Frequently asked questions about health insurance
coverage options in Nebraska
Nebraska utilizes the federally facilitated health insurance marketplace, but with a marketplace plan management model, which means the state oversees various aspects of the plans available for sale in the Nebraska health insurance marketplace, but residents use HealthCare.gov to enroll in plans through the exchange.
Read our guide to the Nebraska health insurance marketplace.
Open enrollment for 2021 Nebraska health insurance plans ran from November 1 through December 15, 2020. Outside of that window, both on-exchange and outside the exchange, Nebraska residents can normally only enroll in an individual market health plan if they experience a qualifying event.
But things are different in 2021, due to the ongoing COVID pandemic and the American Rescue Plan’s significant improvements to the ACA’s premium subsidies. A special enrollment period has been opened to address these issues, and it continues through August 15, 2021. No qualifying event is necessary during this window, and Nebraska residents can use it to newly enroll in a plan through marketplace/exchange, or to switch from one marketplace plan to another.
After August 15, the normal rules will once again apply. A qualifying event will be necessary in order to enroll or make a plan change for 2021, and open enrollment for 2022 coverage will start on November 1, 2021.
Both Bright Health and Medica reduced their average full-price premiums in 2021, by an average of about 2.6%. Medica’s average premiums also decreased the year before.
Enrollment in Nebraska’s health insurance marketplace/exchange reached a record high in 2020, which was fairly unusual for states that use HealthCare.gov. (Most saw declining enrollment from 2017 through 2020.)
For 2021, however, enrollment dropped about 2%, with 88,688 people signing up during the open enrollment period that ended in mid-December 2020. (In most states, there was a slight increase in enrollment from 2020 to 2021.)
Enrollment is increasing in 2021, however, as a result of the COVID/American Rescue Plan enrollment window that runs through August 15, 2021. 3,610 Nebraska residents signed up for coverage during the first several weeks of this enrollment window (in prior years, fewer than 2,000 people enrolled during the same time frame; a qualifying event would normally be necessary to enroll at that time of year, but that’s not the case during the COVID/American Rescue Plan window in 2021).
Read more about Nebraska’s health insurance marketplace.
Although Nebraska did not establish its own exchange and waited until 2020 to accept federal funding to expand Medicaid (and only did so after voters passed a ballot initiative requiring it), the state was already performing better than most in the nation as far as pre-ACA uninsured rates go, and once the law’s key provisions took effect, it continued to do so.
Prior ACA implementation, the uninsured rate in Nebraska was 11.3 percent, according to US Census data. By 2018, it had fallen to 8.3 percent, which was a little lower than the national average — despite the fact that the state hadn’t expanded Medicaid coverage. The uninsured rate in Nebraska remained at 8.3 percent in 2019, although it increased again nationwide, to 9.2 percent. Nebraska’s uninsured rate is expected to drop once Medicaid expansion coverage takes effect.
As of 2020, there are nearly 87,000 people enrolled in private health insurance plans through the marketplace in Nebraska. All of them have coverage for the ACA’s essential health benefits without having to worry about lifetime or annual benefit caps. And 95 percent of those enrollees are receiving premium subsidies that reduce their monthly premium costs.
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 “skinny” repeal.
In the House, all three Nebraska Representatives supported the American Health Care Act (AHCA), an ACA repeal effort that passed the House in May 2017 but stalled when the Senate was unable to pass any of their versions of the bill.
Gov. Ricketts is also opposed to the ACA, and favors many of the reforms preferred by the GOP: tort reform, expanded HSAs, and tax credits to help purchase health insurance. He is opposed to Medicaid coverage expansion and had vowed to continue Gov. Heineman’s rejection of expanding the program, but voters circumvented the state legislature with a Medicaid expansion ballot initiative.
And although Heineman’s administration is implementing a more complicated version of Medicaid expansion, and taking a long time to get it done, the process is moving forward.
In 2018, voters in Nebraska approved a Medicaid expansion ballot initiative. The state then began the process of expanding Medicaid eligibility, with the specifics submitted to the federal government for review in late 2019. But Medicaid plan enrollment in Nebraska didn’t begin until August 2020, with coverage effective in October 2020 – nearly two years after voters approved the Medicaid expansion ballot initiative.
The expansion of Medicaid will mean coverage for about 86,000 Nebraskans, and the federal government will pay 90 percent of the costs associated with Medicaid expansion.
Read more about Nebraska’s Medicaid expansion.
Nebraska law limits short-term health insurance plans to terms of less than 12 months. That’s in line with the federal rules on short-term health insurance plans.
The state does, however, require short-term health insurance plans sold in the state to be filed with the department of insurance, to cover state-mandated benefits, or comply with the state’s internal and external appeal requirements.
Read more about short-term health insurance coverage in Nebraska.
Nebraska Medicare enrollment reached 353,755 as of August 2020. About 20 percent of those enrollees had selected a Medicare Advantage plan instead of Original Medicare; there are pros and cons with either choice.
Read more about Medicare plans in Nebraska, including the state’s rules for Medigap plans.
- Nebraska Department of Insurance’s Affordable Care Act page — Includes information about rate review and approval, enrollment assisters, and health plan availability
- HRS Erase/Resolute — The federally-funded Navigator organization that can help Nebraska residents enroll in coverage through HealthCare.gov.
- Senior Health (SHIIP) — A local service for Medicare beneficiaries that can provide enrollment advice and help to educate Medicare beneficiaries about the resources available to them.
Before the ACA, individual health insurance was underwritten in nearly every state, which meant that pre-existing conditions could prevent a person from obtaining a policy, or could result in significantly higher premiums or policy exclusions. The Nebraska Comprehensive Health Insurance Pool (NCHIP) was created to give 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 issue, making high-risk pools largely obsolete, and NCHIP closed on December 31, 2013. The program is now only available for people who are under 65 and on Medicare due to a disability.