Table D: Specified Low-Income Medicare Beneficiary (SLMB) and SLMB135 SR 20-14, 03/20 (MAM-A)

Assistance Group Size

Monthly Net Income Limits

SLMB

> 100% but < 120%

SLMB135

> 120% but < 135%

1

$1,064 - $1,276

$1,276 - $1,436

2

$1,437 - $1,724

$1,724 - $1,940

3

$1,810 - $2,172

$2,172 - $2,444

4

$2,184 - $2,620

$2,620 - $2,948

5

$2,557 - $3,068

$3,068 - $3,452

6

$2,930 - $3,516

$3,516 - $3,956

7

$3,304 - $3,964

$3,964 - $4,460

8

$3,677 - $4,412

$4,412 - $4,964

9

$4,050 - $4,860

$4,860 - $5,468

10

$4,424 - $5,308

$5,308 - $5,972

11

$4,797 - $5,756

$5,756 - $6,476

12

$5,170 - $6,204

$6,204 - $6,980

For each additional person add:

$374 - $448

$448 - $504