Health insurance in Nebraska
127,449 Nebraska residents bought a marketplace plan for 2026. What they were offered depended on which of the state's 84 counties they live in.
Source: CMS Marketplace Open Enrollment Public Use Files and US Census Small Area Health Insurance Estimates, 2026 release. Figures cover the under-65 population.
Where you enroll
Nebraska uses the federally facilitated marketplace, so you enroll at HealthCare.gov on the federal calendar — the dates are here.
Medicaid covers the bottom of the range in Nebraska
Nebraska expanded Medicaid, so there is no coverage gap here: adults under 138% of the poverty guideline — about $22,025 for one person — go to Medicaid rather than falling between it and the subsidy.
132,185 under-65 Nebraska residents are uninsured all the same, 8.2% of them — 27th of the 51 states and DC, and 0.8× the 26-state median of 9.9%.
Competition is uniform across Nebraska
Every county in Nebraska has the same number of insurers selling on the exchange: 5. That is unusual, and it means the question of where you live inside Nebraska does not change how much competition you get.
No county in Nebraska is down to a single insurer. Since the previous plan year, 84 counties in Nebraska gained an insurer and none lost one.
How many Nebraska residents buy on the marketplace
127,449 Nebraska residents selected a marketplace plan for 2026. Against the state's under-65 population that is 79 per thousand, close to the 26-state median of 79, and 14th highest of the 26 states on this site.
Of those, 14,773 — 12% — were new rather than renewing, which is a fairly typical mix of new and renewing enrollees (25th of 26).
The spread inside Nebraska
Douglas County is the largest county we publish here, with 503,402 under-65 residents; Sarpy County is the smallest, with 177,825. Douglas County has 5 insurers offering 81 plans, and Sarpy County has 5 offering 81.
The widest choice in Nebraska is in Lancaster County — 5 insurers, 84 plans. The narrowest is Douglas County, with 5 insurers and 81 plans. Same state, same rules, 3 more plans to choose from.
Uninsured rates range from 5.4% in Sarpy County to 8.8% in Douglas County — 1.6 times as high, within one state.
The 3 largest counties in Nebraska
By under-65 population, covering 59% of the state's under-65 residents. Nebraska has 84 counties with complete federal data; we publish pages for the largest.
| County | Under 65 | Uninsured | Insurers | Plans | Per 1,000 |
|---|---|---|---|---|---|
| Douglas County | 503,402 | 8.8% | 5 | 81 | 67 |
| Lancaster County | 271,012 | 7.6% | 5 | 84 | 67 |
| Sarpy County | 177,825 | 5.4% | 5 | 81 | 45 |
Source: CMS Marketplace Open Enrollment Public Use Files and US Census Small Area Health Insurance Estimates, 2026 release. "Per 1,000" is marketplace plan selections per thousand under-65 residents.
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