2018 MAGI MEDI-CAL FEDERAL POVERTY LEVEL (FPL) …

1 2018 magi MEDI-CAL FEDERAL POVERTY LEVEL (FPL) INCOME CHART. Parents, Expansion Adults Category Pregnant Women Infant 0-1 Child 1-6 Child 6-19 Caretaker Child 6-19 19-64. Relatives FPL 0-138% 139-213% 214-322% 0-208% 209-266% 0-142% 143-160% 160-266% 0-133% 134-160% 160-266% 108-133% 0-138% 0-109%. 1 $1,397 $2,155 $3,258 $2,105 $2,692 $1,437 $1,619 $2,692 $1,346 $1,619 $2,692 $1,093-$1,346 $1,397 $1,103. 2 $1,893 $2,922 $4,417 $2,854 $3,649 $1,948 $2,195 $3,649 $1,825 $2,195 $3,649 $1,482-$1,825 $1,893 $1,496. 3 $2,390 $3,689 $5,576 $3,602 $4,607 $2,459 $2,771 $4,607 $2,304 $2,771 $4,607 $1,871-$2,304 $2,390 $1,888. Family 4 $2,887 $4,456 $6,736 $4,351 $5,564 $2,971 $3,347 $5,564 $2,782 $3,347 $5,564 $2,259-$2,782 $2,887 $2,280. Size 5 $3,384 $5,223 $7,895 $5,100 $6,522 $3,482 $3,923 $6,522 $3,261 $3,923 $6,522 $2,648-$3,261 $3,384 $2,673. 6 $3,881 $5,989 $9,054 $5,849 $7,480 $3,993 $4,499 $7,480 $3,740 $4,499 $7,480 $3,037-$3,740 $3,881 $3,065.

2 7 $4,377 $6,756 $10,213 $6,598 $8,437 $4,504 $5,075 $8,437 $4,219 $5,075 $8,437 $3,426-$4,219 $4,377 $3,458. 8 $4,874 $7,523 $11,372 $7,346 $9,395 $5,015 $5,651 $9,395 $4,698 $5,651 $9,395 $3,815-$4,698 $4,874 $3,850. M7 M9 P9 T5 P7 T4 T3 P5 T2 T1 M5 M1 M3. Citizen Citizenship 0E. Status (MCAP). Note: Effective May 2016, all children under the age of 19 are eligible to full scope benefits due to the implementation of Undoc. M8 M0 M2 M4. SB75. Children's restricted scope aid codes are no longer being used. Unsubsidized Coverage AI/AN CSR. Category APTC CSR. (Private Insurance) Only FPL 100-150% 151-200% 201-250% 250-400% 100-300% 400+%. 1. $1,012-$1,518 $2,024 $2,530 $4,047 $1,012-$3,036 $4,048. 2. $1,372-$2,058 $2,744 $3,430 $5,487 $1,372-$4,116 $5,488. No Income Test 3. $1,732-$2,598 $3,464 $4,330 $6,927 $1,732-$5,196 $6,928. 4. $2,092-$3,138 $4,184 $5,230 $8,367 $2,092-$6,276 $8,368.

3 Family Size 5. $2,452-$3,678 $4,904 $6,130 $9,807 $2,452-$7,356 $9,808. 6. $2,812-$4,218 $5,624 $7,030 $11,247 $2,812-$8,436 $11,248. 7. $3,172-$4,758 $6,344 $7,930 $12,687 $3,172-$9,516 $12,688. 8. $3,532-$5,298 $7,064 $8,830 $14,127 $3,532-$10,596 $14,128. Aid X2 X3 X4 X1 X5 X7 X6. Code Rev. (2/18) MCP/HCR Page 1. 2018 NON- magi MEDI-CAL FEDERAL POVERTY LEVEL (FPL) INCOME CHART. Non- magi PICKLE- TMC 250% WDP Medicare Savings Programs (MSP) A&D. M/C Last SSI/SSP Check Received Family 185% Maintenance Between Multiplier Size 250% 100% QMB 120% SLMB 135% QI-1 100% 1/17-12/17 (2nd 6 Mos) Need levels (4/18) (3/18) (3/18) (3/18) (4/18) 1/16-12/16 (4/18) (MMNL) 1/15-12/15 1/14-12/14 1 $1,872 $600 $2,530 $1,012 $1,214 $1,366 $1,012 1/13-12/13 1/12-12/12 2 $2,538 $750* $3,430 $1,372 $1,646 $1,852 $1,372 1/11-12/11 1/10-12/10 1/09-12/09 3 $3,204 $934 $4,330 $1,732 $2,078 $2,338 $1,732 1/08-12/08 1/07-12/07 4 $3,870 $1,100 $5,230 $2,092 $2,510 $2,824 $2,092 1/06-12/06 1/05-12/05 1/04-12/04 5 $4,536 $1,259 $6,130 $2,452 $2,942 $3,310 $2,452 1/03-12/03 1/02-12/02 6 $5,202 $1,417 $7,030 $2,812 $3,374 $3,796 $2,812 1/01-12/01 1/00-12/00 1/99-12/99 7 $5,868 $1,550 $7,930 $3,172 $3,806 $4,282 $3,172 1/98-12/98 1/97-12/97 8 $6,534 $1,692 $8,830 $3,532 $4,238 $4,768 $3,532 1/96-12/96 1/95-12/95 1/94-12/94 9 $7,200 $1,825 9,730 $3,892 $4,670 $5,254 $3,892 1/93-12/93 1/92-12/92 1/91-12/91 10 $7,866 $1,959 10,630 $4,252 $5,102 $5,740 $4,252 1/90-12/90 1/89-12/89 *2 Adults $934 1/88-12/88 Each Add'l 1/87-12/87 $666 $900 $360 $432 $486 $360.

4 Person $14 1/86-12/86 2018 SSI/SSP PAYMENT STANDARDS 2018 MEDICARE 2018 SGA DISABLED AVERAGE 2018 SSA COLA Multiplier INDEPENDENT LIVING ARRANGEMENT Part B PREMIUM $1,180 PRIVATE PAY $134 / $130 (To determine INDIVIDUAL A&D FPL DEDUCTIONS Period of 2018 FEDERAL Benefit Rate Jan-Dec 2018 2017 MEDICARE Jan-Dec 2018 ineligibility) Individual (ABD) $750. Part B PREMIUM 2018 Pending* Couple (ABD) $1,125. Aged/Disabled $ $134 / $109 Individual $230 2017 $8,515. Blind $ Spouse Couple $310 2016 $8,189 2018 LONG TERM CARE BUDGET FACTORS. Disabled Minor $ 2018 TB CSRA Limit $123,600. 2015 $8,092. INCOME STANDARD* 2018 QMB/SLMB/QI-1 Community Spouse $3,090. 2014 $7,628. COUPLE $1,585 SSI Standard Allocation $375 Maintenance Need Jan-Dec 2018 "Any Income" Deduction $20 2013 $7,549 Family Member Maximum $2,030. INCOME CONVERSION 2012 $7,092 Base Allocation Both Aged/ Disabled $1, FACTOR 2018 MSP Property Limits 2011 $6,840 (07/01/2017 - 06/30/2018).

5 Both Blind $1,751 Weekly Individual $7,560 2010 $6,311 Home Maintenance Allowance* $209. One Blind/Other Aged or Disabled $1,666 Bi-Weekly Couple $11,340 2009 $5,698 Shared Home Maintenance Allowance* $138. (every 2 weeks) 2008 $5,496 Maintenance Need $35. *2018 values pending release 2007 $5,101. 2006 $5,031. Rev. (2/18) MCP/HCR Page 2.