All Kids and new textExtended Medical Standards, Premiums and Co-pays

All Kids Level 2

2016 Income Standards

# in

unit

Premium Level 2

MAGI - Over 209% to 318% FPL

(includes 5% disregard)

new textMedical Extension

(No limit for first 6 months;

limit for Adults after first 6 months only)

1 $2,070 - 3,148 $1,832
2 2,791 - 4,245 2,470
3 3,512 - 5,342 3,108
4 4,233 - 6,440 3,746
5 4,954 - 7,537 4,385
6 5,675 - 8,634 5,023
7 6,398 - 9,733 5,663
8 7,123 - 10,836 6,304
9 7,848 - 11,938 6,945
10 8,573 - 13,040 7,586
Each add'l +1,102 +641

All Kids & FamilyCare Premiums and Physician Co-Pays

Assist

children & adults

Share

children

Premium Level 1

children

Premium Level 2

children

Co-Pay for Physician Office Visit

$0 for children;

$3.90 for adults

$3.90 $5 for children $10 for children
Monthly Premium None None

$15 - 1 person

$25 - 2 persons

$5 each add'l

$40 per child
Max Monthly Premium N/A N/A $40 for 5 or more persons $80 for 2 or more children
Max Co-Payments per Year N/A $100 per family $100 per family $125 per child per calendar quarter