Health Insurance Marketplace in Nebraska
Choosing the Right Health Insurance Plan
There are 5 categories of Marketplace insurance plans: Bronze, Silver, Gold, Platinum, and Catastrophic.
Plans range from bare bones “bronze” plans which cover 60% of pocket medical costs to “platinum” plans which have greater coverage but come with higher premiums. In general higher premiums mean lower out-of-pocket costs and a wider insurer network of doctors and hospitals.The plans are as listed below:
NOTE: All cost sharing is of out of pocket costs. Please see ObamaCare health benefits for services that are covered at no out of pocket charge on all plans. The maximum out-of-pocket costs for any Marketplace plan for 2014 are $6,350 for an individual plan and $12,700 for a family plan.
Bronze Plan: The bronze plan is the lowest cost plan available. It has the lowest premiums and in exchange has the lowest actuarial value. The actuarial value of a bronze plan is 60%. This means that 60% of medical costs are paid for by the insurance company, leaving the other 40% to be paid by you.
Silver Plan: The Silver plan is the second lowest cost plan, it has an actuarial value of 70%. This means that 70% of medical costs are paid for by the insurance company, leaving the other 30% to be paid by you. The Silver plan is the standard choice for most reasonably healthy families who historically use medical services.
Gold Plan: The Gold plan is the second most expensive plan, it has an actuarial value of 80%. This means that 80% of medical costs are paid for by the insurance company, leaving the other 20% to be paid by you.
Platinum Plan: The Platinum plan is the plan with the highest premiums offered on the insurance exchange. The Platinum plan as an actuarial value of 90%. This means that 90% of medical costs are paid for by the insurance company, leaving the other 10% to be paid by you. This plan is suggested to those with high incomes and those in poor health. Although coverage is more expensive up front the 90% coverage of costs will help those who use medical services frequently.
Catastrophic plans – which have very high deductibles and essentially provide protection from worst-case scenarios, like a serious accident or extended illness — are available to people under 30 years old and to people who have hardship exemptions from the fee that most people without health coverage must pay.
Nebraska has not chosen to expand its Medicaid program at this time. Read “What if my state isn’t expanding Medicaid?” to learn more. You can find out whether you qualify for Medicaid under Nebraska’s current rules 2 ways: Contact your state Medicaid agency right now or fill out an application for coverage in the Health Insurance Marketplace.
Who can help you (the Navigators)
Community Action of Nebraska serves community service organizations and non-profits across the state of Nebraska. The organization will build upon existing statewide infrastructure to provide assistance to nearly 40,000 Nebraskans in need of health coverage through the Marketplace.
The Ponca Tribe of Nebraska will use funds to provide outreach, education, and enrollment services to American Indians residing in the fifteen counties that constitute the Ponca Service Delivery Area. Funds will be used to hire Ponca Navigators, and assistance will be delivered through their five office locations, in person, and via videoconferencing.
If you need more detailed analysis, identification of issues, solutions, and implementation of your health insurance plan please let us know with the form below and we’ll get right back to you.
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Consumer Operated and Oriented Plan Program
Consumer Operated and Oriented Plan (CO-OP) Program are qualified nonprofit health insurance issuers that offer competitive health plans in the individual and small group markets. CO-OP in Nebraska:
Midwest Members Health
Accountable Care Organizations in Nebraska
ACOs are profit-driven health innovators primarily serving Medicare patients who are financially rewarded by the government and private insurance companies for delivering medical services that lead to better health outcomes for less money.
- TransforMED NE – Health Care Innovation Award
- The National Health Care for the Homeless Council NE – Health Care Innovation Award
Health care facilities where Innovation Models are being tested
- SERPA-ACO, LLC Crete, NE – Advance Payment ACO Model
- Saint Elizabeth Regional Medical Center Lincoln, NE – BPCI Initiative: Model 2
- Good Samaritan Hospital Kearney, NE – BPCI Initiative: Model 2
- Nebraska Methodist Hospital Omaha, NE – BPCI Initiative: Model 2
- UniNet Healthcare Network NE – Community-based Care Transition Program
- Community Action Partnership of Western Nebraska Gering, NE – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- The Midwife’s Place Bellevue, NE – Strong Start for Mothers and Newborns Initiative
The Insurance Exchange/Marketplace
What has been done, not been done, or left up to the federal government to do.
Establishing the Exchange in Nebraska
On November 15, 2012, Governor Dave Heineman (R) announced that Nebraska would not establish a health insurance exchange.1Earlier in 2012, the Nebraska legislature introduced two bills (LB 835 and LB 838) to establish a health insurance exchange in Nebraska, however both failed when the legislative session concluded in April.2,3
In 2011, Governor Heineman signed LB 22 into law, which prohibits qualified health insurance plans participating in health insurance exchanges from covering abortions in Nebraska, except when a physician has verified the abortion is necessary to prevent the pregnant woman’s death.4
Prior to Governor Heineman’s announcement, the Department of Insurance (DOI) had explored the possibility of a state-based exchange and released reports summarizing the results of early stakeholder interviews, examining policy options, and analyzing state demographics and the insurance market.5 In addition, the DOI had identified a subcontractor to assist with the planning and design of an exchange, including developing an exchange funding grant application, participating in user group discussions, and developing a cost allocation methodology among state agencies.6
In mid-2012, the DOI described policy assumptions developed through the planning process. Specifically, the assumptions were that Nebraska would have a single state-based exchange, operated within the DOI, which would serve both the individual and small employer markets, though with separate risk pools for the two markets.7 In addition, the exchange would not limit the number of qualified health plans (QHPs). In August and September of 2012, the Governor and DOI held a series of stakeholder meetings and public education sessions to collect public input related to planning an exchange.8
Contracting with Plans: On February 20, 2013, Director of Insurance Bruce Ramge sent a letter to the Center for Consumer Information and Insurance Oversight (CCIIO) requesting to maintain control over plan management functions despite not having entered into a state-federal partnership exchange. The Nebraska Department of Insurance (DOI) has the legal authority and operational capacity to oversee certification of Qualified Health Plans (QHPs). DOI will collect and analyze information on plan rates, covered benefits, and cost-sharing requirements. DOI will also ensure continued plan compliance, manage consumer complaints, and oversee decertification of issuers.9
On March 21, 2013, the state’s Department of Insurance issued a bulletin that spells out the requirements for qualified health plans seeking to sell coverage through the exchange.10 According to the bulletin, insurers must submit their applications by April 30th and plans will be approved by July 31, 2013.
Consumer Assistance and Outreach: The DOI had made development of a marketing and outreach strategy a key next step in the planning process. In addition, the DOI described an approach to the Navigator program and the roles of agents and brokers.11
In addition, Nebraska had planned to establish a call center in the state to respond to inquiries from consumers, Navigators/Assisters, and agents/brokers.12 The call center would have been dedicated to the individual and small business health options program (SHOP) exchanges only, and any questions regarding Medicaid and the Children’s Health Insurance Program (CHIP) transferred to the existing call center in the Nebraska Department of Health and Human Services.
Information Technology (IT): In 2011, the DOI coordinated with the Nebraska Department of Health and Human Services to review the state’s current IT capabilities and operational procedures.13 That same year, the DOI used a Request for Proposals (RFP) to procure subcontractor assistance with the early stages of development, design, and creation of an enrollment, verification, and eligibility IT system for an exchange.14 In March 2012, the DOI released a Request for Information (RFI) for assistance with a cost analysis of current third-party IT platforms and turn-key solutions, components, and services that would be interoperable with existing federal and state systems.15
In September 2012, the state released an RFP for subcontractor assistance with development of multiple components of an exchange’s IT system, including a consumer portal, the enrollment and eligibility system, a case management system, and the business rules engine.16 The contract would have been awarded for a minimum of five years and include both development and maintenance services, though state IT or exchange staff were expect to operate and managed the systems once operational.
Essential Health Benefits (EHB): The ACA requires that all non-grandfathered individual and small-group plans sold in a state, including those offered through the Exchange, cover certain defined health benefits. Based on a subcontractor analysis, actuarial study, and stakeholder insight, the DOI planned to recommend to the Governor that the state’s EHB benchmark plan be Nebraska’s current largest small group plan, Blue Cross Blue Shield of Nebraska- Blue Pride.17 On October 1, 2012, Governor Heineman selected a “Nebraska Option” for the state’s EHB plan.18 However, the plan was not approved by the federal Department of Health and Human Services and the state’s benchmark EHB plan defaulted to Blue Cross Blue Shield of Nebraska- Blue Pride PPO.
The Nebraska Department of Insurance received a federal Exchange Planning grant of $1 million in 2010. In November 2011, the Department of Insurance was also awarded a $5.5 million federal Level One Establishment grant to further plan and design an exchange for the state.19
Expansion of Medicaid
From 2014 to 2017, the federal government will pay for 100% of the difference between a state’s current Medicaid eligibility level and the ACA minimum. Federal contributions to the expansion will drop to 95% in 2017 and remain at 90% after 2020, according to the ACA.
As the ACA was originally written, states would lose all Medicaid funding if they refused to expand their program to the ACA minimum.
However, the Supreme Court in June 2012 ruled that the federal government could not withhold Medicaid funding for states that chose not to expand their programs. The decision effectively allowed state officials to opt out of the expansion, and some have said they will do just that.
Nebraska is not participating in Medicaid expansion.
On March 8, 2013, Nebraska received approval from CCIIO to perform plan management activities. The federal government will retain control over all other Exchange functions.20
1. Governor Dave Heineman’s Remarks, November 15, 2012.http://www.governor.nebraska.gov/news/2012/11/pdf/Federal_Health_Insurance_Exchange.pdf
2. LB 835. Nebraska’s 2012 Health Benefits Exchange Act.http://nebraskalegislature.gov/FloorDocs/Current/PDF/Intro/LB835.pdf
3. LB 838. Nebraska’s 2012 Health Benefit Exchange Act.http://nebraskalegislature.gov/FloorDocs/Current/PDF/Intro/LB838.pdf
4. LB 22. Nebraska’s Mandate Opt-Out and Insurance Coverage Clarification Act of 2011.http://nebraskalegislature.gov/FloorDocs/Current/PDF/Slip/LB22.pdf
5. “Health Insurance Exchange Planning Overview and Recommendations.” Nebraska Department of Insurance. October 2011. http://www.doi.ne.gov/healthcarereform/exchange/Health_Insurance_Exchange_Planning.pdf
6. Nebraska Department of Insurance RFP 12-002Z1, Selection a qualified contractor to provide continued planning and design of the potential exchange. March 12, 2012 http://www.doi.ne.gov/rfp/RFP_12-002Z1/RFP_12-002Z1.pdf
7. Presentation by the Nebraska Department of Insurance. “State of Nebraska’s Health Insurance Exchange: A Presentation to the Public.” September 2012.http://www.statereforum.org/sites/default/files/nebraska_public_meetings_9-14-12.pdf
8. Press release from the office of Governor Heineman. “Gov. Heineman Announces Informal Public Meetings to Discuss Health Insurance Exchanges.” August 15, 2012.http://www.governor.nebraska.gov/news/2012/08/15_health_ins.html
9. Letter from Director Ramge to Gary Cohen. February 20, 2013. http://cciio.cms.gov/Archive/Technical-Implementation-Letters/ne-exchange-letter-2-20-2013.pdf
10. Nebraska Department of Insurance, “Filing Individual and Small Employer Health and Dental Plans in Nebraska,” March 21, 2013. http://www.doi.nebraska.gov/bulletin/cb130.pdf
11. Presentation by the Nebraska Department of Insurance. “State of Nebraska’s Health Insurance Exchange: A Presentation to the Public.” September 2012.
12. Nebraska Request for Proposal. RFP #4119Z1. September 14, 2012.http://www.das.state.ne.us/materiel/purchasing/RFP4119.pdf
13. Nebraska: Healthcare Exchange Planning. Grant #1 HBEIE100048-0101. Reporting Quarter 07/01/2011-09/30/2011. http://www.doi.ne.gov/healthcarereform/exchange/quarterly_reports/2011.09.30.pdf
14. Nebraska Department of Insurance RFP 11-001Z1, Exchange Planning Information Technology (IT) Consulting Services. March 7, 2011. http://www.doi.ne.gov/rfp/11-001Z1/RFP_11-001Z1.pdf
15. Nebraska Department of Insurance RFP 12-001Z1, HIX Information Technology Solution. March 7, 2011http://www.doi.ne.gov/rfp/RFI_12-001Z1/RFI_12-001Z1.pdf
16. Nebraska Request for Proposal. RFP #4119Z1. September 14, 2012.
17. Nebraska Department of Insurance. “Presentation to the Banking, Commerce, and Insurance Committee.” September 14, 2012. http://www.statereforum.org/sites/default/files/nebraska_unicameral_9-14-12.pdf
18. Press release. “Governor Heineman Submits ‘Nebraska Option’ for Obamacare Deadline.” October 1, 2012.http://www.governor.nebraska.gov/news/2012/10/01_ne_option.html
19. Centers for Medicare & Medicaid Services. “Creating a New Competitive Marketplace: Health Insurance Exchange Establishment Grants Awards List.”http://www.healthcare.gov/news/factsheets/2011/05/exchanges05232011a.html (Accessed November 29, 2011).
20. Letter from Gary Cohen to Director Ramge. March 8, 2013. http://cciio.cms.gov/Archive/Technical-Implementation-Letters/ne-pm-letter-3-8-2013.pdf
Also of interest
Provided by the Henry J. Kaiser Family Foundation