Revision 24-1; Effective May 2, 2024
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 percent of Supplemental Security Income.
Copayment Schedule
Net Monthly Income From | Net Monthly Income To | Net Monthly Income Percentage |
---|---|---|
$0 | $2,829.00 | 0% |
$2,829.01 | $3,182.63 | 3% |
$3,182.64 | $3,300.50 | 5% |
$3,300.51 | $3,772.00 | 7% |
$3,772.01 | $4,243.50 | 9% |
$4,243.51 | $4,715.00 | 12% |
$4,715.01 | $5,186.49 | 15% |
$5,168.50 | $5,657.99 | 20% |
$5,658.00 | $6,129.49 | 30% |
$6,129.50 | $6,600.99 | 40% |
$6,601.00 | $7,072.49 | 50% |
$7,072.50 | $7,779.74 | 60% |
$7,779.75 | $8,486.99 | 70% |
$8,487.00 | $9,429.98 | 80% |
$9,429.99 | $10,372.98 | 90% |
$10,372.99 | Higher | 100% |