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Heath Care Reform

Small business tax credits.  38,300 small businesses in Nebraska could be helped by a new small business tax credit that makes it easier for businesses to provide coverage to their workers and makes premiums more affordable.1  Small businesses pay, on average, 18 percent more than large businesses for the same coverage, and health insurance premiums have gone up three times faster than wages in the past 10 years.  This tax credit is just the first step towards bringing those costs down and making coverage affordable for small businesses.

Closing the Medicare Part D donut hole. Last year, roughly 23,100 Medicare beneficiaries in Nebraska hit the donut hole, or gap in Medicare Part D drug coverage, and received no extra help to defray the cost of their prescription drugs.2 Medicare beneficiaries in Nebraska who hit the gap this year will automatically be mailed a one-time $250 rebate check. These checks will begin to be mailed to beneficiaries in mid-June and will be mailed monthly throughout the year as new beneficiaries hit the donut hole. The new law continues to provide additional discounts for seniors on Medicare in the years ahead and completely closes the donut hole by 2020. 

Support for health coverage for early retirees. An estimated 9,820 people from Nebraska retired before they were eligible for Medicare and have health coverage through their former employers. Unfortunately, the number of firms that provide health coverage to their retirees has decreased over time.3  Beginning June 1, 2010, a $5 billion temporary early retiree reinsurance program will help stabilize early retiree coverage and help ensure that firms continue to provide health coverage to their early retirees. Companies, unions, and state and local governments are eligible for these benefits.

New consumer protections in the insurance market beginning on or after September 23, 2010.

Insurance companies will no longer be able to place lifetime limits on the coverage they provide, ensuring that the 1.1 million Nebraska residents with private insurance coverage never have to worry about their coverage running out and facing catastrophic out-of-pocket costs.

Insurance companies will be banned from dropping people from coverage when they get sick, protecting the 127,000 individuals who purchase insurance in the individual market from dishonest insurance practices.

Insurance companies will not be able to exclude children from coverage because of a pre-existing condition, giving parents across Nebraska peace of mind.

Insurance plans’ use of annual limits will be tightly regulated to ensure access to needed care.  This will protect the 1 million residents of Nebraska with health insurance from their employer, along with anyone who signs up with a new insurance plan in Nebraska.

Health insurers offering new plans will have to develop an appeals process to make it easy for enrollees to dispute the denial of a medical claim.

Patients’ choice of doctors will be protected by allowing plan members in new plans to pick any participating primary care provider, prohibiting insurers from requiring prior authorization before a woman sees an ob-gyn, and ensuring access to emergency care.

Extending coverage to young adults. Beginning on or after September 23, 2010, plans and issuers that offer coverage to children on their parents’ policy must allow children to remain on their parents’ policy until they turn 26, unless the adult child has another offer of job-based coverage in some cases. This provision will bring relief to roughly 5,830 individuals in Nebraska who could now have quality affordable coverage through their parents.4  Some employers and the vast majority of insurers have agreed to cover adult children immediately.

Affordable insurance for uninsured with pre-existing conditions. $22.6 million federal dollars are available to Nebraska starting July 1 to provide coverage for uninsured residents with pre-existing medical conditions through a new transitional high-risk pool program, funded entirely by the Federal government. The program is a bridge to 2014 when Americans will have access to affordable coverage options in the new health insurance exchanges and insurance companies will be prohibited from denying coverage to Americans with pre-existing conditions. If states choose not to run the program, the Federal government will administer the program for those residents.

Strengthening community health centers. Beginning October 1, 2010, increased funding for Community Health Centers will help nearly double the number of patients seen by the centers over the next five years. The funding could not only help the 26 Community Health Centers in Nebraska but also support the construction of new centers.

More doctors where people need them. Beginning October 1, 2010, the Act will provide funding for the National Health Service Corps ($1.5 billion over five years) for scholarships and loan repayments for doctors, nurses and other health care providers who work in areas with a shortage of health professionals. This will help the 5% of Nebraska’s population who live in an underserved area.

New Medicaid options for states. For the first time, Nebraska has the option of Federal Medicaid funding for coverage for all low-income populations, irrespective of age, disability, or family status. 

State Government Insurance Programs Offered

Nebraska Comprehensive Health Insurance Pool (Ne CHIP)


Nebraska Comprehensive Health Insurance Pool (Ne CHIP) www.nechip.com Coverage: NECHIP: Must be a legal Nebraska resident for at least 6 months prior to application, uninsured or ineligible for Medicaid or Medicare and exhausted COBRA continuation. Previous coverage terminated for reasons other than non-payment of premium or fraud, or within last 6 months was rejected for coverage due to pre-existing conditions, or offered coverage with restricted benefits or premiums higher than NECHIP’s. You have a qualified pre-existing condition. Those eligible for HIPAA plans or Trade Adjustment Assistance are also qualified.

Medicaid www.hhs.state.ne.us (Search: Medicaid)


Hospital, Physician, Laboratory and x-ray, Nurse midwife and practitioner services, Clinic services and family planning, Home health agency and personal care aide, Medical transportation, Ambulance, and chiropractic, Durable medical equipment, Orthotics, Prosthetics, and medical supplies, Prescription drugs and hearing aid services, Therapies (physical, occupational, speech pathology, audiology) and podiatry, Adult day treatment, Mental health and substance abuse, Vision and dental, Preventive care (e.g. mammograms). Coverage: Must be a Nebraska resident and U.S. citizen or legal qualified alien. Income limits: Pregnant woman and infants 0-1: 185% FPL. Children ages 1-5: 133% FPL. Children ages 6–18: 100% FPL. Aged, blind, and disabled: For singles, 74% FPL with asset limit of $2,000; for couples not on SSI, 82% FPL with asset limit of $3,000. Parents/caretakers living with children ages 0–18: 58% FPL. Medically-needy: Singles and couples earning $392 a month, with asset limit of $4,000 for singles and $6,000 for couples

Kids Connection Program (KCP) (S-CHIP) www.hhs.state.ne.us/med/ kidsconx.htm


Coverage: KCP: Hospital services, Physician services, Laboratory and x-ray, Family planning, Health checks, Home health agency, Medical transportation, Ambulance, Chiropractic, Dental, Durable medical equipment, Orthotics, Prosthetics and medical supplies, Prescribed drugs, Hearing aids, Therapy (physical, occupational, speech, pathology, and audiology), Podiatry, Mental health and substance abuse, and Vision. WIC: Nutrition education and services, breastfeeding promotion and education, monthly food prescription of nutritious foods, and maternal, prenatal and pediatric health-care services Eligibility: Must be a Nebraska resident under 19 years of age or be a primary care giver with a child under the age of 19, and a U.S. citizen or legal alien and with household income of 200% FPL. Must not be covered by health insurance (including Medicaid).

Every Woman Matters(EWM) www.hhs.state.ne.us/hew/ owh/ewm Nebraska Colon Cancer Screening Program (NCCSP) www.hhs.state.ne.us/CRC


Coverage EWM: Breast exams, Mammograms, Pap test every 2 years, Pelvic exams, various checkups. NCCSP: Fecal occult blood test (FOBT) kits for at home testing, colonoscopies, and education about healthy living. Eligibilty Both: Must be a Nebraska resident and U.S. citizen or a qualified alien. Income limit of 225% FPL. EWM: Must be ages 40–74. Must not belong to an HMO (Health Maintenance Organization), or have Medicaid or Medicare. NCCSP: Men and women who are at least 50 years old.

Indian Health Services www.ihs.gov (Search: Aberdeen)


The Aberdeen Area Office in Aberdeen, South Dakota, works together with its 13 Service Units to provide health care to approximately 94,000 Indians on reservations located in North Dakota, South Dakota, Nebraska, and Iowa. The Service Units include nine hospitals, eight health centers, two school health stations, and several smaller health stations and satellite clinics. Eligibility: Must exhaust all private, state, and other federal programs. Must be regarded by the local community as an Indian; is a member of an Indian or Group under Federal supervision; resides on tax-exempt land or owns restricted property; actively participates in tribal affairs; any other reasonable factor indicative of Indian descent; is a non-Indian woman pregnant with an eligible Indian’s child for the duration of her pregnancy through post-partum (usually 6 weeks); is a non-Indian member of an eligible Indian’s household and the medical officer in charge determines that services are necessary to control a public health hazard or an acute infectious disease which constitutes a public health hazard.

Medicare www.medicare.gov


Offers Part A, inpatient care in hospitals and rehabilitative centers; Part B, doctor and some preventive services and outpatient care; Part C allows Medicare benefits through private insurance (Medicare Advantage); Part C includes Parts A, B, and C not covered by Medicare. Part D covers prescription drugs. Must be U.S. citizen or permanent U.S. resident, and: 1) If 65 years or older, you or your spouse worked for at least 10 years in Medicare-covered employment, or 2) You have a disability or end-stage renal disease (permanent kidney failure requiring dialysis or transplant) at any age

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