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

Effective Date:  April 1, 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

    1479

    1415

382

 1968

 1595

 2127

1415

 2659

1064

 1064

 1276

 1436

 2127

   54

2

  544

    1997

    1911

468

 2658

 2155

 2874

1911

 3592

 1437

 1437

 1724

 1940

 2874

   72

3

  678

    2516

    2408

583

 3349

 2715

 3620

2408

 4525

 

 

4

 797

    3035

    2904

682

 4040

 3275

 4367

2904

 5459

 

 

5

 912

    3554

    3401

777

 4730

 3835

 5114

3401

 6392

 

 

6

 1012

    4073

    3897

857

 5421

 4395

 5860

3897

 7325

 

 

7

 1072

    4592

    4394

897

 6112

 4955

 6607

4394

 8259

 

 

8

 1132

    5111

    4890

938

 6802

 5515

 7354

4890

 9192

 

 

9

 1196

    5630

    5387

982

 7493

 6075

 8100

5387

 10,125

 

 

10

 1257

    6149

   5884

    1023

 8184

 6635

 8847

5884

11,059

 

 

 

 

 

 

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

 

 

Presumed Maximum Value (PMV)

 

Single:  $281            Couple:  $411.66

 

 

Nursing Home Personal Needs Allowance

 

$45

 

Medicare Part B Premium Amounts

 

$144.60