Table D: Specified Low-Income Medicare Beneficiary: SLMB, SLMB135, and SLMB175 SR 04-15, 04/04 (AAM-A)

Assistance Group Size

Monthly Net Income Limits

OÚ?Ü

>100% but <120%

>120% but <135%

1

$776.01 - $931

$931.01 - $1,048

2

$1,041.01 - $1,249

$1,249.01 - $1,406

3

$1,306.01 - $1,567

$1,567.01 - $1,763

4

$1,571.01 - $1,885

$1,885.01 - $2,121

5

$1,836.01 - $2,203

$2,203.01 - $2,479

6

$2,101.01 - $2,521

$2,521.01 - $2,837

7

$2,366.01 - $2,839

$2,839.01 - $3,194

8

$2,631.01 - $3,157

$3,157.01 - $3,552

9

$2,896.01 - $3,475

$3,475.01 - $3,910

10

$3,161.01 - $3,793

$3,793.01 - $4,268

11

$3,426.01 - $4,111

$4,111.01 - $4,625

12

$3,691.01 - $4,429

$4,429.01 - 4,983

For each additional person add:

$265 - $318

$318 - $358