Nebraska Medicaid Complete Guide
Did you know that while 26% of Nebraska residents are considered low-income, only 13% are covered by Medicaid? Thousands of people nationwide don’t even realize that they qualify for assistance and are paying too much for their prescriptions and healthcare services. We specialize in Medicare Advantage plans, including special-needs plans for people who are eligible for both Medicare and Medicaid. Our ultimate guide to Nebraska Medicaid can help you discover whether or not you might qualify for more benefits.
Click below to learn more about NE Medicaid:
- What Does NE Medicaid Cover?
- Heritage Health Managed Care Organizations
- Nebraska Medicaid Income Guidelines and Eligibility
- Complete the Nebraska Medicaid Application
- How to Get Both Medicare and Medicaid in Nebraska
What Does NE Medicaid Cover?
The Nebraska Medicaid program includes comprehensive health benefits for medically necessary services, like*:
- Ambulance travel and services
- Chiropractic services (x-rays, 12 manual spinal manipulation appts per year)
- Dental (cleanings, fillings, extractions, x-rays, surgeries, disease control)
- Durable medical equipment, orthotics, prosthetics, and medical supplies
- Family planning (consultations, treatments, lab services, prescriptions, midwife services, etc.)
- EPSDT (early and periodic screening, diagnostic and treatment – for those 20 and under)
- Hearing aids (aids, repairs, batteries/supplies)
- Home health services (aides and nurses, medical supplies, therapy, etc.)
- Hospital services (inpatient, outpatient, emergency room)
- ICF/DD (Intermediate care facilities for persons with intellectual disabilities)
- IMDs (Institutes for mental disease)
- Lab tests and X-rays
- Mental health and substance abuse services
- Non-emergency medical transportation to doctor’s appointments
- Nursing facility services
- Physician services, except for sterilization, sex reassignment surgery, radial keratotomy, cosmetic procedures, and weight control
- Personal assistance for disabled persons, like housekeepers and home aides
- Prescription drugs and some over-the-counter medicines
- Screening services, like mammograms
- Therapy (physical, occupational, speech)
- Vision services and glasses
*There may be limitations on these services and coverage is subject to change each year.
NE Medicaid Prescription Drug Coverage
Doctors are encouraged to prescribe generic versions of prescriptions for Medicaid recipients and are asked to use this preferred drug list. If a doctor needs to pick a non-preferred or a brand-name drug, the doctor is required to seek approval from Nebraska Medicaid. This list represents the over-the-counter drugs that you may be able to get coverage for from NE Medicaid.
The Nebraska Medicaid program has a comprehensive mental health benefit to match its physical health benefit, including most outpatient services either by psychiatrist or psychologist (substance abuse evaluations, family conferences/counseling, medication checks, behavioral analysis, behavioral assessments, therapy, substance abuse services, etc.). Nebraska also has several therapeutic group homes and day care programs that keep mental health patients out of hospitals while they slowly transition back into the “real world.”
Home and Community-Based Services
These are the different types of home and community-based services included with Nebraska Medicaid and how they may apply to you:
- Adult day services – supervision, social activities, meals, and some health services for adults with physical, emotional, or cognitive impairments
- Assisted living – shelter, food, housekeeping, personal care, and medical services provided for aged and disabled members. Members may owe payment for assisted living
- Assistive technology and home/vehicle modifications – specialized equipment and supplies like wheelchair lifts or housekeeping assistance for aged or disabled persons in need
- Disabled child care – medical and personal support for parents of disabled children to allow the parent to work or attend school or job training
- Early Development Network Services – for kids up to age three who are not developing as quickly as they should (includes special instruction, speech/language therapy, physical therapy, psychological services, assistive technology, audiology, transportation, and vision services
- Home-delivered meals – meals containing at least ⅓ of the minimum daily nutrition requirement delivered to disabled adults and seniors who cannot prepare their own food
- Independence Skills Building Service – training in daily living activities (bathing, dressing, mobility, cleaning, accident prevention, etc.) for adults with disabilities
- Personal assistance services – help with daily activities like bathing, dressing, cleaning, etc. for adults living at home with disabilities
- PERS (personal emergency response system) – communication devices for those who live alone or have conditions that may result in frequent falls or other needs for immediate assistance
- Respite – temporary caregivers that can replace primary caregivers who need a break
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Heritage Health Managed Care Organizations
The Nebraska Medicaid program is managed through Heritage Health. Managed Care Organizations like Heritage Health keep the Medicaid program organized and help provide the best possible services for members. Each MCO combines the Nebraska Medicaid physical and behavioral health programs with the pharmacy benefit* to create single “plans” for members.
Each Nebraska Medicaid will enroll in one of the three MCOs. Centene Nebraska Total Care, WellCare of Nebraska, and UnitedHealthcare Community Plan are available in 2019. When you are accepted into the Nebraska Medicaid program, you will receive a packet that tells you which MCO you were automatically enrolled in. If you are unhappy with your automatic selection, you’ll have 90 days to switch. You can change plans and review your benefits from your online account.
*Dental, non-emergency medical transportation, long-term care, nursing home care, and other services for the elderly and disabled will be managed separately through the state and not through your MCO.
Nebraska Total Care
Centene hosts the Nebraska Total Care MCO. Most essential services (hospital stays, home health care, therapy, vision, hearing, urgent care, etc.) are covered at no cost to you. However, you may be asked to pay $3 copayments for brand-name drugs, so it’s important to ask your doctor for generic prescriptions whenever possible.
Some of the unique benefits that this MCO offers are breast pumps, educational baby showers for expecting mothers, a 24-hour nurse advice line, free cell phones for eligible members, incentives for post-hospital appointments, and a “CentAccount.” You can use your CentAccount like cash for doctor visits, immunizations, and more. Young members can also get free Boys & Girls Club memberships. Other members have access to a three-month YMCA membership and an online Weight Watchers membership.
WellCare of Nebraska
WellCare of Nebraska covers annual exams, well visits, generic drugs, family planning, and more at 100%. The only copayments you may need to pay with this plan are $3 for brand-name drugs and $2 for vision exams and glasses. This plan also offers a Healthy Rewards program where you can get reimbursed for performing healthy behaviors, plus you can get a no-cost Weight Watchers membership!
Some of the additional benefits that make the WellCare Nebraska MCO unique are the discount card for necessary items like bread, milk, and detergent, the hypoallergenic bedding benefit for asthmatic members, the additional prenatal and well-baby benefits, and the “community baby showers” which provide education and gift opportunities to pregnant members. Additionally, WellCare gives away ten $1,000 college scholarships each year to Nebraska Medicaid members over the age of 18 and provides dorm room items for college-bound foster care children. Additionally, members over the age of 16 can receive job training, financial education classes, and GED testing at no cost. All members will also receive a monthly card worth $10 to spend on necessities like cold medicine, vitamins, and toothbrushes.
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UnitedHealthcare Community Plans
There are two UnitedHealthcare Community Plan options in Nebraska. One, the UnitedHealthcare Dual Complete plan, is only for those who also have Medicare. It comes with a $0 monthly premium, $1,500 towards dental services, an annual vision exam with $200 towards eyewear, and a card worth $560 to spend on over-the-counter healthcare goods throughout the year (eligible for items like painkillers, cold medicine, and blood pressure monitors). The plan is available in Adams, Buffalo, Burt, Cass, Dodge, Douglas, Gage, Hall, Lancaster, Madison, Otoe, Saline, Sarpy, Saunders, Seward, and Washington counties.
The other UnitedHealthcare Community Plan option is referred to as Heritage Health and is for Nebraska children, families, pregnant women, and other adults who are eligible for NE Medicaid. There are no copayments for this plan, and you can see your primary doctor as many times as you want throughout the year.
Nebraska Medicaid Income Guidelines and Eligibility
Medicaid eligibility is mostly based on your household income and family size. Nebraska does not count all resources as income. That means that you can own a home, one vehicle, and business-related property and still qualify for Medicaid. Additionally, any burial funds and your first $4,000 in resources ($6,000 for couples and an extra $25 for each family member) are not counted. Anyone under 18 will not face any resource income analysis.
Complete the Nebraska Medicaid Application
You can apply for Medicaid either online, by phone, or by a mailed application. We recommend applying online so that you can save your application and activate your online account. Once you have an account, you can perform actions like switching MCOs, renewing your coverage, and looking into your current benefits from the comfort of your home. Nebraska makes the application process easy through ACCESS Nebraska. If you are unfamiliar with using a computer or need further assistance, you can call ACCESS Nebraska customer service from 8 a.m. to 5 p.m. Monday through Friday at 402-471-3121.
How to get Both Medicare and Medicaid in Nebraska
You can benefit from both Medicare and Medicaid by enrolling in a dual-eligible special needs plan, like the UnitedHealthcare Dual Complete Plan mentioned above. There are different dual-eligible plans available in each county, and each plan offers a different set of benefits. To learn about all of the different plans available in your area and for help making a decision, click here for our free service.