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Are you looking for affordable healthcare in Nebraska? If so, consider applying for the Heritage Health plan. This article will cover the main features of the Heritage Health Nebraska plan and plan eligibility requirements. Applying for Nebraska Medicaid can ensure you can get the healthcare you need when you need it.
The Heritage Health plan is Nebraska’s state-managed Medicaid program within which as of 2023, 265,299 Nebraskans are enrolled. Heritage Health combines Nebraska’s physical and behavioral health and pharmacy programs into a single program for managing medical benefits.
This article will cover the main points of Heritage Health, such as how to apply and what procedures and medications are covered.
We will talk about the main Heritage Health plans. With this information, you can ensure you make the best healthcare decisions for yourself and your family.
Also, to prevent shouldering the debt of unexpected medical expenses, many Nebraskans extend their Medicaid coverage to include a more comprehensive range of benefits and services by way of private health insurance.
Nebraska Medicaid aims to provide additional healthcare coverage to low-income children and adults in Nebraska. The program is state-funded, so the Nebraska Department of Health and Human Services runs it.
Nebraska Medicaid might cover doctor visits, surgeries, medications, therapy, and more, depending on the program and patient eligibility. Nebraska expanded Medicaid coverage in 2020 with its Heritage Health Adult program, built on the existing Heritage Health plan. The state and federal governments fund the Nebraska Medicaid programs. The 2022 expenditures for Nebraska Medicaid were approximately $3 billion and paid for 19% of Nebraskan’s medical procedures.
Nebraska’s Heritage Health Adult covers three distinct healthcare plans:
Eligible applicants can choose the plan they want and change their plans. Depending on the medical service, copayments for Nebraska Medicaid services typically range between $1 and $15.
Those accepted to the Heritage Health plan can change their healthcare plan in the first 90 days of enrollment or during open enrollment between November 1 and December 15. The main features of the three plans are as follows:
Healthy Blue covers all primary care visits and emergency hospital care, as well as generic and mail-order pharmacy prescriptions. Healthy Blue also offers a 24/7 behavioral health crisis helpline and coverage for non-medical transportation for women, infants, and children. Healthy Blue also provides health education programs for children and nutrition programs to promote a healthy diet.
Nebraska Total Care covers all PCP visits, hospital stays, family planning, and urgent care. Generic medications are free, while brand medications have a $3 copay. Additional programs for Nebraska Total Care include rewards programs, NICU support, and a 24/7 nursing advice line. Nebraska Total Care Members can also receive discounted gym memberships.
UnitedHealthcare covers all necessary medication and hospital care, as well as vision and hearing services. UnitedHealthcare provides every patient with a dedicated coordinator to help them access individual medical services they may need. Unlike the other programs, UnitedHealthcare offers programs to help quit smoking.
A Nebraska Medicaid card is a nine-digit card that Medicaid members can use to get medical services. Depending on the provider an individual is signed up with, the information on the card may vary slightly. For the most part, the nine-digit code also has a two-digit identifier that makes the code unique to the cardholder. Patients can present their Nebraska Medicaid card to medical providers to determine eligibility.
Each card contains the date of issuance, the client’s name, their nine-digit ID number, and electronic routing information for their pharmacy in the upper-left corner. The ID number is unique and is meant to be yours for all medical procedures.
You can apply for Nebraska’s Medicaid program online at ACCESSNebraska. You can also use the online portal to verify program eligibility documents. You first will have to create an account and answer the application questionnaire. These questions are then used to determine your eligibility for the program. Once you submit the application, you will receive a confirmation number.
It normally takes about 20 to 30 minutes to complete the application. Instead of applying online, you can call a state Medicaid office at (855) 632-7633 and request a paper application. You can also go and fill out an application in person by visiting a local DHHS office.
To be eligible for Nebraska Medicaid, a patient must:
Those who hold Nebraska Medicare are also eligible for Nebraska Medicaid but cannot get it through the expanded Heritage Health Adult plan. Medicaid eligibility income levels for those under 65 years old are as follows.
| Size of Household | Max Income Eligibility Limit |
|---|---|
| 1 | $19,392 |
| 2 | $26,228 |
| 3 | $33,064 |
| 4 | $39,900 |
| 5 | $46,737 |
| 6 | $53,573 |
| 7 | $60,409 |
| 8 | $67,245 |
Households with more than eight people can add an additional $6,836 per person. Note that income limits do not count some specific assets, such as:
Children under the age of 18 and eligible pregnant women are not subject to resource limit requirements. You can also apply for Heritage Health if you have marketplace health insurance. If you apply for Heritage Health and have a third-party plan, you need to inform them. You can also apply for Heritage Health if you have an employer-sponsored healthcare plan.
If the Department of Health determines you are ineligible for Medicaid, they will send your application to the marketplace, where you can buy a plan instead.
Once you enroll in a Medicaid program and are accepted, you should receive your Medicaid card in the mail. It will take about two weeks for your card to reach you. If your card still hasn’t arrived in two weeks, you can call the main Medicaid office to check on it. You will need to provide your unique Medicaid ID number to check on the status of your card.
Instead of a card, you may use a Nebraska Medicaid Presumptive Eligibility of Application. The patient will receive this document after the department deems their application eligible. Presumptive eligibility begins on the first of the month, and you can present this application to receive medical services while waiting for your Medicaid card.
If your Medicaid card is lost or stolen, you must call your provider for a replacement card. Using a Medicaid card that is not yours is illegal, so stolen cards should be reported. Once you report a stolen card, the state will send you a new one in the mail within a few weeks.
Keep in mind that if you have Heritage Health Adult Medicaid, you need to contact your specific plan provider to get a new card. So, for example, if you are enrolled under Healthy Blue Nebraska, you must contact Healthy Blue to get a new Medicaid card.
Medicaid recipients must renew coverage yearly to determine whether they are still eligible. The Department of Health and Human Services will send you a reminder when it’s time to renew. You can renew your Medicaid coverage online by printing and mailing/faxing a physical application.
Nebraska Medicaid covers all necessary medical assistance and care, including doctor visits and hospital care. Below is a detailed list of what Nebraska Medicaid does and does not cover. Nebraska Medicaid ensures comprehensive coverage, encompassing vital medical services like doctor visits and hospital care. The spectrum extends to prescriptions, dental needs, and extended healthcare. Travel for medical purposes is also discussed. A detailed list clarifies the breadth of coverage, aiding beneficiaries in optimizing their healthcare benefits.
Nebraska Medicaid and Heritage Health cover teeth cleanings, fillings, teeth extractions, X-rays, and dental surgeries. Medicaid will also cover any root canal therapy for permanent teeth. Some dental services will require prior authorization. The annual cap for dental services for adults is $750 per year. Medicaid will cover prior authorized braces for patients 20 years or younger if teeth correction is medically necessary. Dental copayments are a minimum of $3 per selected service. While Nebraska Medicaid and Heritage Health provide comprehensive dental coverage, the limitations may see roadblocks for those who have more serious dental issues. Investing in private dental plans in Nebraska is advisable.
Nebraska Medicaid and Heritage Health cover most prescribed medications and some OTC medications. Nebraska’s preferred drug list requires prior authorization and has a maximum opioid limit of 120 milligrams per day. Medicaid will cover drugs not on the PDL if the patient has an allergy, contraindication, or adverse reaction to a drug on the preferred list.
Medicaid copayments for prescription drugs are as follows:
Prescriptions are limited to no more than three months of medication per filling or more than one month of any controlled substance or injectable medication, except insulin. Medicaid will not cover any drugs not approved by the FDA and excludes many drugs from its preferred list, so be sure to check whether your medication is covered.
Nebraska Medicaid will not cover healthcare services in other states unless it is to care for an immediately life-threatening condition or you are not stable enough to be transferred to a medical center in Nebraska. If you are traveling outside of Nebraska for leisure, invest in proper travelers insurance.
Nebraska has a number of programs that extend Medicaid coverage to individuals not normally eligible to apply.
Routine checkups and basic medical treatments will only get you so far. Many patients require additional care, but they go without because of financial concerns, lack of coverage, and restricted access. Investing in quality disability insurance is an excellent way to assist with some of the costs incurred with not being able to work either temporarily or permanently, and to help with the cost of medical needs.
On top of coverage for prescription drugs and dental work, Nebraska Medicaid also covers extended health care services.
Here are some examples of extended health care available through the Nebraska Medicaid system:
The Children’s Health Insurance Program is a Medicaid expansion program for children who are not eligible for Medicaid but don’t have another healthcare plan. CHIP benefits are the same as Medicaid benefits and have a simpler application process. Nebraska also has the 5099 CHIP program, which is specifically for unborn children of pregnant women who are not eligible for CHIP or Medicaid.
Nebraska Medicaid does not have any special coverage status for students over the age of 18 years old. Adult students can be eligible for Nebraska Medicaid if they make less than 138% of the federal poverty level.
Seniors over the age of 65 in Nebraska are eligible for Medicaid coverage, including nursing home care, long-term care, and special disability care (e.g., blind, deaf, etc.). Otherwise, the same eligibility requirements apply to seniors as to everyone else who applies to Nebraska Medicaid. The main difference is seniors cannot get Medicaid through Heritage Health Adult plans.
Nebraska also offers Medicaid benefits for Indigenous Americans and military service members and veterans.
Nebraska offers Medicaid coverage for American Indian or Alaska Native individuals. Native Americans and Alaskans are exempt from Medicaid premiums and copay, but they still have to participate in spend-down programs to meet eligibility requirements. Nebraska also offers advanced premium tax credits so that tribal members can lower health insurance costs.
Nebraska works with the Department of Veterans Affairs to provide medical services to military personnel and their families. Nebraska has crisis intervention services specifically for veterans as well as emotional counseling and support services, including VetSet, NAMI Homefront, and the Joint Family Support Assistance Program.
Nebraska Medicaid and its programs will not cover unnecessary medical or cosmetic procedures. Medicaid also does not cover medications not on the preferred drug list unless you demonstrate you need an alternative. Neither does Medicaid cover private hospital services, such as private hospital rooms or private nursing treatment.
More specifically, Nebraska Medicaid will not cover:
Medicaid coverage may change from year to year, so ensure you check back frequently to see whether covered procedures and medications have changed.
It can be confusing to know whether a particular procedure is covered by Nebraska Medicaid. And so, we put together the following list to cover common medical procedures that Medicaid does and does not cover.
| Dental | |
|---|---|
| Nebraska Medicaid will cover most dental procedures provided you receive prior authorization. | |
| X-Rays and Exams | Yes, Nebraska Medicaid covers dental X-rays and routine exams. Medicaid will cover one dental exam every 180 days (six months), unless a doctor determines the patient needs more frequent medical checkups. |
| Wisdom Teeth | Yes, Nebraska Medicaid will cover wisdom teeth extraction as long as your dentist determines it is medically necessary to avoid dental occlusions and other complications. You will need prior authorization for Medicaid to cover wisdom teeth extraction. |
| Vision | |
|---|---|
| Eye Exams | Yes, Nebraska Medicaid covers one eye exam every two years for patients over 21 years old and 12 months for patients younger than 20. Patients can receive more frequent eye exams if deemed necessary. |
| Glasses | Yes, Nebraska Medicaid covers eyeglasses, including lenses and frames. Medicaid will cover contact lenses as long as they meet general contact lens guidelines or the patient cannot wear glasses because of another condition. |
| Laser Eye Surgery | Nebraska Medicaid generally does not cover laser eye surgery procedures, such as LASIK. |
| Surgery | |
|---|---|
| In general, Nebraska will cover surgical procedures if they are medically necessary for the patient’s health or comfort. Medicaid does not cover cosmetic procedures without a medical purpose. Nebraska Medicaid will cover up to 14 days of post-surgery care. | |
| Rhinoplasty | Yes, Nebraska Medicaid will cover rhinoplasty and nose surgery if it is medically necessary to help correct breathing issues. Rhinoplasties for purely cosmetic reasons are not covered by Medicaid. |
| Breast Reduction | Yes, breast reduction for medical reasons will be covered by Nebraska Medicaid. The portion of the surgery covered by Medicaid depends on the surgery provider. The patient must demonstrate that their breasts cause back or neck pain. Medicaid will also cover breast reconstruction procedures. |
| Hospital | |
|---|---|
| Nebraska Medicaid will generally cover all hospital-related expenses, including inpatient, outpatient, and emergency care. | |
| Hospital stays | Yes, Nebraska Medicaid covers all necessary hospital services, including the costs of a room, lab tests, procedures, and food. Medicaid will not cover any additional services that are not part of a normal hospital stay. |
| Ambulance transportation | Yes, Medicaid will cover ambulance transportation for medically necessary conditions. Medicaid will not cover ambulance trips or transportation that is not medically necessary. |
| Giving birth | Yes, Nebraska Medicaid will cover prenatal care, as well as delivery and post-natal care. |
| Sexual Health | |
|---|---|
| Gynecologist visits | Yes, Nebraska Medicaid covers gynecological care for adults. OBGYN-covered care includes examinations, pap smears, mammograms, and breast cancer screenings. |
| Erectile Dysfunction | Nebraska will not cover drugs prescribed specifically for erectile dysfunction, but it will cover ED drugs if they are prescribed for a different purpose. Getting ED drugs will require prior authorization. |
| Birth Control | Yes, Nebraska Medicaid covers family planning services, including consultations, procedures, follow-up visits, and laboratory services. Medicaid can also cover contraceptive supplies and counseling services, such as IUDs and birth control medication. |
| Fertility Treatment | Yes, Nebraska will cover fertility treatments if infertility is the result of a suspected medical condition. However, Medicaid will not cover fertility treatment if the goal is to simply improve the chances of pregnancy. Neither will Medicaid cover in-vitro fertilization. |
| Specialist Services | |
|---|---|
| Nebraska’s Medicaid program generally will cover specialist visits if you receive a referral from your primary care physician. | |
| Dermatology | Yes, Nebraska Medicaid covers dermatologist appointments and necessary dermatological procedures. |
| Physiotherapy | Yes, Nebraska Medicaid will pay for all necessary physical therapy and occupational therapy services. Patients can receive services in their homes, at a doctor’s office, or at a hospital. |
| Massage Therapy | Yes, Medicaid covers all physically necessary rehabilitation, including massage therapy, as it is part of recovering from an injury or an illness. |
| Podiatry and Foot Care | Yes, Nebraska Medicaid covers podiatry and foot care in the office, hospital, or home. For example, Medicaid will cover callus removal, foot hygiene procedures, and foot surgery for medically necessary reasons. |
| Allergy Testing | Yes, allergy testing is covered under Nebraska Medicaid as a diagnostic procedure. |
| Sleep Physician Services and CPAP Machines | Yes, Nebraska Medicaid will cover therapeutic services like sleep therapy if they are reasonably medically necessary. Similarly, Medicaid will cover the cost of a CPAP machine with prior authorization if you have sleep apnea. |
Nebraska Medicaid coverage covers several necessary medical procedures and services, but it doesn’t cover everything. Nothing in Nebraska Medicaid prevents you from getting additional private health insurance coverage to fill gaps in Medicaid coverage. For example, a third-party private insurance policy might cover a specific medication that is not on the Nebraska PDL. Other types of private insurance, such as life insurance, can help pay for medical costs Medicaid will not cover, especially in the event of your passing.
More specifically, a third-party insurance plan can provide:
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