Copayment  B - Family Size 2

revised textMonthly Income Monthly Copayment
$ 0 - 505 $ 1.00
506 - 631 1.50
632 - 757 5.00
758 - 883 8.50
884 - 1009 13.00
1010 - 1135 18.50
1136 - 1261 25.00
1262 - 1387 32.50
1388 - 1513 41.00
1514 - 1640 50.00
1641 - 1766 60.00
1767 - 1892 71.00
1893 - 2018 83.00
2019 - 2144 96.00
2145 - 2270 109.50
2271 - 2333 118.50

Copayment B - Family Size 3

revised textMonthly Income Monthly Copayment
$ 0 - 637 $ 1.00
638 - 796 1.50
797 - 955  6.50
956 - 1114 10.50
1115 - 1273 16.50
1274 - 1432 23.50
1433 - 1591 31.50
1592 - 1750 41.00
1751 - 1909 51.50
1910 - 2069 63.00
2070 - 2228 76.00
2229 - 2387 90.00
2388 - 2546 105.00
2547 - 2705 121.00
2706 - 2864 138.50
2865 - 2944 149.50

Copayment B - Family Size 4

revised textMonthly Income Monthly Copayment
$ 0 - 769 $ 1.00
770 - 961  1.50
962 - 1153  8.00
1154 - 1345 12.50
1346 - 1537 19.50
1538 - 1729 28.50
1730 - 1921 38.00
1922 - 2113 49.50
2114 - 2305 62.00
2306 - 2498 76.00
2499 - 2690 91.50
2691 - 2882 108.50
2883 - 3074 126.50
3075 - 3266 146.00
3267 - 3458 167.00
3459 - 3554 180.50
Copayment B - Family Size 5
revised textMonthly Income Monthly Copayment
$ 0 - 901 $ 1.00
902 - 1126  1.50
1127 - 1351 9.50
1352 - 1576 15.00
1577 - 1801 23.00
1802 - 2026 33.00
2027 - 2251 44.50
2252 - 2476 58.00
2477 - 2701 73.00
2702 - 2927 89.00
2928 - 3152 107.50
3153 - 3377 127.00
3378 - 3602 148.50
3603 - 3827 171.50
3828 - 4052 196.00
4053 - 4165 211.50

Copayment B - Family Size 6

revised textMonthly Income Monthly Copayment
$ 0 - 1033 $1.00
1034 - 1291  1.50
1292 - 1549 10.50
1550 - 1807 17.00
1808 - 2065 26.50
2066 - 2323 38.00
2324 - 2581 51.50
2582 - 2839 66.50
2840 - 3097 83.50
3098 - 3356 102.50
3357 - 3614 123.00
3615 - 3872 145.50
3873 - 4130 170.00
4131 - 4388 196.50
4389 - 4646 224.50
4647 - 4775 242.50
Copayment B - Family Size 7
revised textMonthly Income Monthly Copayment
$ 0 - 1,165 $ 1.00
1166 - 1456  1.50
1457 - 1747 12.00
1748 - 2038 19.00
2039 - 2329 30.00
2330 - 2620 43.00
2621 - 2911 58.00
2912 - 3202 75.00
3203 - 3493 94.00
3494 - 3785 115.50
3786 - 4076 139.00
4077 - 4367 164.00
4368 - 4658 192.00
4659 - 4949 221.50
4950 - 5240 253.00
5241 - 5386 273.50
Copayment B - Family Size 8
revised textMonthly Income Monthly Copayment
$ 0 - 1297 $ 1.00
1298 - 1621  1.50
1622 - 1945 13.50
1946 - 2269 21.50
2270 - 2593 33.50
2594 - 2917 47.50
2918 - 3241 64.50
3242 - 3565 83.50
3566 - 3889 104.50
3890 - 4214 128.50
4215 - 4538 154.50
4539 - 4862 183.00
4863 - 5186 213.50
5187 - 5510 246.50
5511 - 5834 282.00
5835 - 5996 304.50
Copayment B - Family Size 9
revised textMonthly Income Monthly Copayment
$ 0 - 1429 $ 1.00
1430 - 1786 1.50
1787 - 2143 14.50
2144 - 2500 23.50
2501 - 2857 36.50
2858 - 3214 52.50
3215 - 3571 71.00
3572 - 3928 92.00
3929 - 4285 115.50
4286 - 4643 141.50
4644 - 5000 170.00
5001 - 5357 201.50
5358 - 5714 235.50
5715 - 6071 271.50
6072 - 6428 310.50
6429 - 6607 335.50
Copayment B - Family Size 10
revised textMonthly Income Monthly Copayment
$ 0 - 1561  $ 1.00
1562 - 1951 1.50
1952 - 2341 16.00
2342 - 2731 25.50
2732 - 3121 40.00
3122 - 3511 57.50
3512 - 3901 77.50
3902 - 4291 100.50
4292 - 4681 126.00
4682 - 5072 154.50
5073 - 5462 186.00
5463 - 5852 220.00
5853 - 6242 257.00
6243 - 6632 297.00
6633 - 7022 339.50
7023 - 7217 366.50