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REV. MAY 8, 2026 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY

HEALTH AND HUMAN SERVICES 477-000-012

HH Size - 2 Low High Monthly Premium Annual Premium $1,804 $3,606 $0 $0 $3,607 $3,786 $54 $648 $3,787 $3,966 $133 $1,596 $3,967 $4,147 $218 $2,616 $4,148 $4,327 $270 $3,240 $4,328 $4,509 $325 $3,900 HH Size - 3 Low High Monthly Premium Annual Premium $2,277 $4,553 $0 $0 $4,554 $4,780 $68 $816 $4,781 $5,008 $167 $2,004 $5,009 $5,235 $275 $3,300 $5,236 $5,463 $340 $4,080 $5,464 $5,692 $410 $4,920 HH Size - 4 Low High Monthly Premium Annual Premium $2,750 $5,499 $0 $0 $5,500 $5,774 $83 $996 $5,775 $6,049 $202 $2,424 $6,050 $6,324 $333 $3,996 $6,325 $6,599 $411 $4,932 $6,600 $6,875 $495 $5,940 HH Size - 5 Low High Monthly Premium Annual Premium $3,224 $6,446 $0 $0 $6,447 $6,768 $97 $1,164 $6,769 $7,090 $237 $2,844 $7,091 $7,413 $390 $4,680 $7,414 $7,735 $482 $5,784 $7,736 $8,059 $580 $6,960 HH Size - 6 Low High Monthly Premium Annual Premium $3,697 $7,393 $0 $0 $7,394 $7,762 $111 $1,332 $7,763 $8,132 $272 $3,264 $8,133 $8,501 $447 $5,364 $8,502 $8,871 $553 $6,636 $8,872 $9,242 $665 $7,980