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.

Copayment Schedule
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%