2000, Copayment Schedule

Revision 25-1; Effective May 7, 2025

Refer to the following copayment schedule to determine the person’s copayment percentage. The copayment schedule is based on paying a copayment when the income limit exceeds 300% of Supplemental Security Income.

Copayment Schedule

Net Monthly Income FromNet Monthly Income ToNet Monthly Income Percentage
$0$2,901.000%
$2,901.01$3,263.633%
$3,263.64$3,384.505%
$3,384.51$3,868.007%
$3,868.01$4,351.509%
$4,351.51$4,835.0012%
$4,835.01$5,318.4915%
$5,318.50$5,801.9920%
$5,802.00$6,285.4930%
$6,285.50$6,768.9940%
$6,769.00$7,252.4950%
$7,252.50$7,977.7460%
$7,977.75$8,702.9970%
$8,703.00$9,669,9880%
$9,669.99$10,636.9890%
10,636.99Higher100%