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