The new income and resource standards will be applied to all LIS applications filed on or after January 1, 2017.

2017 POVERTY GUIDELINES

ALL STATES (EXCEPT ALASKA AND HAWAII) AND D.C.

ANNUAL GUIDELINES

FAMILY PERCENT OF POVERTY GUIDELINE
SIZE                         
100% 135%             140% 145%             150%
1 12,060.00 16,281.00 16,884.00 17,487.00 18,090.00
2 16,240.00 21,924.00 22,736.00 23,548.00 24,360.00
3 20,420.00 27,567.00 28,588.00 29,609.00 30,630.00
4 24,600.00 33,210.00 34,440.00 35,670.00 36,900.00
5 28,780.00 38,853.00 40,292.00 41,731.00 43,170.00
6 32,960.00 44,496.00 46,144.00 47,792.00 49,440.00
7 37,140.00 50,139.00 51,996.00 53,853.00 55,710.00
8 41,320.00 55,782.00 57,848.00 59,914.00 61,980.00

For family units of more than 8 members, add $4,180 for each additional member.

 

 

MONTHLY GUIDELINES

FAMILY

SIZE

PERCENT OF POVERTY GUIDELINE
                                    
100%             135% 140% 145% 150%
1 1,005.00 1,356.75 1,407.00 1,457.25 1,507.50
2 1,353.33 1,827.00 1,894.67 1,962.33 2,030.00
3 1,701.67 2,297.25 2,382.33 2,467.42 2,552.50
4 2,050.00 2,767.50 2,870.00 2,972.50 3,075.00
5 2,398.33 3,237.75 3,357.67 3,477.58 3,597.50
6 2,746.67 3,708.00 3,845.33 3,982.67 4,120.00
7 3,095.00 4,178.25 4,333.00 4,487.75 4,642.50
8 3,443.33 4,648.50 4,820.67 4,992.83 5,165.00

 

 

Resource Limits Used to Determine Eligibility for Low-Income Subsidy (LIS)

LIS Level* Marital Status 2016 LIS Resource

Limit**

2017 LIS Resource

Limit**

Full Subsidy LIS Single $8,780 $8,890
Married $13,930 $14,090
All Other LIS Single $13,640 $13,820
Married $27,250 $27,600

 

 

2017 Maximum LIS Beneficiary Cost-Sharing Table

 

Lowincome Subsidy Category

 

Deductible

Copayment up to Out-of-Pocket Threshold* Copayment above Out-of-pocket Threshold*
Institutionalized Full-Benefit Dual Eligible; or

 

Beneficiaries Receiving Home and Community- Based Services

$0 $0 $0
Full-Benefit Dual Eligible ≤ 100% FPL $0 $1.20 generic,

$3.70 brand

$0
Full-Benefit Dual Eligible > 100% FPL; or

 

Medicare Saving Program Participant (QMB-only, SLMB-only, or QI); or

 

Supplemental Security Income (but not Medicaid) Recipient; or

 

Applicant < 135% FPL with resources ≤ $8,890

($14,090 if married)**

$0 $3.30 generic,

$8.25 brand

$0
Applicant < 150% FPL with resources between

$8,890 – $13,820 ($14,090 – $27,600  if married)**

$82 15% $3.30 generic,

$8.25 brand

*Out-of-Pocket Threshold is $4,950 for 2017.

** Resource limits displayed include $1,500 per person for burial expenses.

*** Please Click Here to view Additional State information and to view the entire memorandum from CMS

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