Financial Impact of Nebraska Revised Statute 44 -3612 on
Nebraska Seniors

NEW NEBRASKA LAW LB852 AFFECTS HOW YOUR SUPPLEMENTAL INSURANCE POLICY PAYS

 

Do you or someone you love use medical equipment, prosthetics or orthotics?

(Walker, rollator, wheelchair, scooter, power wheelchair, lift chair, patient lift, hospital bed, orthotic shoe inserts or diabetic shoes, artificial limbs and body parts, and repairs to this equipment)

 

PLEASE GO TO THE WEBSITE BELOW TO LEARN MORE. WE ARE FIGHTING TO REPEAL OR REVISE NEBRASKA REVISED STATUTE 44-3612 COMPLETE THE SHORT SURVEY AND SEND IT IN. WE WILL USE THE SURVEY TO CONVINCE OUR LEGISLATORS THAT THIS LAW NEEDS TO BE REPEALED OR REVISED. THANK YOU FOR YOUR SUPPORT!

 

WEBSITE: RepealLB852.com (Please complete the survey)

 

What’s going on? This new law went in to effect on 7/19/24 and it overrides your private contract with your insurance company. If you have federal Medicare and a Plan F, G, or J supplemental insurance policy, then you are financially affected by this law. Your supplemental insurance policy is a federally regulated policy that insurance companies can not change for any reason.  The insurance industry had tried in the past to get Medicare to put a 15% limiting fee on medical equipment, prosthetics and othotics, only to be told by the federal government that they would never change their law and put a limiting fee on these products.  So to try and find a way around that, in the summer of 2023, a senior representative from Mutual of Omaha went to Senator Mike Jacobson of North Platte to complain that there was a handful of companies they believed were overcharging for their products with no actual proof, and told the senator that this 15% limiting fee would be good for Nebraska seniors.

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During the 2024 Legislative session, the Nebraska Unicameral passed LB852 that allows supplemental insurance companies to reduce their payments for the excess above Medicare’s allowable on Durable Medical Equipment, Prosthetics and Orthotics (DMEPOS) from 100% of the excess, to only 15% of the excess above Medicare’s allowable. The Centers for Medicare and Medicaid Services (CMS) has always had a law in place stating there was no limiting fee on DMEPOS equipment because it is a product within a category. Within that category, there are many products to choose from that have different features, comfort, weight, quality and pricing. Medicare was not going to restrict a persons freedom of choice to choose a product within a category that best suites their medical equipment needs. With this new law, Nebraska is the first state in the country to override the federal government’s law and impose a limiting fee on DMEPOS.

 

How did this happen? The supporter's of this bill, Mutual of Omaha, Blue Cross Blue Shield of Nebraska, and UnitedHealthcare/AARP gave false and misleading testimony to our senators in the Banking, Commerce and Insurance Committee. They convinced our senators that this new law would reduce Nebraska senior’s insurance premiums because their insurance company’s financial liability to pay out on claims would be reduced. Of course, nobody’s insurance premiums in Nebraska have gone down since the law went into effect. Instead, the cost to seniors who use DMEPOS equipment has grown exponentially because of it. Only the three companies listed above, along with the Nebraska Insurance Federation, testified at the legislature’s committee hearing with misleading and false information prior to the senator’s vote on the bill. Senator Jacobson did not inform anyone who may possibly testify against the bill, so there was literally no opposition to stop this bill from becoming law.

 

What does this mean for me or my loved ones? Medicare sets their allowable on a product category based on the least costly piece of equipment available. Medicare pays 80% of that allowable price. A supplemental Plan F, G, and J policy contract pays the 20% coinsurance of Medicare’s allowable, and 100% of the excess above that allowable amount. Therefore prior to 7/19/24, you would have $0 out of pocket for all DMEPOS equipment. See some examples in the chart below. This chart only shows Medicare’s non-rural allowable, rural areas in the state have a higher allowable rate. (Pricing is rounded to nearest dollar)

 

DME Equipment Category        Price          Medicare               Supp. Ins.            Supp. Ins.             Previous             New Cost

                                                                      Allowable/            Payment             Payment             Cost to                to Seniors

                                                                      Payment               Before                 After                    Seniors                After Law

                                                                      Amount                 7/19/24               7/19/24                Before Law _________________________________________________________________________________________Walker with seat – low end       $100          $77/$62                 $38                      $27                      $0                        $11

Walker with seat – high end     $1,380        $77/$62                 $1,318                   $27                      $0                        $1,318

Lift chair – low end                    $795          $334/$267             $528                    $117                     $0                        $411

Lift Chair – high end                  $4,045       $334/$267             $3,778                  $117                     $0                        $3,661

Power Wheelchair – low end    $3,295       $2,592/$2,074        $1,221                  $821                     $0                        $400

Power Wheelchair – high end   $45,000    $2,592/$2,074        $43,237               $821                     $0                        $42,537

Batteries (12V 35A -Pair)           $300         $181/$145               $155                    $58                       $0                        $97

Batteries (12V 50A - Pair)          $590         $275/$220             $315                    $96                       $0                       $274

 

The above chart only shows the low end and high end of pricing of products in each category. There are many other equipment products that are available and priced in between the low and high end price.

 

What can I do? The number one thing you can do to help repeal this bill to get your insurance coverage benefits back is to complete the survey on this website and click the button to email the survey to us.  With your help, we will be able add your voice to the list of tens of thousands of Nebraskans financially harmed by LB852.

 

Contact Governor Jim Pillen and the state Senator from your district by email, letter or phone and ask them to repeal or revise this law. Inform them that this law has done the following:

(Some or all of these may apply to you)

1. It is taking money out of your pocket for medical care expenses and directly putting your money into the pockets of billion dollar insurance companies.

2. It has not lowered your insurance premiums even though the financial liability of your insurance company to pay out on your claims has been reduced. Your insurance company is saving money, but you are paying more for your medical care needs.

3. You pay a higher premium for your Plan F, G or J policy with the excess protection than you would pay for a standard policy that only covers the 20% coinsurance on Medicare’s allowable. You believe this is not fair.

4. This law is preventing you from getting the equipment you believe is best suited for your individual medical care needs, and stopping you from getting the repairs needed to your current equipment because you can not afford the out of pocket expense to do so.

5. With this law, Nebraska has violated your personal private legal contract with your private insurance company and you believe this is unconstitutional.

6.  You believe that your supplemental insurance policy and benefits should be grandfathered in if you purchased your policy prior to the new law going into effect.

6. The law did not accomplish it’s intended outcome to protect you from alleged over-billing by providers as providers can still balance bill you for their provided services creating an out of pocket expense for you.

7. You chose an insurance policy plan that would eliminate all of your out of pocket expenses for your medical care, and the state passed a law that negated your freedom of choice to have a policy that best suited your financial situation and medical care.

 

On January 15, 2025, Nebraska Scooter Mart’s attempt to find a senator to sponsor a bill to repeal or revise Nebraska Revised Statute 44-3612 has ended for the 2025 Legislative Session. We hired two former state senators, Burke Harr and John Lindsay, who are now lobbyists, to help us find a sponsor for our bill and get it passed. Our lobbyists informed us that Senator Jacobson went to all the other senators and told them that they would be wasting their time to sponsor our bill because as the Chairman of the Banking, Commerce and Insurance Committee, he has the authority to push the bill back to the last day of the session and it would be dead on arrival and not see the light of day in his committee.

 

We are currently working with Kenny Voeller, Policy Research Director for Governor Pillen, to determine if your insurance policy was grandfathered in if it was purchased prior to this law becoming effective, to determine if the law was unconstitutional as it overrides the federal government's law and if it violates private contract laws.  We will keep you informed via our website.

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Governor Jim Pillen: 402-471-2244 or Email: Kristine.Hulse@nebraska.gov or Mail: PO Box 94848 Lincoln, NE 68509-4848 (See attached State Senator contact information)