Medicare in Nebraska

Medicare enrollment in Nebraska

As of September 2022, there were 367,303 Nebraska residents with Medicare coverage, amounting to about 18% of the state’s population.

Most Medicare beneficiaries are eligible for coverage because they’re at least 65 years old. But Medicare eligibility is also triggered when a person has been receiving disability benefits for 24 months, or if the person has ALS or end-stage renal disease.

Nationwide, about 12% of all Medicare beneficiaries are under 65 and eligible due to disability. It’s a little lower in Nebraska, with less than 11% of the state’s Medicare population eligible due to a disability. The rest of the state’s Medicare beneficiaries are at least 65 years old.

Medicare Advantage in Nebraska

Medicare Advantage is available as an alternative to Original Medicare. Medicare Advantage includes all of the benefits of Original Medicare (hospital and outpatient/physician coverage), although out-of-pocket medical costs can be very different between the two options, as Medicare Advantage plans can set their own coinsurance, copays, and deductible levels (within parameters set by CMS).

Most Medicare Advantage plans also include Part D coverage for prescription drugs, as well as extra programs like dental and vision coverage. But Medicare Advantage plans tend to have localized provider networks, as opposed to Original Medicare’s nationwide access to medical providers who accept Medicare assignment. There are pros and cons to either option, and no single solution that works for everyone.

Although most counties in the United States do have Medicare Advantage plans available for purchase, there are some rural areas in Nebraska where Original Medicare is the only option. Nebraska has 93 counties, and Medicare Advantage plans are available in 87 of them in 2023. Across those 87 counties, plan availability ranges from just three plans in several counties, up to 34 in some of the more populous counties.

Only 15% of beneficiaries of Medicare in Nebraska had Medicare Advantage plans as of 2018, compared with an average of 34% nationwide. The lower Medicare Advantage enrollment in Nebraska is due in part to the fact that some counties in Nebraska don’t have Medicare Advantage plans available for purchase.

As of the fall of 2022, there were 106,019 Medicare beneficiaries in Nebraska who were enrolled in private Medicare plans (as opposed to Original Medicare; that figure does not include people who had private coverage to supplement Original Medicare), although that had grown from only about 50,000 in late 2018.

The private plan enrollment as of September 2022 was about 29% of the state’s Medicare population, which was nearly double the percentage it had been four years earlier. Nationwide, about 46% of Medicare beneficiaries were enrolled in private plans — almost entirely Medicare Advantage plans — as of 2022.

Medicare’s annual open enrollment period (October 15 to December 7 each year) allows Medicare beneficiaries the opportunity to switch between Medicare Advantage and Original Medicare and/or add or drop a Medicare Part D prescription plan. Medicare Advantage enrollees also have the option to switch to a different Advantage plan or to Original Medicare during the Medicare Advantage open enrollment period, which runs from January 1 to March 31.

Medigap in Nebraska

Original Medicare does not limit out-of-pocket costs, so most enrollees maintain some form of supplemental coverage. More than half of Original Medicare beneficiaries receive their supplemental coverage through an employer-sponsored plan or Medicaid. But for those who don’t, Medigap plans (also known as Medicare Supplement plans) are designed to pay some or all of the out-of-pocket costs (deductibles and coinsurance) that Medicare beneficiaries would otherwise have to pay themselves.

Medigap plans are sold by private insurers, but the plans are standardized under federal rules, with ten different plan designs (differentiated by letters, A through N). The benefits offered by a particular plan (Plan G, Plan F, etc.) are the same regardless of which insurer is selling the plan. So plan comparisons are much easier for Medigap policies than for other types of health insurance; consumers can base their decision on premiums and less tangible things like customer service, since the benefits themselves are uniform.

There are 48 insurers in Nebraska that offer Medigap plans, and according to an AHIP analysis, there were 182,378 Nebraska Medigap enrollees in 2020. So about 60% of Nebraska’s Original Medicare population (and about half of the state’s entire Medicare population) had supplemental coverage through Medigap plans. This is higher than the rate in most states; nationwide, about a quarter of Original Medicare beneficiaries have Medigap coverage.

Unlike other private Medicare coverage enrollment (Medicare Advantage and Medicare Part D plans), there is no annual open enrollment window for Medigap plans. Instead, federal rules provide a one-time six-month window when Medigap coverage is guaranteed issue. This window starts when a person is at least 65 and enrolled in Medicare Part B (you must be enrolled in both Part A and Part B to buy a Medigap plan).

People who aren’t yet 65 can enroll in Medicare if they’re disabled and have been receiving disability benefits for at least two years, and about 11% of Nebraska Medicare beneficiaries are under 65 years old. But federal rules do not guarantee access to Medigap plans for people who are under 65.

The majority of the states have stepped in to ensure at least some access to private Medigap plans for disabled enrollees under the age of 65, but Nebraska has not. Medigap insurers in Nebraska are not required to offer coverage to people under 65 years of age, although United American Insurance Company and State Farm Mutual voluntarily offer some Medigap plans to disabled Medicare beneficiaries in Nebraska who are under age 65, albeit at significantly higher premiums than the rates that apply when a person is 65.

Instead of requiring private insurers to offer coverage, Nebraska’s safety-net option is to allow Medicare enrollees under the age of 65 to enroll in the state’s high-risk pool (NECHIP). Coverage through NECHIP began to be offered in the 1980s, for people who were unable to obtain medically underwritten health coverage. That’s no longer necessary for people who buy individual/family coverage, due to the ACA (medical underwriting is prohibited in that market). But the ACA did not change anything about medical underwriting for Medigap plans outside of a person’s initial enrollment window. So NECHIP is still available to people who are enrolled in Medicare under the age of 65, and the coverage helps to cover out-of-pocket costs that enrollees would otherwise have (Alaska, Iowa, New Mexico, North Dakota, South Carolina, Washington, and Wyoming also have high-risk pools that remain operational and offer supplemental coverage to Medicare beneficiaries).

As of 2019, however, there were only two people enrolled in NECHIP coverage in Nebraska. It appears that the vast majority of the state’s disabled Medicare beneficiaries either have supplemental Medicaid or employer-sponsored coverage, have obtained Medigap coverage via United American or State Farm Mutual (the private Medigap insurers in Nebraska that offer coverage to beneficiaries under age 65), or have enrolled in Medicare Advantage plans instead of Original Medicare. There are also likely some who are just relying on Original Medicare without any supplemental coverage. Disabled Medicare beneficiaries have access to the normal federally-required Medigap open enrollment period when they turn 65, regardless of how long they’ve been enrolled in Original Medicare at that point.

Although the Affordable Care Act eliminated pre-existing condition exclusions in most of the private health insurance market, those regulations don’t apply to Medigap plans. Medigap insurers can impose a pre-existing condition waiting period of up to six months, if you didn’t have at least six months of continuous coverage prior to your enrollment. And if you apply for a Medigap plan after your initial enrollment window closes (assuming you aren’t eligible for one of the limited guaranteed-issue rights), the insurer can look back at your medical history in determining whether to accept your application, and at what premium.

Nebraska Medicare Part D

Original Medicare does not cover outpatient prescription drugs. More than half of Original Medicare beneficiaries have supplemental coverage via an employer-sponsored plan or Medicaid, and these plans often include prescription coverage. But Medicare enrollees without creditable drug coverage need to obtain Medicare Part D prescription coverage. Medicare Part D plans can be purchased as a stand-alone plan, or as part of a Medicare Advantage plan that includes Medicare Part D prescription drug coverage.

Insurers in Nebraska are offering 24 stand-alone Part D plans for sale in 2021, with premiums that range from about $5 to $114/month.

As of September 2022, there were 191,153 Medicare beneficiaries in Nebraska with stand-alone Medicare Part D plans. Another 91,161 had Medicare Part D coverage as part of their Medicare Advantage plans.

Medicare Part D enrollment follows the same schedule as Medicare Advantage enrollment: Beneficiaries can select a Medicare Part D plan when they’re first eligible for Medicare, and the annual election period each fall (October 15 to December 7) allows people to pick a different plan or enroll for the first time if they didn’t enroll when they were first eligible (there’s a late enrollment penalty for people who enroll in Medicare Part D after their initial enrollment window, unless they maintained creditable drug coverage from another source).

Medicare in Nebraska: Resources

If you have questions about Medicare eligibility in Nebraska or Medicare enrollment in Nebraska, the Nebraska Senior Health Insurance Information Program (SHIIP) can provide assistance with a wide range of topics related to Medicare in Nebraska.

Nebraska Medicare beneficiaries with limited income and assets may be eligible for Medicaid as well (nationwide, about 1 in 5 Medicare beneficiaries is also eligible for Medicaid). You can contact the Nebraska Department of Health and Human Services to learn more about Medicaid eligibility for people who are enrolled in Medicare.

The Nebraska Department of Insurance maintains a helpful consumer information page about Medicare supplements (Medigap), including a list of the companies that offer Medigap plans and how much they charge for a 65-year-old applicant.

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Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.