|
HH Size |
PCR |
Pregnant Woman & CM 0-5 |
CM 6-18 |
Med. Family Needy & Refugee
|
12 Month TR |
CHIP Plan B |
CHIP Plan C & UPP |
Adult Expansion |
ABD |
Medicare Cost Sharing |
TAM |
||||
|
MWI |
Med Needy |
QMB |
SLMB |
QI-1 |
QDWI |
||||||||||
|
|
|
139% FPL |
133% FPL |
BMS Level |
185% FPL |
150% FPL |
200% FPL |
133% FPL |
250% FPL |
100% FPL |
100% FPL |
120% FPL |
135% FPL |
200% FPL |
5% FPL |
|
1 |
438 |
1745 |
1670 |
382 |
2322 |
1883 |
2510 |
1670 |
3138 |
1255 |
1255 |
1506 |
1695 |
2510 |
63 |
|
2 |
544 |
2368 |
2266 |
468 |
3152 |
2555 |
3407 |
2266 |
4259 |
1704 |
1704 |
2044 |
2300 |
3407 |
86 |
|
3 |
678 |
2991 |
2862 |
583 |
3981 |
3228 |
4304 |
2862 |
5380 |
|
|
||||
|
4 |
797 |
3614 |
3458 |
682 |
4810 |
3900 |
5200 |
3458 |
6500 |
|
|
||||
|
5 |
912 |
4238 |
4055 |
777 |
5640 |
4573 |
6097 |
4055 |
7621 |
|
|
||||
|
6 |
1012 |
4861 |
4651 |
857 |
6469 |
5245 |
6994 |
4651 |
8742 |
|
|
||||
|
7 |
1072 |
5484 |
5247 |
897 |
7299 |
5918 |
7890 |
5247 |
9863 |
|
|
||||
|
8 |
1132 |
6107 |
5844 |
938 |
8128 |
6590 |
8787 |
5844 |
10984 |
|
|
||||
|
9 |
1196 |
6730 |
6440 |
982 |
8958 |
7263 |
9684 |
6440 |
12105 |
|
|
||||
|
10 |
1257 |
7354 |
7036 |
1023 |
9787 |
7935 |
10580 |
7036 |
13225 |
|
|
||||
|
Social Security – Supplemental Security (SSI) Information
Full SSI for Single living alone: $967 (No State Supplement) SSI for Single receiving In-Kind Support: $644.67 (+$3.13 State Supplement) Full SSI for Couple living alone: $1,450 (+$4.60 State Supplement) SSI for Couple receiving In-kind Support: $966.34 (+$9.73 State Supplement)
|
|
|
Dependent Expected to be Required to File Threshold
Earned: $14,600 Unearned: $1,150 Qualifying Relative Limit: $4,400
|
|
|
Presumed Maximum Value (PMV)
Single: $342.33 Couple: $503.33
|
Nursing Home Personal Needs Allowance
$45 |
|
Medicare Part B Premium Amounts
$185
|
Standard Mileage Rate for Business
67 cents |