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Low-Income Assistance Chart (based on Social Security Administration Guide)
Federal Poverty
Level Indicator |
<100% |
<135% |
136%-140% |
141%-145% |
146%-149% |
February 2005 Federal
Poverty Levels |
$9,570/yr for an individual;
$12,830 for a couple |
$12,919/yr-individual;
$17,320/yr-couple |
$13,015-$13,876/yr-individual;
$17,448-$17,962/yr-couple |
$13,493-$13,876/yr-individual;
$18,090-$18,604/yr-couple |
$13,972-$14,230/yr-individual;
$18,732-$19,117/yr-couple |
| Monthly Premiums |
100% subsidy |
100% subsidy |
100% subsidy |
75% premium subsidy |
50% premium subsidy |
25% premium subsidy |
| Deductible ($250) |
$0 |
$0 |
$0 |
$50 |
$50 |
$50 |
Cost-sharing, Initial
Benefit (<$2,250)
|
$0 |
$1 generic
$3 brand |
$2 generic
$5 brand |
15% coinsurance |
15% coinsurance |
15% coinsurance |
Cost-Sharing,
Coverage Gap |
$0 |
$1 generic
$3 brand |
$2 generic
$5 brand |
Cost-sharing,
Catastrophic Benefit
(> $5,100) |
$0 |
$0 |
$0 |
$2 generic
$5 brand |
$2 generic
$5 brand |
|
| Medicaid Eligible |
Full benefit
dual eligible,
insitutionalized |
Full benefit
dual eligible
QMB,SLMB |
QMB,SLMB,QI |
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For additional information, go to the Social Security Administration site for Assistance for Low Income Particpants
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