Table D: Specified Low-Income Medicare Beneficiary (SLMB) and SLMB135 SR 19-14, 03/19 (MAM-A)

Assistance Group Size

Monthly Net Income Limits

SLMB

> 100% but < 120%

SLMB135

> 120% but < 135%

1

$1,041 - $1,249

$1,249 - $1,406

2

$1,410 - $1,691

$1,691 - $1,903

3

$1,778 - $2,133

$2,133 - $2,400

4

$2,146 - $2,575

$2,575 - $2,897

5

$2,515 - $3,017

$3,017 - $3,395

6

$2,883 - $3,459

$3,459 - $3,892

7

$3,251 - $3,901

$3,901 - $4,389

8

$3,620 - $4,343

$4,343 - $4,886

9

$3,988 - $4,785

$4,785 - $5,384

10

$4,356 - $5,227

$5,227 - $5,881

11

$4,725 - $5,669

$5,669 - $6,378

12

$5,093 - $6,111

$6,111 - $6,875

For each additional person add:

$369 - $442

$442 - $498