Revision 17-1; Effective January 1, 2018
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 | $ 2,250.00 | 0% |
| $ 2,250.01 | $ 2,531.25 | 3% |
| $ 2,531.26 | $ 2,625.00 | 5% |
| $ 2,625.01 | $ 3,000.00 | 7% |
| $ 3,000.01 | $ 3,375.00 | 9% |
| $ 3,375.01 | $ 3,750.00 | 12% |
| $ 3,750.01 | $ 4,125.00 | 15% |
| $ 4,125.01 | $ 4,500.00 | 20% |
| $ 4,500.01 | $ 4,875.00 | 30% |
| $ 4,875.01 | $ 5,250.00 | 40% |
| $ 5,250.01 | $ 5,625.00 | 50% |
| $ 5,625.01 | $ 6,187.50 | 60% |
| $ 6,187.51 | $ 6,750.00 | 70% |
| $ 6,750.01 | $ 7,500.00 | 80% |
| $ 7,500.01 | $ 8,250.00 | 90% |
| $ 8,250.01 | Higher | 100% |