Medicaid is a free or low-cost health insurance program. It is for people and families who do not make a lot of money. If you qualify, Medicaid pays for your trips to the doctor. It pays for your medicine at the pharmacy. It pays for the hospital if you get sick or hurt. You do not have to worry about huge medical bills.
Getting health insurance can feel confusing. The words are hard, and the rules seem tricky. This guide will make it easy to understand. We will walk you through exactly what Nebraska Medicaid is. We will explain who can get it, what it pays for, and the steps you must take to sign up today.
Medicaid is a team effort between the United States government and the state of Nebraska. The main federal website for the whole country is medicaid.gov. But because each state helps run its own program, the rules are a little bit different depending on where you live.
In Nebraska, the Medicaid program is managed by a state office. This office is called the Nebraska Department of Health and Human Services, or DHHS for short.
When you get Medicaid in Nebraska, the state puts your physical care, your mental health care, and your medicine all into one single plan. The state calls this plan “Heritage Health.” Whenever you see the name Heritage Health on a paper or a website in Nebraska, it just means the state’s Medicaid program.
To understand Medicaid, you need to know what health insurance does. Health insurance is a way to help pay for your medical bills. Doctors and hospitals cost a lot of money. A simple trip to the emergency room can cost thousands of dollars.
Most people pay a large amount of money every single month just to have health insurance. This monthly bill is called a premium.
If you get Medicaid, the government pays the cost for you. You usually have no monthly bill at all. You can go to the doctor without worrying about how you will pay the huge cost. Medicaid protects you and your family from going into debt just because someone got sick.
Not everyone can get Medicaid. You have to meet certain rules. The biggest rule is about how much money you make. The program is built to help people who do not have enough money to buy their own health plan.
There are five main groups of people who can get Medicaid in Nebraska.
In the past, it was very hard for a healthy adult to get Medicaid if they did not have children. But Nebraska changed its rules. This change was called Medicaid Expansion.
Now, adults between the ages of 19 and 64 can get Medicaid. You just need to have an income below a certain line. You do not need to have children to get it. You do not need to have a disability. If you do not make a lot of money, you can apply.
Children who live in a family that does not make a lot of money can get Medicaid. The rules for kids are much easier than the rules for adults. Even if a family makes a little too much money for the parents to get Medicaid, the children might still qualify.
If a family makes a bit more money, the children might get put into a program called the Children’s Health Insurance Program, or CHIP. In Nebraska, CHIP works just like Medicaid. It makes sure kids can see the doctor, get their teeth cleaned, and get glasses.
Having a baby costs a lot of money. Nebraska Medicaid has special rules to help pregnant mothers. If you are pregnant, the income rules are easier to meet.
If you are approved for Medicaid while you are pregnant, the plan will pay for your doctor visits before the baby is born. It pays for the hospital bill when you have the baby. After the baby is born, you keep your Medicaid coverage for a full year to make sure you stay healthy. Your new baby will also get Medicaid right away.
If you are blind, or if you have a medical problem that makes it so you cannot work, you might qualify for Medicaid. The state looks at your medical records to see if your disability meets their rules.
People who are 65 years old or older can get Medicaid if their income is very low. Most people who are 65 or older get a different type of insurance called Medicare. Medicaid can work together with Medicare. If you have both, Medicaid can help pay for the things that Medicare does not cover.
You must meet all of these basic rules to get Nebraska Medicaid.
To find out if you can get Medicaid, the state looks at your income. Income means the money you get from working at a job. It also includes money you get from other places, like unemployment checks or disability checks.
The government uses a math formula to set the limit. They call this formula the Federal Poverty Level, or FPL.
Because of Medicaid Expansion, an adult in Nebraska can make up to 138% of the Federal Poverty Level and still get Medicaid. The exact dollar amounts change a little bit every single year. The state looks at how many people live in your home and how much money everyone makes together.
Here is a general guide to show you the income limits for an adult applying for Medicaid in Nebraska. These numbers give you an idea of where the line is.
| People in Your Home | Approximate Monthly Income Limit | Who This Rule Is For |
|---|---|---|
| 1 Person (Just You) | About $1,732 a month | Single adults ages 19 to 64 |
| 2 People | About $2,351 a month | Couples or one parent with one child |
| 3 People | About $2,970 a month | A family of three |
| 4 People | About $3,588 a month | A family of four |
Note: The exact limits update every year. Pregnant women and children have higher limits, meaning they can make more money and still get approved.
When you apply, the state asks for your income before taxes are taken out. This is called your gross income. If you look at your pay stub from work, it is the bigger number at the top, not the smaller number you actually take home on payday.
You have to count the money for everyone who lives with you and is part of your family tax group. If you are married, you must count your husband or wife’s income, even if they do not want Medicaid.
Medicaid pays for almost all of the health care you need. It is not a cheap plan that only covers emergencies. It is a full health insurance plan. Here is a clear list of what Nebraska Heritage Health covers when you are approved.
You can go to a regular doctor when you are sick. You can also go to the doctor for a checkup when you feel fine. Checkups help find small problems before they turn into big sicknesses. Medicaid pays for the doctor’s time.
If you get very sick or have a bad accident, Medicaid pays for the emergency room. If the doctor says you need to stay in a hospital bed for a few days, Medicaid pays for the room. It pays for the nurses, the food you eat in the hospital, and the treatments they give you. You will not get a huge bill in the mail when you go home.
Doctors sometimes need to run tests to see what is going on inside your body. They might draw your blood to look at it in a lab. They might take an X-ray of your arm to see if a bone is broken. Medicaid covers these tests.
When a doctor writes you a note for medicine, you take it to a pharmacy. This is called a prescription. Medicaid pays for most medicines. Sometimes, you might have to pay a very tiny amount at the store, like one or two dollars. The state pays the rest of the cost.
Your brain is just as important as your body. Medicaid pays for mental health care. You can talk to a counselor or a therapist if you feel very sad, worried, or stressed. If someone is having trouble with drinking alcohol or taking drugs, Medicaid covers the programs to help them stop and get better.
Medicaid covers all the doctor visits while a mother is pregnant. It pays for the ultrasound pictures to look at the baby. It pays for the hospital delivery room. It also pays for a doctor to check on the mother after the baby is born.
Children on Medicaid get even more benefits than adults. There is a special federal rule called EPSDT. That stands for Early and Periodic Screening, Diagnostic, and Treatment.
In plain language, it means kids get everything they need to grow up healthy. Nebraska Medicaid pays for kids to go to the dentist to get their teeth cleaned and get cavities fixed. It pays for eye exams and gives them free eyeglasses if they need them. It pays for shots to keep them from getting diseases.
Adults do not get as much dental or vision care. Adults on Medicaid can usually get their teeth pulled if they hurt, but they might not get free cleanings or free glasses unless they meet special rules.
When you get approved for Nebraska Medicaid, the state does not pay your doctor directly. Instead, the state hires private health insurance companies to do the work.
In Nebraska, you will pick a health insurance company to run your Heritage Health coverage. You might pick a company like UnitedHealthcare, Nebraska Total Care, or Molina Healthcare.
When you have one of these plans, you must learn about a rule called a “network.”
A network is a list of doctors, hospitals, and pharmacies that have agreed to work with your specific insurance company. You cannot just go to any doctor in the city. You must go to a doctor that is on your plan’s list. If you go to a doctor who is not on the list, the insurance company will not pay, and you will get the bill.
Always call a doctor’s office before you go. Ask them, “Do you take my Nebraska Heritage Health plan?” If they say yes, you are safe.
To learn more about how lists of doctors work, you can read our page explaining What Is a Network?
Signing up for Medicaid requires a few steps. You have to fill out an application. You have to tell the truth about who you are and how much money you make.
The easiest way to learn about the federal rules is to visit medicaid.gov. But to actually apply for your coverage, you must go through the state of Nebraska.
The state office that handles this is the Nebraska Department of Health and Human Services (DHHS). They have an online system called ACCESSNebraska. You will need to search for the Nebraska DHHS website to find the ACCESSNebraska portal.
Here are the ways you can apply:
Applying online is the fastest way. You can use a computer or a smartphone. You go to the ACCESSNebraska website. You will create an account with a password. Then, you will answer questions on the screen. The computer will ask for your name, your address, and your income.
If you do not like using computers, you can call the state office on the phone. A worker will answer the phone. They will ask you the same questions that are on the computer. They will type your answers in for you.
You can also apply face-to-face. There are local DHHS offices in cities and towns across Nebraska. You can walk into the building, ask for a paper application, and sit down to fill it out. A worker in the office can help you if you do not understand a question.
The state will not just take your word for it. You have to prove that what you say is true. You need to show them documents. It is a good idea to gather these papers before you start your application.
Here is what you need to show them:
After you hand in your application and your papers, you have to wait. The state has workers who read your application. They check their computers to make sure your numbers are correct.
By law, the state has up to 45 days to tell you their answer. If you are applying because you have a disability, it takes longer. They have up to 90 days because they have to read your medical records.
If you are approved, you will get a thick envelope in the mail. This is your welcome packet. Inside, you will find:
Once you have your card, you should call a doctor to set up a checkup. Do not wait until you get sick. It is good to meet a doctor while you are healthy so they have your records ready when you actually need them.
Medicaid does not last forever on its own. Your income might change. You might get a better paying job. You might move out of the state. Because things change, the state checks your rules every single year.
This check-up is called a renewal.
About once a year, you will get a letter in the mail from the Nebraska DHHS. The letter will say it is time to renew your Medicaid. You cannot ignore this letter. If you throw it away, you will lose your health insurance, even if you still qualify.
The letter will ask if you still live at the same address. It will ask if you make the same amount of money. You will probably have to send in new pay stubs to prove your current income.
If your income is still under the line, your Medicaid will keep going for another year. If you make too much money now, your Medicaid will end.
Sometimes, people apply for Medicaid and the state says no. Sometimes, people have Medicaid for a few years, but then they get a raise at work and the state stops their coverage.
Do not panic if this happens. You have other choices.
If you are denied Medicaid because you make too much money, you can usually buy health insurance on the regular market. The government has a system to help pay for it. If you make just a little bit above the Medicaid line, the government will give you a very large discount on a private health plan.
This discount is called an Advance Premium Tax Credit, or a subsidy. It acts like a coupon to lower the price of your monthly bill. Many people find plans that only cost them ten or twenty dollars a month after the discount is applied.
You can learn exactly how these discounts work by reading our guide to Tax (APTC, Deductions) in Nebraska.
You might also be able to get health insurance through your job. Many companies offer plans to their workers. You can read more about how all the different types of health insurance fit together in our Health Insurance Overview: Nebraska.
If you need health insurance and you do not make a lot of money, your next step is very simple: You need to apply.
Do not try to guess if you qualify by doing the math in your head. Let the state do the math for you. Gather your pay stubs, find your ID card, and search online for the Nebraska DHHS ACCESSNebraska website.
The application is completely free to fill out. The worst thing that can happen is the state says no, and then you can look at other discounted plans. The best thing that can happen is you get free health insurance that covers you and your family all year long. Start your application today.