Table D: Specified Low-Income Medicare Beneficiary (SLMB) and SLMB135 SR 17-14, 03/17 (MAM-A)

Assistance Group Size

Monthly Net Income Limits

SLMB

> 100% but < 120%

SLMB135

> 120% but < 135%

1

$1,005 - $1,206

$1,206 - $1,357

2

$1,354 - $1,624

$1,624 - $1,827

3

$1,702 - $2,042

$2,042 - $2,298

4

$2,050 - $2,460

$2,460 - $2,768

5

$2,399 - $2,878

$2,878 - $3,238

6

$2,747 - $3,296

$3,296 - $3,708

7

$3,095 - $3,714

$3,714 - $4,179

8

$3,444 - $4,132

$4,132 - $4,649

9

$3,792 - $4,550

$4,550 - $5,119

10

$4,140 - $4,968

$4,968 - $5,589

11

$4,489 - $5,386

$5,386 - $6,060

12

$4,837 - $5,804

$5,804 - $6,530

For each additional person add:

$349 - $418

$418 - $471