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.

Copayment Schedule
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%