1 | Updated 20210101 | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
2 | Estimated 2021 Poverty Guideline | |||||||||||
3 | Individual Fee | Estimated 2021 200% Poverty | ||||||||||
4 | Monthly Income | NUMBER of HOUSEHOLD DEPENDENTS | ||||||||||
5 | % of Poverty* | Min. range | Max. range | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | |
6 | 100% | $0 | $1,063 | $5.00 | $5.00 | $5.00 | $5.00 | $5.00 | $5.00 | $5.00 | $5.00 | |
7 | 150% | $1,064.00 | $1,595.00 | $10.00 | $10.00 | $10.00 | $10.00 | $5.00 | $5.00 | $5.00 | $5.00 | |
8 | 200% | $1,596.00 | $2,127.00 | $20.00 | $10.00 | $10.00 | $10.00 | $10.00 | $5.00 | $5.00 | $5.00 | |
9 | 250% | $2,128.00 | $2,658.00 | $30.00 | $20.00 | $10.00 | $10.00 | $10.00 | $10.00 | $10.00 | $5.00 | |
10 | 300% | $2,658.00 | $3,189.00 | $40.00 | $30.00 | $20.00 | $10.00 | $10.00 | $10.00 | $10.00 | $10.00 | |
11 | 350% | $3,190.00 | $3,720.00 | $50.00 | $40.00 | $30.00 | $20.00 | $10.00 | $10.00 | $10.00 | $10.00 | |
12 | 400% | $3,721.00 | $4,251.00 | $60.00 | $50.00 | $40.00 | $30.00 | $20.00 | $10.00 | $10.00 | $10.00 | |
13 | 450% | $4,252.00 | $4,782.00 | $70.00 | $60.00 | $50.00 | $40.00 | $30.00 | $20.00 | $10.00 | $10.00 | |
14 | 500% | $4,783.00 | $5,313.00 | $80.00 | $70.00 | $60.00 | $50.00 | $40.00 | $30.00 | $20.00 | $10.00 | |
15 | 550% | $5,314.00 | $5,844.00 | $90.00 | $80.00 | $70.00 | $60.00 | $50.00 | $40.00 | $30.00 | $20.00 | |
16 | 600% | $5,845.00 | $6,375.00 | Full Fee | $90.00 | $80.00 | $70.00 | $60.00 | $50.00 | $40.00 | $30.00 | |
17 | $6,376.00 | $6906.00+ | Full Fee | Full Fee | Full Fee | Full Fee | Full Fee | Full Fee | Full Fee | Full Fee | ||
18 | * based on 2020 Poverty Guidelines | |||||||||||
19 | MONTHLY MAX** | |||||||||||
20 | Monthly Income | NUMBER of HOUSEHOLD DEPENDENTS | ||||||||||
21 | % of Poverty* | Min. range | Max. range | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | |
22 | 100% | $0 | $1,063 | $30.00 | $30.00 | $30.00 | $30.00 | $30.00 | $30.00 | $30.00 | $30.00 | |
23 | 150% | $1,064.00 | $1,595.00 | $60.00 | $60.00 | $60.00 | $60.00 | $30.00 | $30.00 | $30.00 | $30.00 | |
24 | 200% | $1,596.00 | $2,127.00 | $120.00 | $60.00 | $60.00 | $60.00 | $60.00 | $30.00 | $30.00 | $30.00 | |
25 | 250% | $2,128.00 | $2,658.00 | $180.00 | $120.00 | $60.00 | $60.00 | $60.00 | $60.00 | $60.00 | $30.00 | |
26 | 300% | $2,658.00 | $3,189.00 | $240.00 | $180.00 | $120.00 | $60.00 | $60.00 | $60.00 | $60.00 | $60.00 | |
27 | 350% | $3,190.00 | $3,720.00 | $300.00 | $240.00 | $180.00 | $120.00 | $60.00 | $60.00 | $60.00 | $60.00 | |
28 | 400% | $3,721.00 | $4,251.00 | $420.00 | $350.00 | $280.00 | $210.00 | $140.00 | $70.00 | $70.00 | $70.00 | |
29 | 450% | $4,252.00 | $4,782.00 | $490.00 | $420.00 | $350.00 | $280.00 | $210.00 | $140.00 | $70.00 | $70.00 | |
30 | 500% | $4,783.00 | $5,313.00 | $560.00 | $490.00 | $420.00 | $350.00 | $280.00 | $210.00 | $140.00 | $70.00 | |
31 | 550% | $5,314.00 | $5,844.00 | $630.00 | $560.00 | $490.00 | $420.00 | $350.00 | $280.00 | $210.00 | $140.00 | |
32 | 600% | $5,845.00 | $6,375.00 | Full Fee | $630.00 | $560.00 | $490.00 | $420.00 | $350.00 | $280.00 | $210.00 | |
33 | $6,376.00 | $6906.00+ | Full Fee | Full Fee | Full Fee | Full Fee | Full Fee | Full Fee | Full Fee | Full Fee | ||
34 | ** Max based on an equivalent of 6/7 outpatient visits per month | |||||||||||