Table C: Qualified Medicare Beneficiary (QMB) SR 15-14, 03/15 (MAM-A)

Assistance Group Size

Monthly Net Income

<100%

1

$981

2

$1,328

3

$1,675

4

$2,021

5

$2,368

6

$2,715

7

$3,061

8

$3,408

9

$3,755

10

$4,101

11

$4,448

12

$4,795

For each additional person add:

$347

References: 42 CFR 406, Section 1905(p)(1) & (p)(2)(C) of the Social Security Act (SSA), 42 USC 1396d(p)(2)(C), 42 USC 9902(2)