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REV. MAY 8, 2026 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY
HEALTH AND HUMAN SERVICES 477-000-012
TMA Premium Payment Chart – Effective 1/1/26 FAMILY SIZE 1 FAMILY SIZE 2 FAMILY SIZE 3
ADJUSTED
ADJUSTED
ADJUSTED
MONTHLY
MONTHLY
MONTHLY
EARNED
EARNED
EARNED
INCOME
Fee INCOME
Fee INCOME
Fee
1330 - 1396.99 36 1804 - 1893.99 49 2277 - 2390.99 62 1397 - 1462.99 38 1894 - 1983.99 52 2391 - 2503.99 65 1463 - 1529.99 40 1984 - 2073.99 54 2504 - 2617.99 68 1530 - 1595.99 42 2074 - 2163.99 57 2618 - 2731.99 71 1596 - 1662.99 44 2164 - 2253.99 59 2732 - 2845.99 75 1663 - 1728.99 46 2254 - 2343.99 62 2846 - 2959.99 78 1729 - 1795.99 47 2344 - 2434.99 64 2960 - 3073.99 81 1796 - 1861.99 49 2435 - 2524.99 67 3074 - 3186.99 84 1862 - 1928.99 51 2525 - 2614.99 69 3187 - 3300.99 87 1929 - 1994.99 53 2615 - 2704.99 71 3301 - 3414.99 90 1995 - 2061.99 55 2705 - 2794.99 74 3415 - 3528.99 93 2062 - 2127.99 56 2795 - 2884.99 76 3529 - 3642.99 96 2128 - 2194.99 58 2885 - 2975.99 79 3643 - 3756.99 99 2195 - 2260.99 60 2976 - 3065.99 81 3757 - 3869.99 103 2261 - 2327.99 62 3066 - 3155.99 84 3870 - 3983.99 106 2328 - 2393.99 64 3156 - 3245.99 86 3984 - 4097.99 109 2394 - 2461.00 66 3246 - 3337.00 89 4098 - 4212.00 112
FAMILY SIZE 4 FAMILY SIZE 5 FAMILY SIZE 6
ADJUSTED
ADJUSTED
ADJUSTED
MONTHLY
MONTHLY
MONTHLY
EARNED
EARNED
EARNED
INCOME
Fee INCOME
Fee INCOME
Fee
2750 - 2887.99 75 3224 - 3384.99 88 3697 - 3881.99 101 2888 - 3024.99 79 3385 - 3545.99 92 3882 - 4065.99 106 3025 - 3162.99 83 3546 - 3706.99 97 4066 - 4250.99 111 3163 - 3299.99 86 3707 - 3867.99 101 4251 - 4435.99 116 3300 - 3437.99 90 3868 - 4028.99 105 4436 - 4620.99 121 3438 - 3574.99 94 4029 - 4189.99 110 4621 - 4805.99 126 3575 - 3712.99 98 4190 - 4351.99 114 4806 - 4990.99 131 3713 - 3849.99 101 4352 - 4512.99 119 4991 - 5174.99 136 3850 - 3987.99 105 4513 - 4673.99 123 5175 - 5359.99 141 3988 - 4124.99 109 4674 - 4834.99 127 5360 - 5544.99 146 4125 - 4262.99 113 4835 - 4995.99 132 5545 - 5729.99 151 4263 - 4399.99 116 4996 - 5156.99 136 5730 - 5914.99 156 4400 - 4537.99 120 5157 - 5318.99 141 5915 - 6099.99 161 4538 - 4674.99 124 5319 - 5479.99 145 6100 - 6283.99 166 4675 - 4812.99 128 5480 - 5640.99 149 6284 - 6468.99 171 4813 - 4949.99 131 5641 - 5801.99 154 6469 - 6653.99 176 4950 - 5088.00 135 5802 - 5964.00 158 6654 - 6839.00 181