Table D: Specified Low-Income Medicare Beneficiary (SLMB) and SLMB135 SR 21-14, 03/21 (MAM-A)

Assistance Group Size

Monthly Net Income Limits

SLMB

> 100% but < 120%

SLMB135

> 120% but < 135%

1

$1,074 - $1,288

$1,288 - $1,449

2

$1,452 - $1,742

$1,742 - $1,960

3

$1,830 - $2,196

$2,196 - $2,471

4

$2,209 - $2,650

$2,650 - $2,982

5

$2,587 - $3,104

$3,104 - $3,492

6

$2,965 - $3,558

$3,558 - $4,003

7

$3,344 - $4,012

$4,012 - $4,514

8

$3,722 - $4,466

$4,466 - $5,025

9

$4,100 - $4,920

$4,920 - $5,535

10

$4,479 - $5,374

$5,374 - $6,046

11

$4,857 - $5,828

$5,828 - $6,557

12

$5,235 - $6,282

$6,282 - $7,068

For each additional person add:

$379 - $454

$454 - $511