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Financial help for Nebraska Medicare enrollees

Medicaid expansion enrollees who are 55 or older will be subject to Medicaid estate recovery in Nebraska

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As a Medicare beneficiary, where you live – meaning your state of residence – can have a significant impact on the care that you receive and how you pay for that care during your “golden years.” This page explains how Nebraska’s regulations and policies are likely to affect your bottom line.

Does Nebraska help with my Medicare premiums?

Many Medicare beneficiaries who struggle to afford the cost of Medicare coverage are eligible for help through a Medicare Savings Program (MSP). In Nebraska, these programs pay for Medicare Part B premiums, Medicare Part A and B cost-sharing, and – in some cases – Part A premiums.

  • Qualified Medicare Beneficiary (QMB) / Medicaid for the aged, blind and disabled: The income limit is $1,063 a month if single and $1,437 a month if married. QMB pays for Part A and B cost sharing, Part B premiums, and – if a beneficiary owes them – it also pays their Part A premiums. Nebraska QMB enrollees receive full Medicaid benefits if they have assets below $4,000 if single and $6,000 if married.
  • Specified Low Income Medicare Beneficiary (SLMB):  The income limit is from QMB levels up to $1,276 a month if single or $1,724 a month if married. SLMB pays for Part B premiums.
  • Qualified Individuals (QI): The income limit is from SLMB levels up to $1,436 a month if single or $1,940 a month if married. QI pays for Part B premiums.

Nebraska doesn’t count – or it ‘disregards’ – the first $20 of an applicant’s unearned income (e.g. Social Security or pensions) when determining their eligibility for an MSP, Medicaid for the aged, blind and disabled, and Long Term Services and Supports (LTSS) programs. When an applicant has income from employment, less than half of that income is counted.

Income and asset limits for QMB, SLMB and QI always vary based on marital status, but in most states the eligibility limits for Medicaid for the aged, blind and disabled and Long Term Services and Supports (LTSS) vary based on the number of household members (but not marriage status).

MSP asset limits: The asset limit for QMB, SLMB and QI is $7,860 if single and $11,800 if married. As noted above, QMB enrollees with assets below $4,000 if single and $6,000 if married also qualify for full Medicaid benefits.

Who's eligible for Medicaid for the aged, blind and disabled in Nebraska?

Medicare covers a great number services – including hospitalization, physician services, and prescription drugs – but Original Medicare doesn’t cover important services like vision and dental benefits. Some beneficiaries – those whose incomes make them eligible for Medicaid – can receive coverage for those additional services if they’re enrolled in regular Medicaid benefits for the aged, blind and disabled.

Income eligibility: The income limit is $1,063 a month for a one person household or $1,437 for a two person household.

Asset limits: The asset limit is $4,000 for one person household and $6,000 for a two person household.

Nebraska’s Medicaid spend-down for regular Medicaid for the aged, blind and disabled benefits and LTSS

Applicants who are over-income for Medicaid benefits for the aged, blind and disabled in Nebraska can enroll in the Medicaid spend-down, which allows enrollees to subtract incurred medical expenses from their income that is counted toward the Medicaid income limit.

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When an applicant is approved for the spend-down, Medicaid calculates the portion of their monthly income above the program’s income limit – which is known as “excess income.” Enrollees activate their spend-down benefits by submitting medical bills equal to this amount. Spend-down benefits are usually approved in one month increments, with submission of additional medical expenses required for additional coverage.

An applicant’s excess income is reduced by what they pay for health insurance premiums (such as Medicare Part B or Medigap).

The spend-down in Nebraska covers Long Term Services and Supports (LTSS).

Income eligibility: The income limit is $392 a month for both one and two person households (but this limit increases by $91 a month for each additional household member).

Asset limits: The asset limit is $4,000 if single and $6,000 if married.

How does Nebraska regulate long-term services and supports (LTSS)?

Medicare beneficiaries increasingly rely on long-term services and supports (LTSS) – or long-term care – which is mostly not covered by Medicare. In fact, 20 percent of Medicare beneficiaries who lived at home received some assistance with LTSS in 2015. Medicaid fills this gap in Medicare coverage for long-term care, but its complex eligibility rules can make qualifying for benefits difficult. What’s more – eligibility rules vary significantly from state to state.

Medicaid nursing home coverage

Income limits: The income limit is $1,063 a month if single and $1,437 a month if married. If only one spouse needs Medicaid, the income limit for single applicants is used (and usually only the applicant’s income is counted).

However, nursing home enrollees are not allowed to keep all of their income up to this limit. Enrollees must pay nearly all their income each month toward their care, other than a small personal needs allowance (of $60 a month) and money to pay for health insurance premiums (such as Medicare Part B and Medigap).

Assets limits: The asset limit is $4,000 if single and $6,000 if married. If only one spouse has Medicaid, the other spouse can keep up to $128,640.

Certain assets are never counted, including many household effects, family heirlooms, certain prepaid burial arrangements, and one car.

Home and Community Based Services (HCBS) waivers

Every state’s Medicaid program covers community-based LTSS services. Programs offering this type of care are called Home and Community Based Services (HCBS) waivers. Enrollees continue living in the community, rather than entering a nursing home. In Nebraska, HCBS recipients must need a nursing home level of care.

Income limits: The income limit is $1,063 a month for a one person household and $1,437 a month for a two person household.

If only one spouse needs Medicaid, the income limit for single applicants is used – and usually only the applicant’s income is counted.

Asset limits: The asset limit is $4,000 for a one person household and $6,000 for a two person household. If only one spouse has Medicaid, the other spouse can keep up to $128,640.

Spousal impoverishment protections in Nebraska

Eligibility rules for Medicaid LTSS programs differ from other Medicaid benefits when only one spouse is applying. When this occurs, only the applying spouse’s income is counted. (Normally with Medicaid benefits, the income of both spouses is counted – regardless of who is applying.)

If only one spouse has Medicaid, spousal impoverishment rules allow the other spouse to keep a Minimum Monthly Maintenance Needs Allowance (MMMNA) from their Medicaid spouse’s income (along with resource and housing allowances). These rules only apply when one spouse needs Medicaid nursing home care or HCBS, and the other spouse doesn’t receive any Medicaid benefits.

In Nebraska in 2020, these spousal impoverishment rules allow community spouses to keep:

Medicaid home equity limit in Nebraska

Federal law requires states to limit eligibility for Medicaid nursing home and HCBS to applicants with a home equity interest below a specific dollar amount. In 2020, states set this home equity level based on a federal minimum of $595,000 and maximum of $893,000.

Nebraska requires applicants for Medicaid LTSS to have a home equity interest of $595,000 or less.

Penalties for transferring assets in Nebraska

Because long-term care is expensive, individuals can have an incentive to give away or transfer assets so they qualify for Medicaid. To curb these asset transfers, federal law requires states to penalize applicants for Medicaid nursing home care who have given away or transferred assets for less than their value. States can choose to also have a penalty period for HCBS. Medicaid will not pay for LTSS during this period.

Nebraska has chosen to have an asset transfer penalty for nursing home care and HCBS. This penalty is based on a 60 month lookback period, and is calculated by dividing the amount of money transferred or given away during that period by the monthly cost of nursing home care.

Estate recovery in Nebraska

A state’s Medicaid agency is required to recover what it paid for LTSS and related medical costs while a beneficiary was 55 or older. The law allows states to also pursue estate recovery against enrollees who did not receive LTSS.

Nebraska has chosen to recover the cost of all Medicaid benefits received beginning at the age of 55. This means the state pursues estate recovery against enrollees in that age group who received Medicaid coverage for services like primary care or hospitalizations. And under the state’s current rules, Medicaid expansion enrollees who are 55 or older will also be subject to Medicaid estate recovery when they pass away (Medicaid expansion takes effect in Nebraska in October 2020). Nebraska will also recover from the estates of younger enrollees who were institutionalized.

When Medicaid coverage was administered by a Managed Care Organization (MCO) (i.e., a private insurer with which the state contracts to administer Medicaid coverage), the state will attempt to recover what it paid the MCO. This means the estate recovery amount could be more (or less) than the actual cost of Medicaid services received. As a result, estates of enrollees who use little care may be hit large estate recovery charges.
Nebraska may choose to not pursue estate recovery from enrollees who are survived by their spouse or a child who is under 21 or disabled. The state may also grant a hardship exemption from estate recovery for certain enrollees based on their specific situation.

Congress exempted Medicare premiums and cost sharing from Medicaid estate recovery starting with benefits paid after December 31, 2009, but will attempt to recover the cost of MSP benefits paid through that date.

Where can Medicare beneficiaries get help in Nebraska?

Nebraska State Health and Insurance Assistance Program (SHIP)

Free volunteer Medicare counseling is available by contacting the Nebraska State Health and Insurance Assistance Program (SHIP) at (800) 234-7119.

The SHIP can help beneficiaries enroll in Medicare, compare and change Medicare Advantage and Part D plans, and answer questions about state Medigap protections. SHIP counselors may also be able to offer referrals to local agencies for services like home care and long-term care. The SHIP’s website has more information on the services it offers.

Elder Law Attorneys

Elder law attorneys can help individuals plan for Medicaid long-term care benefits. The National Academy of Elder Law Attorneys (NAELA) has a search feature beneficiaries can use to find an elder attorney locally.

Nebraska Area Agencies on Aging (AAAs)

In Nebraska, Area Agencies on Aging (AAAs) can provide information about services to help with aging or living with a disability, and can help with planning for long-term care. This is a list of AAAs in Nebraska.

Where can I apply for Medicaid in Nebraska?

The Medicaid program is administered by the Nebraska Department of Health and Human Services (DHHS). Seniors and people with disabilities can apply for Medicaid by visiting this website, calling (855) 632-7633 or visiting a local Public Assistance office.


Josh Schultz has a strong background in Medicare and the Affordable Care Act. He coordinated a Medicare technical assistance contract at the Medicare Rights Center in New York City, where he represented clients in extensive Medicare claims and appeals. In addition to advocacy work, Josh helped implement federal and state health insurance exchanges at the technology firm hCentive. He has also held consulting roles, including at Sachs Policy Group, where he worked with hospital, insurer and technology clients.

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