Nebraska health insurance marketplace guide 2023

Nebraska uses the federally facilitated exchange, but with a marketplace plan management model, which means that residents enroll in coverage through HealthCare.gov, but the state oversees various aspects of the plans available for sale in the exchange.

Despite work completed by the Nebraska Department of Insurance (DOI), then-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.

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 work group, 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 was no longer available to establish a state-run exchange.

The open enrollment period for individual/family health coverage runs from November 1 through January 15 in Nebraska.

Outside of open enrollment, a qualifying life event is generally necessary to enroll or make changes to your coverage. But Native Americans can enroll year-round, as can subsidy-eligible applicants with household income up to 150% of the poverty level. And Medicaid/CHIP enrollment is also available year-round.

For 2023 coverage, there are four insurers that offer exchange plans in Nebraska:

• Blue Cross Blue Shield of Nebraska (new for 2023)
• Medica
• Oscar 
• Ambetter from Nebraska Total Care 

All four insurers offer plans statewide.

Bright Health will no longer offer coverage in the individual/family market after the end of 2022, so their plans are not available for 2023.

In 2014, the first year that the ACA-created exchanges were operational, Nebraska’s exchange had three insurers offering plans: Aetna, CoOpportunity (an Iowa-based ACA-created CO-OP), and Blue Cross Blue Shield of Nebraska.

Time (Assurant) joined the exchange for 2015, but CoOpportunity stopped selling plans in December 2014 and was subsequently liquidated; remaining members had to transition to new plans by March 2015. So for 2015, Nebraska’s exchange had plans from Time, Aetna, and Blue Cross Blue Shield of Nebraska.

But Assurant announced in June 2015 that they would exit the individual market nationwide, and their plans were no longer available as of 2016. But two new carriers joined the Nebraska exchange for 2016: UnitedHealthcare of the Midlands, and Medica. So for 2016, there were four insurers offering plans in Nebraska’s exchange: Aetna, Blue Cross Blue Shield of Nebraska, UnitedHealthcare, and Medica.

But UnitedHealthcare announced fairly early in 2016 that they would exit the exchanges in most states — including Nebraska — at the end of 2016. United only joined the Nebraska exchange for 2016 – they weren’t available in the exchange in 2014 and 2015. But their rates were competitive in Nebraska. They offered plans state-wide, and in 65 of the state’s 93 counties, United offered at least one of the two least-expensive silver plans in the exchange.

At that point, it looked like three insurers would participate in Nebraska’s exchange in 2017, and the Nebraska Department of Insurance confirmed by phone in August 2016 that Aetna, Blue Cross Blue Shield of Nebraska, and Medica all planned to offer coverage in the state’s exchange for 2017.

Blue Cross Blue Shield of Nebraska is new to the state’s exchange for 2023, and Bright Health has left the exchange. But for the other three insurers, the following average rate changes are applicable for 2023, according to ratereview.healthcare.gov (most enrollees receive premium subsidies; these rate changes apply to full-price premiums):

• Blue Cross Blue Shield of Nebraska: New for 2023.
• Medica: 2.6% average increase.
• Oscar Health: 8.8% average increase.
• Ambetter from Nebraska Total Care: 10.4% decrease.

Depending on a person’s income and age, there may be free or very low-cost plans available in Nebraska. There are far more plan options available now than there were a few years ago, although subsidy amounts are smaller than they used to be prior to 2022 (due to the entry of new low-cost health plans in Nebraska’s marketplace for 2022). As an example, consider a 50-year-old in Lincoln who earns $30,000/year. For ease of comparison, we’ll keep him the same age each year (in reality, premiums increase as a person ages, even if the insurer’s overall rates do not increase).

• In 2019, he was eligible for a premium subsidy of $840/month, and had access to seven plans with no premium at all after the subsidy was applied.
• In 2020, his subsidy amount dropped to $745. But because of the influx of new plans (Bright joined the exchange for 2020) and lower-cost options from Medica, he had access to even more free plans (nine of them) after the subsidy was applied, despite the fact that the subsidy amount was smaller.
• For 2021, his subsidy amount increased to $765/month (before the American Rescue Plan further increased subsidy amounts nationwide), and 15 of the 22 available plans were free. The free plans are mostly at the bronze level, but they include one free gold plan and one free silver plan.
• For 2021, after the American Rescue Plan was enacted, he qualified for a subsidy of $875/month. 15 of the 22 plans were still free, and the other seven ranged from $62/month to $155/month.
• For 2022, there are dramatically more plans available, with Oscar and Ambetter offering coverage in addition to Bright and Medica. Although the American Rescue Plan’s provisions were still in effect, his subsidy was quite a bit smaller for 2022, at $608/month. Ambetter has taken over the benchmark spot in Lincoln, driving down the cost of coverage and thus reducing subsidy amounts (here’s more about how this works). This person will still have access to a dozen premium-free plans, although they are all at the Bronze level. There were a total of 95 plans available to him for 2022, and most of them do have a premium after the subsidy is applied.
• For 2023, this person’s subsidy has grown a little, to $629/month, due to the increase in the cost of the benchmark plan. There are 107 plans available to this applicant, and 18 of them have $0 premiums.

For perspective, average unsubsidized premiums in Nebraska’s exchange are higher than the national average, at $707/month in 2022 (versus a national average of $594 in states that use HealthCare.gov, but down from $866/month in 2019).

In Nebraska, 95% of exchange enrollees were receiving premium subsidies in early 2022 (versus a nationwide average of 89%). 

• 2015: The Nebraska Department of Insurance released a sampling of 2015 rates in September 2014. 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 was 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 was 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 (Assurant ended up leaving the market, nationwide, at the end of 2015.An analysis conducted by the Commonwealth Fund and published in December 2014 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 became smaller once CoOportunity’s plans were no longer for sale, since the CO-OP had raised its rates considerably for 2015.
• 2016: In the fall of 2015, the Nebraska Department of Insurance published final approved rates for 2016:
  • Blue Cross Blue Shield of Nebraska: 14.8 percent average rate increase
  • Coventry: 21.89 percent average rate increase (but actual rates are still lower than BCBS in every sample scenario).
  • UnitedHealthcare of the Midlands: New to the exchange, but the approved rates for 2016 were lower than BCBS and Coventry for every sample scenario (note that United only participated in the exchange in 2016; they did not offer plans for 2017).
  • Medica: New to the exchange for 2016. Approved rates for 2016 were lower than BCBS and Coventry in some scenarios, and higher in others.
• 2017: For the two carriers offering coverage in the Nebraska exchange, average rate increases for 2017 were as follows:
  • Medica: 51.3 percent
  • Aetna: 40.5 percent (a sample of approved rate increases for various ages and zip codes)
• 2018: Aetna left the market. Medica increased their average rates by 31 percent. Medica’s rate filing noted that while their plans would be available on and off-exchange for 2018, they were not actively marketing off-exchange plans. Medica offered their “Medica Insure” plan in all 93 counties in Nebraska for 2018. They also offered their “Medica Insure Gold” in 70 counties, and “Medica with CHI Health” in the remaining 23 counties.Medica proposed a 31 percent average rate increase (as of their revised rate filing dated August 15, 2017, which was based on the assumption that cost-sharing reduction (CSR) funding would not continue in 2018). The additional cost to cover CSR was added to silver plans. This turned out to be a prescient decision, as the Trump Administration announced in October 2017 that CSR funding would end immediately.Medica had previously proposed a 16.9 percent average rate increase, based on the assumption that CSR funding would continue. But with no allocation of funding from Congress, and no assurance from the Trump Administration that funding would actually continue, revised rates were filed in August. Medica initially added a 14.5 percent load to silver plans, bringing the total overall average rate increase to 28.3 percent (as of August 4). But they submitted an additional revised filing on August 15, which also incorporated updated claims experience through the end of July. The result of that additional information, plus the 14.5 percent load on silver plans to cover the cost of CSR, brought Medica’s overall proposed average rate increase to 31 percent.
• 2019: Medica was once again the only insurer in Nebraska’s exchange (indeed, in their entire individual market, including on- and off-exchange plans). Overall, the average rate increase across all of Medica’s plans was 2.2 percent for 2019. This was a much smaller average rate change than prior years, but that’s due in part to the fact that Medica switched from a PPO to an EPO for 2019. It’s also indicative of a more stable insurance market than the state has had in the past few years, and is testament to the fact that the sharp rate increases in 2017 and 2018 appear to have “right-sized” premiums in the state, getting them to where they need to be in order to cover the cost of claims.
• 2020: Medica initially proposed an average rate decrease of 5.3 percent for 2020, but later revised it to a 6.9 percent average decrease, which was approved (SERFF filing number MEDI-132000751). And Bright Health joined Nebraska’s exchange, statewide, for 2020, giving residents additional coverage options. The lower premiums for Medica plans and the introduction of Bright’s plans resulted in shifting prices for the benchmark plan and corresponding changes in premium subsidy amounts for some enrollees — although consumers may or may not have noticed a change in their net premiums, even with fluctuations in the subsidy amounts.
• 2021: Both Bright and Medica decreased their average premiums by about 2.6% for 2021, so overall average premiums in Nebraska were about 2.6% lower in 2021 than they were in 2020. And CMS reported that the average benchmark premium in Nebraska is 2% lower for 2021 than it was for 2020.
• 2022: The average rate increase for Bright and Medica was about 8.6% for 2022. Ambetter and Oscar also joined the Nebraska exchange for 2022. 

99,011 people enrolled in health plans through Nebraska’s health insurance exchange during the open enrollment period for 2022 coverage, which was by far a record high. The sharp increase in enrollment matched what we saw nationwide in 2022, and was driven largely by the affordability enhancements provided by the American Rescue Plan. 

Across all states that use HealthCare.gov, there were average enrollment decreases every year from 2017 through 2020. This is due to a variety of factors, including the elimination of the individual mandate penalty, the Trump administration’s relaxed rules for short-term health plans and association health plans, and the administration’s decision to slash funding for outreach and enrollment assistance (under the Biden administration, this funding has been boosted to record-high levels). But enrollment in Nebraska’s exchange increased in 2018 and again in 2020, bucking the general trend of steady declines that we saw in the majority of states that use HealthCare.gov.

For perspective, here’s a look at individual market QHP (private plans) enrollment numbers in Nebraska over the years:

• 2014: 42,975 people enrolled.
• 2015: 74,152 people enrolled.
• 2016: 87,835 people enrolled.
• 2017: 84,371 people enrolled.
• 2018: 88,213 people enrolled.
• 2019: 87,416 people enrolled
• 2020: 90,845 people enrolled.
• 2021: 88,688 people enrolled.
• 2022: 99,011 people enrolled.