Table D: Specified Low-Income Medicare Beneficiary (SLMB) and SLMB135 SR 22-14 Dated 03/22 (MAM-A)

Assistance Group Size

Monthly Net Income Limits

SLMB

> 100% but < 120%

SLMB135

> 120% but < 135%

1

$1,133- $1,359

$1,359 - $1,529

2

$1,526 - $1,831

$1,831 - $2,060

3

$1,920 - $2,303

$2,303 - $2,591

4

$2,313 - $2,775

$2,775 - $3,122

5

$2,706 - $3,247

$3,247 - $3,653

6

$3,100 - $3,719

$3,719 - $4,184

7

$3,493 - $4,191

$4,191 - $4,715

8

$3,886 - $4,663

$4,663 - $5,246

9

$4,280 - $5,135

$5,135 - $5,777

10

$4,673 - $5,607

$5,607 - $6,308

11

$5,066 - $6,079

$6,079 - $6,839

12

$5,460 - $6,551

$6,551 - $7,370

For each additional person add:

$394 - $472

$472 - $531