The passage of the 2010 Patient Protection and Affordable Care Act continues to change insurance policies across the nation as individual states alter their regulations to bring them in line with federal statute. The major changes already in place deal with pre-existing conditions. Insurers are no longer allowed to deny coverage to children based on such conditions, and children may remain on their parents’ health policies up to age 26. Neither educational nor marital status limits this provision.
General Insurance Regulations
Insurers in Nebraska are required to offer a guarantee of renewability on all plans on which the premiums are up to date. Currently policies can carry pre-existing condition clauses of any duration, and coverage can be denied indefinitely on this basis if the insurer chooses to do so.
Rate levels may be set according to health conditions, but coverage cannot be cancelled on this basis.
Health Care Exchange
Nebraska legislators continue to study the available options for establishing a health insurance exchange in the state, but legislation has been passed that would prevent any exchange that is formed from providing coverage for abortions unless the woman’s life is endangered. Currently the state is waiting for the outcome of the Supreme Court review of the Affordable Care Act scheduled for March 2012.
Pre-Existing Condition Insurance
The Nebraska Pre-Existing Condition Insurance Plan is administered by the U.S. Department of Health and Human services. It provides benefits for primary and specialty care, hospital stays, and prescription medications. According to age and option chosen, the monthly premiums range from $132 to $568 with deductibles of $1000 to $3000. (There are also separate drug deductibles in some cases.) Out-of-pocket expenses are capped at $7000 a year.
The standard for determining Medicaid eligibility is set according to percentages of the Federal Poverty Level, the same formula used to distribute monies from the Children’s CHIP-funded Medicaid Expansions. In Nebraska, children under one year of age are covered by Medicaid at 150% FPL and for CHIP at 200%. The percentages for the 1-5 age group are 133 and 200 respectively, with the 6-19 age bracket qualifying at 100 and 200%.
Pregnant women qualify for Medicaid at 185%, parents at 48%, and non-elderly disabled Social Security recipients at 74%.
The state-funded Kids Connection program covers children from birth to age 19 whose families are at or below 185% FPL.
Approximately 15% of Nebraska residents are enrolled in Medicare coverage, with more than 271,000 resident accessing prescription drug coverage.
Medicare recipients and other low income individuals can also get help with their medical expenses and out-of-pocket costs through the Nebraska Medical Assistance Program.
Additionally, various forms of help are made available through the Long-Term Care Ombudsman Program for Medicare recipients including educational services and counseling.