Obsolete 0320 - Table VII - Income Limits for Medical & Medicare Cost-Sharing Programs

Effective Date:  January 1, 2020 - February 29, 2020

Previous Table

 

 

 

HH Size

 

 

PCR

 

 

Pregnant Woman

&

CM 0-5

 

 

CM 6-18

 

 

Med. Family

Needy

&

Refugee

 

 

 

12 Month TR

 

 

CHIP Plan B

 

 

CHIP Plan C

&

UPP

 

 

Adult Expansion

 

 

ABD

 

 

Medicare Cost Sharing

 

 

TAM

MWI

Med Needy

QMB

SLMB

QI-1

QDWI

 

 

139%  

FPL

133% FPL

BMS

Level

185%

FPL

150% FPL

200% FPL

133%

FPL

250% FPL

100% FPL

100% FPL

120% FPL

135% FPL

200% FPL

5% FPL

1

   438

    1447

    1385

382

 1926

 1562

 2082

1385

 2603

1041

 1041

 1249

 1406

 2082

   53

2

  544

    1959

    1875

468

 2607

 2114

 2819

1875

 3523

 1410

 1410

 1691

 1903

 2819

   71

3

  678

    2471

    2365

583

 3289

 2667

 3555

2365

 4444

 

 

4

 797

    2983

    2854

682

 3970

 3219

 4292

2854

 5365

 

 

5

 912

    3495

    3344

777

 4652

 3772

 5029

3344

 6286

 

 

6

 1012

    4007

    3834

857

 5333

 4324

 5765

3834

 7207

 

 

7

 1072

    4519

    4324

897

 6015

 4877

 6502

4324

 8128

 

 

8

 1132

    5031

    4814

938

 6696

 5429

 7239

4814

 9048

 

 

9

 1196

    5543

    5304

982

 7377

 5982

 7975

5304

 9969

 

 

10

 1257

    6055

   5794

    1023

 8059

 6534

 8712

5794

10,890

 

 

 

 

 

 

Social Security – Supplemental Security (SSI) Information

 

                Full SSI for Single living alone: $783.00 (No State Supplement)            SSI for Single receiving In-Kind Support: $522.00 (+$3.13 State Supplement)

Full SSI for Couple living alone: $1,175.00 (+$4.60 State Supplement)                 SSI for Couple receiving In-kind Support: $783.34 (+$9.73 State Supplement)

 

 

 

Dependent Expected to be Required to File Threshold

 

Earned: $12,000             Unearned: $1,050              Qualifying Relative Limit: $4,050

 

 

Presumed Maximum Value (PMV)

 

Single:  $281            Couple:  $411.66

 

 

Nursing Home Personal Needs Allowance

 

$45

 

Medicare Part B Premium Amounts

 

$144.60