Medicaid in Nebraska
Nebraska expanded Medicaid effective October 2020, after voters passed Initiative 427 in November 2018. The state program, called Heritage Health Adult Expansion, covers adults aged 19 to 64 with household incomes up to 138% FPL (about $22,025 for a single person, or $45,540 for a family of four, for 2027 coverage). Around 90,000 Nebraskans enrolled through expansion.
Expansion adults now face federal work requirements, which states must start no later than January 1, 2027. Most expansion enrollees ages 19 to 64 need to show 80 hours a month of work, school, job training, or community service. Parents of children under 14, pregnant people, people who are disabled or medically frail, and some others are exempt. Check with Nebraska DHHS for how and when to report.
Before expansion, childless adults had no path to Medicaid regardless of income. Nebraska was one of the last states to expand via ballot initiative, following the pattern set by other states where legislatures blocked expansion but voters overrode them.
Nebraska's uninsured rate is approximately 6.4%, with roughly 130,000 residents lacking coverage. That is below the national average, partly because of the relatively strong employer-sponsored insurance market in the state.
What plans cost in 2027
Premiums rose again for 2027. Here is the benchmark (second-lowest cost Silver) premium for a 40-year-old before subsidies, from HealthCare.gov plan data:
- Douglas and Sarpy counties (Omaha): about $714 per month, up from $642 in 2026
- Lancaster County (Lincoln): about $713, up from $682
- Hall County (Grand Island): about $851, up from $757
- Scotts Bluff and Lincoln counties (western Nebraska): about $908, up from $826
The enhanced ACA subsidies expired after 2025 and were not renewed. For 2027, the subsidy cliff sits at 400% FPL ($63,840 for a single person, $86,560 for a family of two), and households above that line get no premium help at all. About 128,000 Nebraskans picked a marketplace plan during 2026 open enrollment, according to CMS.
Carriers in Nebraska (2027)
Five insurers offer individual marketplace plans in Nebraska for 2027, the same five as in 2026. All five sell plans in every county, which is unusual for a rural state:
- Blue Cross and Blue Shield of Nebraska offers the most plan options in the state for 2027 and sells in every county.
- Medica has been a consistent presence in the Nebraska marketplace and offers plans statewide. Their networks include most major hospital systems in the state.
- Ambetter Health (Centene) sells plans statewide, often with lower premiums and narrower networks.
- Oscar Health offers plans statewide for 2027. Oscar focuses on a tech-forward experience with telemedicine integration. Their provider network can be narrower, so check that your doctors are included before enrolling.
- UnitedHealthcare offers plans statewide. UHC brings a large national network, though their local marketplace network may be more limited than their employer-plan offerings.
Because every county has the same five insurers, the bigger differences are in networks and prices by region. Western Nebraska still costs more.
Key regions
Omaha metro
Douglas and Sarpy counties are the population center of Nebraska, and the marketplace is most competitive here. Nebraska Medicine (the University of Nebraska Medical Center system), CHI Health, and Methodist Health System are the major hospital networks. All five marketplace insurers sell plans here. Check which of these systems each plan includes.
Lincoln
Lancaster County (Lincoln) has all five marketplace insurers for 2027. Bryan Health and CHI St. Elizabeth are the major hospital systems. The 2027 benchmark premium in Lincoln is about the same as in Omaha.
Western Nebraska
Rural western counties (Scotts Bluff, North Platte, and surrounding areas) have all five marketplace insurers for 2027. Regional West Medical Center in Scottsbluff and Great Plains Health in North Platte are the anchor hospitals. The 2027 benchmark premium here is about 27% higher than in Omaha because of limited provider competition and higher per-capita healthcare costs.
Estimate your subsidy
Subsidy Estimator
Enter your info below to get a rough estimate of your monthly premium tax credit for a 2027 marketplace plan.
Nebraska-specific things to know
Medicaid expansion closed the gap. Unlike states that have not expanded, Nebraska has no coverage gap. Adults earning under 138% FPL qualify for Medicaid, and those above that threshold can access marketplace subsidies. If your income fluctuates near the 138% line (about $22,025 for a single person), you may move between Medicaid and marketplace coverage during the year.
Rural access is a challenge. Nebraska is a large, sparsely populated state. Many rural counties have limited hospital and specialist access. If you live in western Nebraska, verify that in-network providers are within a reasonable distance. Telehealth coverage has improved, but you still need access to in-person care for many services.
Free enrollment help is available. Nebraska has certified marketplace navigators, including the Nebraska Appleseed Center for Law in the Public Interest, which provides free enrollment assistance statewide. Community health centers also offer in-person help.
Resources
- HealthCare.gov for marketplace enrollment (Nebraska uses the federal marketplace)
- Nebraska DHHS Medicaid for Medicaid eligibility and enrollment
- Nebraska Appleseed for consumer advocacy and enrollment assistance