2000, Copayment Schedule
Revision 23-1; Effective May 2, 2023
To determine the individual’s copayment percentage, refer to the following copayment schedule. The copayment schedule is based on paying a copayment when the income limit exceeds 300 percent of Supplemental Security Income.
Copayment Schedule
| Net Monthly Income From | Net Monthly Income To | Net Monthly Income Percentage |
|---|---|---|
| $0 | $2,742.00 | 0% |
| $2,742.01 | $3,084.75 | 3% |
| $3,084.76 | $3,199.00 | 5% |
| $3,199.01 | $3,656.00 | 7% |
| $3,656.01 | $4,113.00 | 9% |
| $4,113.01 | $4,570.00 | 12% |
| $4,570.01 | $5,026.99 | 15% |
| $5,027.00 | $5,483.99 | 20% |
| $5,484.00 | $5,940.99 | 30% |
| $5,941.00 | Â $6,397.99 | 40% |
| $6,398.00 | $6,854.99 | 50% |
| $6,855.00 | $7,540.49 | 60% |
| $7,540.50 | $8,225.99 | 70% |
| $8,226.00 | $9,139.98 | 80% |
| $9,139.99 | $10,053.98 | 90% |
| $10,053.99 | Higher | 100% |