Expanded Medicaid in Nebraska
When the Affordable Care Act (ACA) or “Obamacare” was passed in 2010, Medicaid Expansion was built in to provide health insurance for adults who weren’t paid enough to qualify for subsidies on the Health Insurance Marketplace. States were given the option to expand and Nebraska voters chose to expand Medicaid to over 94,000 eligible individuals in 2018.
Heritage Health Adult is Nebraska’s name for its expanded Medicaid program. They are the same thing. Learn more about the program on Enroll Nebraska’s expanded Medicaid page.
Medicaid is expanding to cover Nebraskans who previously did not qualify for coverage through the Heritage Health Adult program. Those being paid up to 138% of the Federal Poverty Level (or up to $1467 per month for an individual and $2498 for a family of 3 in 2021) may be eligible.
Expanded Medicaid in Nebraska, called Heritage Health Adult, is finally available for Nebraskans to apply on August 1, 2020 through the ACCESSNebraska system. Coverage begins on October 1, 2020.
Enrollment assistance from local Navigators and Certified Application Counselors (CACs) can be found on Enroll Nebraska’s Enrollment Assister Map. These professionals provide free assistance with enrollment questions or the application process.
People in Nebraska’s new expanded Medicaid program, called Heritage Health Adult, will receive one of two different benefit packages: “Basic” or “Prime.” Prime coverage includes vision and dental services and over-the counter medicine, while Basic does not. People who are pregnant, those who are 19-20 years old, and those who are considered “medically frail” (having certain chronic health conditions) will receive Prime coverage.
Nebraska’s Department of Health and Human Services (DHHS) is moving forward with a plan for Medicaid expansion that includes wellness and work requirements. These requirements would likely go into effect later in 2020 or in 2021. To get Prime coverage, a person who starts in Basic coverage would need to meet these wellness requirements:
1. Participate in health and social determinants screenings upon enrollment and every year after enrollment;
2. Attend a qualifying health visit every year;
3. Select a primary care doctor;
4. Do not miss more than 3 appointments in a 6-month period;
5. Maintain commercial medical coverage, if possible; and
6. Tell DHHS of any changes in status within 10 days of the change.
Additionally, beginning the second year of the program, the following work requirements must be met to gain Prime coverage, unless the person is exempt:
1. Work or volunteer for at least 80 hours a month;
2. Enroll at least half time in an authorized educational program;
3. Be a qualified caregiver or be a relative, kinship, or licensed foster parent;
4. Participate in certain government programs; or
5. Engage in certain job search activities for at least 20 hours per week.
A person’s eligibility for Prime coverage will be reviewed every 6 months, and if a person fails to meet these requirements, they can be locked out of Prime coverage for 6 months or a year.
The Health Insurance Marketplace
Yes! The Affordable Care Act (ACA) or “Obamacare,” is still helping families and individuals find and pay for health insurance in the United States. Although congress had many chances to repeal the law, they ultimately chose to continue the program.
The Affordable Care Act (ACA) or “Obamacare,” is a United States federal statute signed into law by President Barack Obama on March 23, 2010.
This video put together by the Kaiser Family Foundation gives a good, concise explanation of what the Affordable Care Act does.
Similar to other health insurance plans, there is an Open Enrollment Period each year where individuals and families can review their options and select or switch plans. Here is the upcoming open enrollment period:
2021 benefit year: November 1 – December 15, 2020
If you’ve gone through a major life change, you can also sign up for coverage outside of these dates. Here is a list of Special Enrollment circumstances that could be qualifying events.
And, if you are in one of the categories below, you can enroll at any time:
- Eligible for Medicaid or have a child who is eligible for CHIP
- A Native American or Alaska Native
Absolutely. People in Nebraska can go to the Health Insurance Marketplace at Healthcare.gov or call 1-800-318-2596 to look at plans, sign up for health coverage, or update their existing coverage.
We recommend visiting Healthcare.gov to see your options. It’s easy to use and can help with making most decisions. Call the Marketplace Call Center for more information at 1-800-318-2596.
Enrollment assistance from local Navigators and Certified Application Counselors (CACs) can be found on Enroll Nebraska’s Enrollment Assister Map. These professionals provide free assistance with enrollment questions or the application process. The Health Insurance Marketplace call center also offers assistance over the phone at 1-800-318-2596.
Find important dates, health fairs, and events near you on our Events page.
Download this checklist of what you need to bring to your appointment with an enrollment assister.
The most recent data suggests we’re doing about average. Take a look at our Uninsured in Nebraska page to learn more.