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REV. MAY 8, 2026 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY

HEALTH AND HUMAN SERVICES 477-000-012

HH Size - 7 Low High Monthly Premium Annual Premium $4,170 $8,339 $0 $0 $8,340 $8,756 $125 $1,500 $8,757 $9,173 $306 $3,672 $9,174 $9,590 $505 $6,060 $9,591 $10,007 $623 $7,476 $10,008 $10,425 $751 $9,012 HH Size - 8 Low High Monthly Premium Annual Premium $4,644 $9,286 $0 $0 $9,287 $9,750 $139 $1,668 $9,751 $10,214 $341 $4,092 $10,215 $10,679 $562 $6,744 $10,680 $11,143 $694 $8,328 $11,144 $11,609 $836 $10,032 HH Size - 9 Low High Monthly Premium Annual Premium $5,117 $10,233 $0 $0 $10,234 $10,744 $153 $1,836 $10,745 $11,256 $376 $4,512 $11,257 $11,767 $619 $7,428 $11,768 $12,279 $765 $9,180 $12,280 $12,792 $921 $11,052 HH Size - 10 Low High Monthly Premium Annual Premium $5,590 $11,179 $0 $0 $11,180 $11,738 $168 $2,016 $11,739 $12,297 $411 $4,932 $12,298 $12,856 $676 $8,112 $12,857 $13,415 $836 $10,032 $13,416 $13,975 $1,006 $12,072

Premium Payment Process: Nebraska Medicaid Insurance for Workers with Disabilities will work much like TMA Premium Payments.

The client must pay the full premium no later than the 21st of the month following the month for which the payment is designated.