Table D: Specified Low-Income Medicare Beneficiary: SLMB and SLMB135 SR 12-14, 03/12 (AAM-A)

Assistance Group Size

Monthly Net Income Limits

+ 

Ú#

Ü

>100% but <120%

>120% but <135%

1

$931 - $1,117

$1,117 - $1,257

2

$1,261 - $1,513

$1,513 - $1,703

3

$1,591 - $1,909

$1,909 - $2,148

4

$1,921 - $2,305

$2,305 - $2,594

5

$2,251 - $2,701

$2,701 - $3,039

6

$2,581 - $3,097

$3,097 - $3,485

7

$2,911 - $3,493

$3,493 - $3,930

8

$3,241 - $3,889

$3,889 - $4,376

9

$3,571 - $4,285

$4,285 - $4,821

10

$3,901 - $4,681

$4,681 - $5,267

11

$4,231 - $5,077

$5,077 - $5,712

12

$4,561 - $5,473

$5,473 - $6,158

For each additional person add:

$330 - $396

$396 - $446