriers offering 2015 plans in the Nebraska exchange. But in late December, CoOportunity was taken over by Iowa state regulators, and is no longer selling policies in either state.
CoOportunity had about 120,000 policy holders, and most of them are in Nebraska. People who enrolled for 2015 prior to December 15 still have coverage with the CO-OP, but regulators are encouraging them to switch to another plan before the end of open enrollment (February 15). People who enrolled in a CoOportunity plan after December 15 need to enroll with a different carrier, as there are no plans available from the CO-OP with February or March effective dates.
CO-OP members who switch to a new plan with a February or March start date will have to start over again with their deductibles for 2015, even if they have claims with the CO-OP during the first month or two of the year. So it’s recommended that members switch as quickly as possible – if they enroll in a new plan by January 15, they can have coverage in place with a new carrier on February 1.
Officially, CoOportunity has not yet been placed in liquidation, and people who currently have coverage in force will continue to have their claims paid. But the future of the carrier is very uncertain at this point. If it can be successfully rehabilitated, it could re-enter the active market at a later date.
2015 rates and carriers
Now that CoOportunity plans are no longer available in the Nebraska exchange, there are three carriers participating: Blue Cross Blue Shield of Nebraska, Coventry Health Care, and Assurant. Health Alliance Midwest offered policies in 2014, but is not participating in 2015. Assurant is new to the Nebraska exchange for 2015.
The Nebraska Department of Insurance released a sampling of 2015 rates in September. They illustrated 15 different scenarios, with varying household sizes, ages, and geographic locations across the state. For each carrier, they showed the rate change for each scenario, along with an average for all 15 scenarios from each carrier.
Across the four carriers that were originally slated to sell plans for 2015 (including CoOportunity), the unweighted average for the 15 sample scenarios is a 10.7 percent increase in premiums. But one carrier – Coventry – had an average rate decrease of 3.4 percent. And while Assurant’s average rate hike across the sample scenarios is 16 percent, their prices in 2014 (off-exchange) were lower than those offered by the exchange plans – they gained market share in 2014 even though they were only available off-exchange.
PricewaterhouseCooper LLC analyzed individual market premiums, calculating weighted average rates for the 2015 open enrollment period. They found an average increase of 9 percent across the four Nebraska carriers, including on and off-exchange plans (the study was conducted throughout the late summer/autumn, and rates are current as of late November).
But the Kaiser Family Foundation did another analysis in November, looking at a 40 year old enrollee in the Omaha area, who enrolled in the benchmark plan (second lowest-cost silver plan) in 2014 and is willing to switch plans – if necessary – in order to continue to be covered by the benchmark plan in 2015. For that scenario, they found an average price decrease of 2.6 percent.
People in the Omaha area who renew the benchmark plan from 2014 instead of switching to the new benchmark plan could be in for some sticker shock however, and the Omaha area is a perfect example of why auto-renewal is not in your best interest, even if it’s available to you. The NY Times put together an interactive map showing how the benchmark plans are changing for 2015, and there’s a stark difference between renewing versus switching if you’re in northeastern Nebraska.
An analysis conducted by the Commonwealth Fund and published in December found an average rate increase of 10 percent for a 40 year-old non-smoker in the Nebraska exchange, when looking at all plans and metal levels. But for silver plans, the rate increase was an average of just 4 percent, and it’s likely that the rate increase is lower now that CoOportunity’s plans are no longer for sale, since the CO-OP had raised its rates considerably for 2015.
2014 enrollment numbers
During the first open enrollment period that ended in April, 42,975 people finalized their private plan Obamacare enrollments in the Nebraska exchange (as of April 19). And another 10,360 people had enrolled in ACA-compliant plans off-exchange.
An additional 9,879 exchange applicants had been found to be eligible for existing Medicaid in Nebraska (Nebraska has not expanded Medicaid under the ACA, a decision that disproportionately impacts the large rural population).
A recent WalletHub study projected only a slight drop in Nebraska’s uninsured rate post Obamacare implementation. 14.71 percent of the state’s residents were uninsured last year, and the projection is that 13.69 percent will be uninsured this year. States that expanded Medicaid experienced the largest drops – in some cases, as much as ten percentage points – but states like Nebraska that have not expanded Medicaid are experiencing only minimal reductions in their uninsured populations.
No Medicaid expansion in Nebraska
Although Nebraska has not yet expanded Medicaid, a bill was introduced in the 2014 legislative session that would have expanded Medicaid to cover the 33,000 Nebraska residents who have fallen into the coverage gap – they aren’t eligible for current Medicaid, but they have incomes too low to qualify for subsidies in the exchange.
The Nebraska Department of Health and Human Services held a public hearing on LB887, the Wellness in Nebraska Act, on January 29, and the issue has general support from state residents – 56 percent of poll respondents in Nebraska are in favor of Medicaid expansion. But the bill ultimately died in the legislature, although proponents have vowed to take up the cause in next year’s session.
Chuck Hassebrook, the Democratic candidate for Governor in the 2014 election said that he’d make Medicaid expansion a priority. Hassebrook noted that the survival of rural hospitals depends on Medicaid expansion. But ultimately, Pete Ricketts, a Republican who is opposed to Medicaid expansion, won the election. Governor-elect Ricketts is opposed to the ACA in general, and prefers ideas like tort reform, tax credits, and expanded health savings accounts (HSAs).
Supporters of Medicaid expansion are pushing for legislative reform in 2015, but are also considering a ballot initiative in 2016 if they are not successful in the legislature.
HHS is running the exchange in Nebraska via HealthCare.gov. Residents who need enrollment assistance can contact Community Action of Nebraska or the Ponca Tribe of Nebraska – both received federal grants to hire navigators, who can answer questions and assist with the enrollment process.
Community Action of Nebraska has a toll free number (1-800-318-2596) that people can use if they want to enroll over the phone. Residents who want in-person help can also visit one of Community Action’s offices to meet with a navigator.
Nebraska’s Department of Insurance allowed pre-2014 plans to be extended in 2014. Following the Obama Administration’s announcement in March that pre-2014 plans could be extended for up to two more years, the Nebraska Department of Insurance decided in late April to allow pre-2014 health insurance plans to be extended out as far as October 2016.
It is up to each carrier to decide whether to accept this option; Blue Cross Blue Shield of Nebraska announced in May that they would allow pre 2014 plans to be extended into 2016.
Exchange history in Nebraska
Despite work completed by the Nebraska Department of Insurance (DOI), Gov. Dave Heineman announced in November 2012 that the state would not operate a health insurance exchange. In rejecting a state-run exchange, Heineman said it would be much more expensive for the state to run its own exchange. He also expressed doubt that even a state-run exchange would give Nebraska much authority over exchange operations.
Governor Heineman has also refused to expand Medicaid, but state Senator Jeremy Nordquist is pushing for Medicaid expansion and called on Heineman in December to forfeit his own health insurance until all Nebraskans are able to have coverage.
Before Heineman’s final decision, he had expressed some support for a state-run exchange, and the DOI had studied that option. The DOI gathered input from stakeholders, developed a set of working assumptions around policy and operations, and issued a number of requests for information and requests for proposals to engage subcontractors in developing an exchange.
While the federal government manages most functions for the new marketplace, Nebraska oversees participating health plans. The Nebraska legislature also authorized a workgroup, called the Nebraska Exchange Stakeholder Commission, to provide input to state and federal officials on how the marketplace should operate.
In early December, 2014, the Nebraska Exchange Stakeholder Commission announced their recommendation that Nebraska continue to have a federally-run exchange, noting that it would be costly and difficult to switch to a state-run exchange at this point, especially given that federal funding is no longer available to establish a state-run exchange. Despite the possibility that subsidies could be taken away in federally-run exchanges if the Supreme Court rules against the subsidies in King v. Burwell (ruling expected in June 2015), Nebraska will continue to have a federally-run exchange for the foreseeable future.
Contact the exchange
The federal government will operate the exchange in Nebraska; enrollment begins Oct. 1, 2013
More Nebraska health insurance exchange links
State Exchange Profile: Nebraska
The Henry J. Kaiser Family Foundation overview of Nebraska’s progress toward creating a state health insurance exchange.
Nebraska Department of Insurance
Assists consumers who have purchased insurance on the individual market or who have insurance through an employer who only does business in Nebraska.
(877) 564-7323 / Toll Free: (800) 833-7352
Nebraska DOI’s overview of the exchange
An in-depth document published in September 2013 that details how the exchange will work for individuals and small businesses.
Advocacy group working to raise awareness about the Nebraska exchange.