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Revision 20-1; Effective April 10, 2020
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.
| Net Monthly Income From | Net Monthly Income To | Net Monthly Income Percentage |
|---|---|---|
| $ 0 | $ 2,349.00 | 0% |
| $ 2,349.01 | $ 2,642.62 | 3% |
| $ 2,642.63 | $ 2,740.50 | 5% |
| $ 2,740.51 | $ 3,132.00 | 7% |
| $ 3,132.01 | $ 3,523.50 | 9% |
| $ 3,523.51 | $ 3,915.00 | 12% |
| $ 3,915.01 | $ 4,306.50 | 15% |
| $ 4,306.51 | $ 4,698.00 | 20% |
| $ 4,698.01 | $ 5,089.49 | 30% |
| $ 5,089.50 | $ 5,480.99 | 40% |
| $ 5,481.00 | $ 5,872.49 | 50% |
| $ 5,872.50 | $ 6,459.74 | 60% |
| $ 6,459.75 | $ 7,046.99 | 70% |
| $ 7,047.00 | $ 7,829.99 | 80% |
| $ 7,830.00 | $ 8,612.99 | 90% |
| $ 8,613.00 | Higher | 100% |