Table D: Specified Low-Income Medicare Beneficiary (SLMB) and SLMB135 SR 15-14, 03/15 (MAM-A)

Assistance Group Size

Monthly Net Income Limits

 

SLMB

> 100% but < 120%

  

SLMB135

> 120% but < 135%

1

$981 - $1,177

 

$1,177 - $1,325

2

$1,328 - $1,593

 

$1,593 - $1,793

3

$1,675 - $2,009

 

$2,009 - $2,261

4

$2,021 - $2,425

 

$2,425 - $2,729

5

$2,368 - $2,841

 

$2,841 - $3,197

6

$2,715 - $3,257

 

$3,257 - $3,665

7

$3,061 - $3,673

 

$3,673 - $4,133

8

$3,408 - $4,089

 

$4,089- $4,601

9

$3,755 - $4,505

 

$4,505 - $5,069

10

$4,101 - $4,921

 

$4,921 - $5,537

11

$4,448 - $5,337

 

$5,337 - $6,005

12

$4,795 - $5,753

 

$5,753 - $6,473

For each additional person add:

$347 - $416

 

$416 - $468

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)