MinnesotaCare Premium Amounts (Archive)

The MinnesotaCare Premium Table (DHS-4139) approximates a household’s monthly premium amount based on the number of people covered in the household and the household’s gross monthly income.

l  MMIS calculates the official MinnesotaCare premium amounts.

l  The MinnesotaCare maximum premium amounts are on the last page of the DHS-4139.

The maximum premium amounts are used when calculating employer-subsidized insurance (ESI) for people who receive cash benefits from their employer to purchase insurance. See Determining ESI – Cash Benefits for more information on how to use the maximum premium amount in the calculation.

The MinnesotaCare maximum premium amounts, based on household size, are:

Effective Dates

Household Size

One

Two

Three or More

July 1, 2007 - June 30, 2008

$350

$700

$1050

July 1, 2006 - June 30, 2007

$325

$650

$975

July 1, 2005 - June 30, 2006

$313

$626

$939

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