2000, Copayment Schedule

Revision 22-1; Effective March 1, 2022

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 $2,523.00 0%
$2,523.01  $2,838.38  3%
$2,838.39  $2,943.50  5%
$2,943.51  $3,364.00 7%
$3,364.01  $3,784.50 9%
$3,784.51  $4,205.00 12%
$4,205.01  $4,625.49 15%
$4,625.50 $5,045.99 20%
$5,046.00 $5,466.49 30%
$5,466.50 $5,886.99 40%
$5,887.00 $6,307.49 50%
$6,307.50 $6,938.24 60%
$6,938.25 $7,568.99 70%
$7,569.00 $8,409.98 80%
$8,409.99 $9,250.98 90%
$9,250.99 Higher 100%