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

Assistance Group Size

Monthly Net Income Limits

 

SLMB

> 100% but < 120%

  

SLMB135

> 120% but < 135%

1

$973 - $1,167

 

$1,167 - $1,313

2

$1,311 - $1,573

 

$1,573 - $1,770

3

$1,650 - $1,979

 

$1,979 - $2,227

4

$1,988 - $2,385

 

$2,385 - $2,684

5

$2,326 - $2,791

 

$2,791 - $3,140

6

$2,665 - $3,197

 

$3,197 - $3,597

7

$3,003 - $3,603

 

$3,603 - $4,054

8

$3,341 - $4,009

 

$4,009 - $4,511

9

$3,680 - $4,415

 

$4,415 - $4,967

10

$4,018 - $4,821

 

$4,821 - $5,424

11

$4,356 - $5,227

 

$5,227 - $5,881

12

$4,695 - $5,633

 

$5,633 - $6,338

For each additional person add:

$339 - $406

 

$406 - $457

References: 42 CFR 407, Section 1902(a)(10)(E)(iii)-(iv) of the Social Security Act (SSA), 42 USC 1396a(a)(10)(E)(iii)-(iv), 42 USC 9902(2)