TABLE VII - Income Limits for Medical & Medicare Cost-Sharing Programs

Effective Date: March 1, 2022

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

    1575

    1507

382

 2096

 1699

 2265

 1507

 2832

1133

1133

 1359

 1529

 2265

   57

2

  544

   2121 

    2030

468

 2823

 2289

 3052

 2030

 3815

 1526

 1526

 1831

 2060

 3052

   77

3

  678

    2668

    2553

583

 3551

 2879

 3839

 2553

 4798

 

 

4

 797

    3215

    3076

682

 4279

 3469

 4625

 3076

 5782

 

 

5

 912

    3762

    3599

777

 5006

 4059

 5412

 3599

 6765

 

 

6

 1012

    4308

    4122

857

 5734

 4649

 6199

 4122

 7748

 

 

7

 1072

    4855

    4646

897

 6462

 5239

 6985

 4646

 8732

 

 

8

 1132

    5402

    5169

938

 7189

 5829

 7772

 5169

 9715

 

 

9

 1196

    5949

    5692

982

 7917

 6419

 8559

 5692

 10698

 

 

10

 1257

    6495

   6215

    1023

 8645

 7009

 9345

6215

11682

 

 

 

 

 

 

Social Security – Supplemental Security (SSI) Information

 

                Full SSI for Single living alone: $841.00 (No State Supplement)            SSI for Single receiving In-Kind Support: $529.34 (+$3.13 State Supplement)

Full SSI for Couple living alone: $1,261.00 (+$4.60 State Supplement)                 SSI for Couple receiving In-kind Support: $794.00 (+$9.73 State Supplement)

 

 

 

Dependent Expected to be Required to File Threshold

 

Earned: $12,550             Unearned: $1,100              Qualifying Relative Limit: $4,200

 

 

Presumed Maximum Value (PMV)

 

Single:  $300.33            Couple:  $440.33

 

 

Nursing Home Personal Needs Allowance

 

$45

 

Medicare Part B Premium Amounts

 

$170.10