2000, Copayment Schedule

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 FromNet Monthly Income ToNet Monthly Income Percentage
$0$2,829.000%
$2,829.01$3,182.633%
$3,182.64$3,300.505%
$3,300.51$3,772.007%
$3,772.01$4,243.509%
$4,243.51$4,715.0012%
$4,715.01$5,186.4915%
$5,168.50$5,657.9920%
$5,658.00$6,129.4930%
$6,129.50$6,600.9940%
$6,601.00$7,072.4950%
$7,072.50$7,779.7460%
$7,779.75$8,486.9970%
$8,487.00$9,429.9880%
$9,429.99$10,372.9890%
$10,372.99Higher100%