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.
| 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% |