Cost and Coverage of Medicaid in Nebraska

Are you wondering how much does Medicaid cost in Nebraska? This question, together with “What services are covered by Medicaid in Nebraska?" are among the most commonly asked by applicants.

Nebraska Medicaid coverage is a joint federal-state funded program meant to provide affordable health care services to low-income individuals and their families. The Medicaid services are offered under various health programs.

This section covers the following:

  • How much does Medicaid cost in Nebraska?

  • What services are covered by Medicaid in Nebraska?

  • What does Medicaid not cover in Nebraska?

  • Types of Medicaid insurance in Nebraska

How Much Does Medicaid Cost in Nebraska?

Generally, NE Medicaid coverage makes health care services affordable to eligible members. The program ensures the services are available for free or at a low cost. Normal Medicaid cost estimates or copayments do not apply to some members. These members get various services for free: members receiving assistance under the State Disability Program (SDP), members below 18 years and pregnant women through the immediate postpartum period.

To find out how much is NE Medicaid, speak to your health care provider. Your answer to “How much is Medicaid?” may not necessarily be the same as that of another member. The Nebraska Medicaid cost estimates vary depending on your income, household members and other factors.

What Services are Covered by Medicaid in Nebraska?

Nebraska Medicaid coverage caters for medically necessary services offered by a health provider. The provider should be participating in NE Medicaid program for the services to be covered. NE Medicaid services include:

  1. Hospital services. Inpatient, outpatient and emergency room services that are medically necessary.

  2. Physician services. Surgical and medical services performed in a hospital, clinic, your home or at the physician’s office are covered. Other procedures that are part of your treatment or diagnostics, for example X-rays and lab tests, may also be paid for.
    Some medical services have limitations or require approval from Medicaid before they can be performed. Examples include abortions, sterilizations and hysterectomies, cosmetic surgery, and medical transplants.

  3. Lab and X-ray services. NE Medicaid covers medically necessary lab tests, x-rays and other diagnostic tests that are part of your treatment.

  4. Nurse midwife services. Nebraska Medicaid coverage caters for various nurse midwife activities including care to the newborn immediately after birth, normal obstetrical and gynecological services for women, prenatal and postpartum care and attending classes of normal birth.

  5. Nurse practitioner services. Various NE Medicaid services are covered if they are medically necessary.
    The initial diagnostics tests carried out and institution of a plan of therapy or a referral may also be covered. The program also covers the activities of certified family nurse practitioners and certified pediatric nurse practitioners as provided for by federal law.

  6. Clinic services. Various Medicaid services provided by clinics, including Indian Health Services, community mental health centers, federally qualified health centers, and rural health clinics are covered. The program covers both nurse practitioner and physician services.

  7. Family planning services. Medicaid coverage NE program includes family planning services, including consultation and treatment. Services covered include prescribing medications for specific treatment, counseling services, prescribing and supplying contraceptive devices and supplies, lab services, annual and follow-up visits, health history and initial physical examinations.

  8. HEALTH CHECK Services. This Medicaid services program is available to members aged 20 years or younger that are eligible for Medicaid. The program provides complete health check-ups on a regular basis. Members are also covered for diagnostic and treatment services during checkup. Some HEALTH CHECK examinations require prior approval from Medicaid.

Services covered include complete physical examination, health and developmental history, dental and eye examinations, hearing examination, health education, necessary lab tests, immunizations, sport physicals, well-baby, well-child, and treatment of identified problems.

Nebraska Medicaid services covered also include home health agency services, personal assistance services, private-duty nursing services, ambulance services, chiropractic services, dental services, supply of durable medical equipment (DME), prescription drugs, hearing aids, visual care services, screening services (mammograms), nursing facility services, hospice services and ICF/MR services.

What Does Medicaid Not Cover in Nebraska?

What does Nebraska Medicaid not cover? This question is addressed below.

NE Medicaid coverage does not include all health services. For services not covered, you will have to pay for them from your pocket. Below are some services that are not covered:

  • Any services that have been determined not to be medically necessary by your provider

  • Services offered by a provider from out-of-state or out-of-network of the health plan, unless prior authorization has been granted

  • Personal effects or comfort items needed in hospital, e.g. telephone, TV, etc.

  • Use of emergency room for routine treatment

  • Private hospital rooms and private duty nursing

  • Weight control programs not authorized by your provider

  • Sex change surgery and reversal of sterilization

  • Routine physical exams for adults, e.g. when required by your insurance company

  • Treatments generally considered as investigational or experimental

  • Transportation services for members residing in nursing facilities

To find out what is covered by Medicaid, talk with your health care provider. The list of services and items covered by Nebraska Medicaid may be revised from time to time.

Types of Medicaid Insurance in Nebraska

There various types of Medicaid insurance in NE that you can sign up for. The State of Nebraska has contracted various managed care organizations (MCOs) to provide health care services to Medicaid program members. The major health plans in NE are Aetna Better Health of Nebraska, UnitedHealthcare Community Plan and Arbor Health Plan.

The Medicaid types of insurance you apply for will determine the extent of cover you will get for a health service. If you already have a provider that you would like to continue working with after enrolling for Medicaid, find out which health plan he or she has signed up with.



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