Nebraska health insurance Marketplace guide

To qualify for health coverage through the Nebraska Marketplace, you must:⁶

• Live in Nebraska
• Be lawfully present in the United States
• Not be incarcerated
• Not be enrolled in Medicare⁷

Eligibility for financial assistance in the form of premium subsidies and cost-sharing reductions depends on your household income. 

In addition, to qualify for financial assistance with your Marketplace plan you must:⁸

• Not have access to an employer’s health coverage that’s deemed affordable. If your employer offers coverage but you feel it’s too expensive, you can use our Employer Health Plan Affordability Calculator to see if you might qualify for premium subsidies in the Marketplace. 
• Not be eligible for Medicaid or CHIP.
• Not be eligible for premium-free Medicare Part A.⁹
• If married, file a joint tax return with your spouse.¹⁰
• Not be able to be claimed by someone else as a tax dependent.¹⁰

In Nebraska the open enrollment period for individual/family health coverage runs from November 1 through January 15.¹¹ (Due to the federal holiday on January 15, 2024, HealthCare.gov is allowing people until January 16, 2024 to enroll in coverage for 2024.)¹² 

If you need your coverage to start on January 1, you must apply by December 15. If you apply between December 16 and January 15, your coverage will begin on February 1.⁸

Outside of the annual open enrollment period, you may still be able to enroll or make a plan change if you experience a qualifying life event, such as giving birth or losing other health coverage.

Here’s a guide to the special enrollment periods that will let you enroll or make a plan change outside of the annual open enrollment period.

To enroll in an ACA Marketplace plan in Nebraska, you can: 

• Visit HealthCare.gov to compare the health plans that are available in your area, determine whether you’re eligible for financial assistance, and enroll in coverage during open enrollment or during a special enrollment period. 
• Purchase individual and family health coverage with the help of an insurance agent or broker, a Navigator, or certified application counselor.
• Enroll in a Marketplace plan via an approved enhanced direct enrollment entity (EDE).¹³ Note that EDEs can also help you enroll in off-exchange coverage and even non-ACA-compliant coverage, so be clear about wanting a Marketplace plan, as that’s the only way you can qualify for financial assistance.

You can also call HealthCare.gov’s contact center by dialing 1-800-318-2596 (TTY: 1-855-889-4325). The call center is available 24 hours a day, seven days a week, but it’s closed on holidays.

Ninety-five percent of Nebraska Marketplace enrollees saved money on 2024 premium payments amounting to an average savings of $580/month. With subsidies, enrollees paid an average of $115 per month for health coverage (that average includes the 5% of enrollees who paid full price). ¹⁴

(The numbers above are based on effectuated enrollment; the chart below shows some different metrics and is based on all applications submitted during the open enrollment period for 2024.)

The Affordable Care Act also provides income-based assistance with out-of-pocket costs, if the enrollee’s household income isn’t more than 250% of the poverty level and they select a Silver-level plan through the Marketplace.¹⁵

Between the premium subsidies and cost-sharing reductions, you may find that an ACA plan is the cheapest health insurance option for you.

Source: CMS.gov¹⁶

Nebraska expanded Medicaid under the ACA starting in late 2020. So adults (under 65) with household income up to 138% of the poverty level can qualify for Medicaid in Nebraska. Medicaid enrollment is available year-round for eligible applicants.

Five insurers offer coverage for 2025 in the Nebraska Marketplace, and all of them offer coverage statewide:⁴ 

• Blue Cross Blue Shield of Nebraska
• Medica
• Ambetter from Nebraska Total Care
• Oscar Health
• UnitedHealthcare

UnitedHealthcare is new for 2025,³ while the other four insurers already offered coverage in Nebraska’s Marketplace in 2024.

The following average premium changes were approved for 2025 for the health insurance companies that offer coverage in Nebraska’s individual market (calculated before any subsidies are applied):

Source: RateReview.HealthCare.gov¹⁷

For perspective, here’s a summary of how average full-price (pre-subsidy) premiums have changed over time in Nebraska’s individual/family health insurance market:

• 2015: Average increase of 10%¹⁸
• 2016: Average increase of 16.2%¹⁹
• 2017: Average increase of 34.8%²⁰
• 2018: Average increase of 31%²¹ (only one insurer remained at this point)
• 2019: Average increase of 2.2%²²
• 2020: Average decrease of 6.9%²³ (a second insurer joined)
• 2021: Average decrease of 2.6%²⁴
• 2022: Average increase of 8.6%²⁵ (two more insurers joined)
• 2023: Average increase of 0.4%²⁶ (still four insurers, but with one exit and one new entrant)
• 2024: Average increase of 4.7%²⁷

In Nebraska, 117,882 people enrolled in health plans through the state’s ACA Marketplace exchange during the open enrollment period for 2024 coverage.²⁸

The state has seen a significant increase in enrollment since 2021 (see chart below), driven in part by the American Rescue Plan (ARP) making ACA’s premium subsidies more substantial. Under the ARP – now extended through 2025 by the Inflation Reduction Act – subsidies are larger and more widely available than they used to be.²⁹ 

The record-high enrollment in 2024 was also partially due to the “unwinding” of the pandemic-era Medicaid continuous coverage rule. Medicaid disenrollments resumed in 2023 after a three-year pause. CMS reported that by April 2024, nearly 24,000 people had transitioned from Nebraska Medicaid to a Marketplace plan.³⁰

Source: 2014,³¹ 2015,³² 2016,³³ 2017,³⁴ 2018,³⁵ 2019,³⁶ 2020,³⁷ 2021,³⁸ 2022,³⁹ 2023,²⁹ 2024,⁴⁰ 2025⁴¹

HealthCare.gov
The federal government operates the exchange in Nebraska.

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