Skip to Main Content

Benefits Grid

We provide superior Nebraska Medicaid benefits available to all our members. In the benefits grid below, you will find the services available and if prior authorization is required through Nebraska Total Care.

Heritage Health - Nebraska Total Care 

Nebraska Total Care covers many medical services for your healthcare needs. Some services must be prescribed by your doctor. Some services must also be approved by Nebraska Total Care before you get the service. You can check if services were approved in the Member Portal.

There are some Medicaid members who have a copay for some brand name prescriptions. You can see more information about copays on the Pharmacy page.

You do not need a referral from your PCP to see a specialist. You do not need a referral for routine vision care, OB/GYN care, or mental health/counseling services.

Benefits Grid (updated January 1, 2024)
ServiceDescription and limitsPrior authorization required
Allergy careAllergy careYes, for some services
Ambulance - emergencyIncludes ground and emergency helicopterNo
Ambulance - non-emergencyAmbulance transportation from one healthcare facility to another is only covered when it is medically necessary. Arranged for and approved by an in-network provider.Yes
Behavioral HealthAge limitations may apply. Services include crisis stabilization, inpatient psychiatric hospitalization, outpatient assessment and treatment services, peer support, residential treatment facilities, and rehabilitation services. Yes, for some services
Breast pumpsOne electronic breast pump and kit per member, per delivery every two years. For multiples (twins, triplets, etc.) only one pump will be provided. Your doctor will need to write a prescription for a breast pump. No
Chiropractic servicesManual treatment of the spine, one set of spinal x-rays per year, traction, electrical stimulation, ultrasound, and other evaluation and therapy procedures.No, if provided by a Chiropractor
Continuous Glucose MonitorOne per member, with repair and replacement as considered medically necessary.Yes
Dental care, preventiveTwo visits every year for members age one and older. Members covered under 599 CHIP are excluded.No
Dental care, treatmentTreatment that is medically necessary and ordered by a dental provider.Yes, in some situations
Durable Medical Equipment (DME)Items that are not medically necessary and are not ordered by a provider are not covered.Yes, in some situations
Drugs: prescription/pharmacyUse a pharmacy in our network. This can include mail-order pharmacies. Prescription drugs and OTC items approved by the U.S. Food and Drug Administration (FDA).Yes, for some medications
Drugs: over the counter (OTC)Over the counter medications require a doctor's prescription.No
Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)/Well-child examServices are for members age 20 and younger. Sports and school physicals annually.No
Eye care services and eye glassesUnder age 21, eye exam annually and one pair of frames and lenses every 2 years. Age 21 and older, eye exam and one pair of frames and lenses every 2 years.No
Family planningFamily planning services can be from any Medicaid doctor. This includes well-women exams, screening, and pregnancy testing. No
Foot careHouse calls are only covered if visiting a provider would cause you harm. Foot care visits may be limited. Orthotics are covered for some conditions. Yes, in some situations
Hearing aids and servicesHearing aids and services.Yes, for cochlear implants
High-risk prenatal and infant servicesCare management provides special support for members at risk or with special health needs.Notify plan
Home health careCare must be prescribed by your doctor. And, not able to be received at the hospital or provider's office. Other conditions apply. Yes
Hospice ServicesOther than an inpatient facility.Yes
Immunizations for childrenAvailable to members age 21 and younger.No
Inpatient and outpatient hospital careItems that are not medically necessary are not covered. Yes, including observation services
Lab services and testingPaternity testing and infertility treatment tests are not covered.Yes
Lactation ConsultationFive sessions per child, up to 90 minutesNo
Maternity careSee your provider as soon as you know you are pregnant. Send us the Notice of Pregnancy form at first visit. Prenatal through postpartum services are covered.Yes, for more than two OB ultrasounds.
Nurse midwife servicesCovered with all in network providers. Yes, for non-participating providers. 
OB ultrasoundsTwo are allowed per pregnancy unless ordered by perionatologist. Yes, if more than two.
Office visitsCovered with all in network providers. Yes, for non-participating providers
Pain managementNot applicable for post-operative pain management. Yes
Physician servicesOne routine physical exam every 12 months performed by your PCP. Health visits as needed.No
Private duty nurse servicesOvernight nursing services and respite care hours are limited. Yes
Psychiatric hospital servicesPsychiatric hospital servicesYes
Psychiatric servicesPsychiatric servicesYes, for some services
Psychological servicesPsychological servicesYes, for some services
Radiology and x-raysMust be ordered by a provider. Yes, for high-tech radiology, including CT, MRI, MRA
Reconstructive surgerySurgery that is performed to make you look better and is determined to be cosmetic is not covered.Yes
Rehabilitation servicesRehabilitation servicesYes
Skilled Nursing Facility careItems that are not medically necessary are not covered. This includes private rooms or convenience/comfort items.Yes
Sterilization servicesSterilizations require informed consent forms 30 days prior to the date of procedures. Hysterectomies are covered on a limited basis.  No
Therapy (occupational, physical, speech) servicesThere is a combined limit of 60 therapy sessions per year for members 21 and over. This includes physical therapy, occupational therapy, and speech therapy services. Yes, after the first 12 sessions
Stop smoking/ tobacco cessationCertain medications, patches, or gum to help you stop smoking are covered. Call 1-800-QUIT-NOW (1-800-784-8669) for more information.No
SurgerySurgeryYes, except in an emergency
Transplant servicesTransplant servicesYes
Urgent careUrgent careNo