200% Federal Poverty Level - Working Disabled, CHIP

Working Disabled Part A Medicare Beneficiaries, CHIP

Income Limit

Number of Individuals

Income

1

$1,862

2

2,522

3

3,182

4

3,842

5

4,502

6

5,162

7

5,822

8

6,482

9

7,142

10

7,802

11

8,462

12

9,122

{Rev. 1/1/12}