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 From | Net Monthly Income To | Net Monthly Income Percentage |
---|---|---|
$0 | $2,901.00 | 0% |
$2,901.01 | $3,263.63 | 3% |
$3,263.64 | $3,384.50 | 5% |
$3,384.51 | $3,868.00 | 7% |
$3,868.01 | $4,351.50 | 9% |
$4,351.51 | $4,835.00 | 12% |
$4,835.01 | $5,318.49 | 15% |
$5,318.50 | $5,801.99 | 20% |
$5,802.00 | $6,285.49 | 30% |
$6,285.50 | $6,768.99 | 40% |
$6,769.00 | $7,252.49 | 50% |
$7,252.50 | $7,977.74 | 60% |
$7,977.75 | $8,702.99 | 70% |
$8,703.00 | $9,669,98 | 80% |
$9,669.99 | $10,636.98 | 90% |
10,636.99 | Higher | 100% |