Health Insurance in Nebraska

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 $20,780 for a single person in 2026). Around 90,000 Nebraskans enrolled through expansion.

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 2026

Nebraska marketplace premiums saw moderate increases for 2026. The benchmark Silver plan (second-lowest-cost Silver) varies significantly by rating area, with monthly premiums for a 40-year-old ranging from about $500 to $650 before subsidies depending on the county. Rural western Nebraska tends to have higher premiums than the Omaha and Lincoln metro areas due to fewer providers and less competition.

With the enhanced ACA subsidies expiring after 2025, many Nebraskans face higher out-of-pocket costs for 2026. The subsidy cliff is back at 400% FPL (about $62,160 for a family of two), meaning households above that threshold get no premium help at all. Nebraska had roughly 100,000 marketplace enrollees in 2025, and that number could drop as costs rise.

Carriers in Nebraska (2026)

Three insurers offer individual marketplace plans in Nebraska for 2026:

• Medica is the largest marketplace carrier in Nebraska, offering plans statewide. Medica has been a consistent presence in the Nebraska marketplace and offers both HMO and PPO options in some areas. Their networks include most major hospital systems in the state.
• Oscar Health offers plans in the Omaha metro area (Douglas, Sarpy, and surrounding counties). Oscar focuses on a tech-forward experience with telemedicine integration. Their provider network is narrower than Medica's, so check that your doctors are included before enrolling.
• UnitedHealthcare offers plans in select Nebraska counties. UHC brings a large national network, though their local marketplace network may be more limited than their employer-plan offerings. Available primarily in the eastern part of the state.

Rural counties in western Nebraska often have only one carrier (Medica), which limits price competition. The Omaha metro area has the best competition with all three carriers available.

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 three marketplace carriers operate in the Omaha area, giving consumers the most plan choices in the state.

Lincoln

Lancaster County (Lincoln) is served by Medica and UnitedHealthcare. Bryan Health and CHI St. Elizabeth are the major hospital systems. Lincoln premiums tend to be slightly lower than Omaha due to lower regional healthcare costs.

Western Nebraska

Rural western counties (Scotts Bluff, North Platte, and surrounding areas) typically have only Medica as a marketplace option. Regional Medical Center in Scotts Bluff and Great Plains Health in North Platte are the anchor hospitals. Premiums here can run 15-25% higher than in Omaha because of limited provider competition and higher per-capita healthcare costs.

Estimate your subsidy

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 $20,780 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