This guide provides an overview of the Nebraska Health Insurance Exchange including the history of the exchange, how the exchange will operate, and exchange information for Nebraska residents and small businesses.
Nebraska Health Insurance Exchange - Introduction
Beginning in 2014 as part of the Affordable Care Act (ACA), health insurance coverage for individuals and small businesses will become available through new state health insurance exchanges (also called health insurance marketplaces).
Most importantly, the key tax credits (e.g. the small business healthcare tax credits) and tax subsidies (e.g. individual health insurance tax subsidies) will only be available for coverage purchased through a state health insurance exchanges.
All states have three options for setting up an exchange for 2014:
- Build a state-based exchange,
- Enter into a state-federal partnership exchange, or
- Default to a federally-facilitated exchange.
Nebraska will default to a federally-facilitated health insurance exchange, but will maintain control over the plan management functions. The Nebraska Health Insurance Exchange will open for enrollment on October 1, 2013, with coverage starting January 1, 2014.
Nebraska Health Insurance Exchange - History
In November 2012, Nebraska Governor Dave Heineman announced that Nebraska would default to the federally-run Health Insurance Exchange. This came after previous legislation failed to pass the 2012 legislative sessions, and after the Nebraska Department of Insurance (DOI) received federal funding to explore the possibility of a state-based exchange.
In March 2013, Nebraska received approval from the Center for Consumer Information & Insurance Oversight (CCIIO) to perform plan management activities, meaning the Nebraska DOI will review and approve all insurance plans offered through the Exchange.
Nebraska Health Insurance Exchange - What is It?
The Nebraska Health Insurance Exchange will be operated through a federally-run health insurance exchange, also called the Health Insurance Marketplace. Starting in October 2013, Nebraska residents will be able to access information about all the plans available through the Exchange. The SHOP Exchange will also be available to Nebraska small businesses with fewer than 100 employees.
A key part of the Nebraska Health Insurance Exchange is that eligible individuals and families will be able to access individual premium tax subsidies, capping the cost of their premium between 2% to 9.5% of income. Eligibility is based on household size and income (up to 400% FPL). The Exchange will also screen for Medicaid and public assistance programs. These premium tax subsidies will only be available through the Exchange.
According to an estimate by healthcare.gov, approximately 95,713 or 13% of Nebraska’s non-elderly residents are uninsured, of whom 181,023 (92% of these) may qualify for either tax subsidies to purchase coverage in the Marketplace or for Medicaid -- if Nebraska participates in Medicaid expansion.
Nebraska Health Insurance Exchange - What Plans will be Available?
All plans offered through the Nebraska Health Insurance Exchange will meet the ACA definition of a Qualified Health Plan (QHP). The plans will be offered by level of coverage for essential health benefits (EHB), to allow consumers to compare plans on an "apples to apples" basis.
The four "metal" levels are: Bronze (plan pays 60%), Silver (plan pays 70%), Gold (plan pays 80%), and Platinum (plan pays 90%).
Insurance carriers had until April 30, 2013 to submit applications. Insurance carriers and plan rates will go through a formal review process, and are expected to be finalized by the Nebraska DOI by September 4, 2013.
Nebraska Health Insurance Exchange - Role of Insurance Professionals & Navigators
The Nebraska Health Insurance Exchange will follow federal guidelines for insurance professionals selling policies through the Exchange and for navigators assisting consumers and small businesses.
Insurance professionals will be able to register with the Exchange and receive any commissions directly from the carriers (using their Exchange ID number and NPN).
The Nebraska Health Insurance Exchange navigator program will assist consumers in making choices about their health care options and accessing their new health care coverage, including access to premium tax credits for eligible consumers.
Further details on the Nebraska Health Insurance Exchange insurance broker and navigator programs are expected this summer. More information for brokers and navigators can be found here.