Group Size

Annual
FPL

100% Monthly
FPL

150% Monthly
FPL

200% Monthly
FPL

300% Monthly
FPL

1

$10,400

$867

$1,301

$1,734

$2,601

2

$14,000

$1,167

$1,751

$2,334

$3,501

3

$17,600

$1,467

$2,201

$2,934

$4,401

4

$21,200

$1,767

$2,651

$3,534

$5,301

5

$24,800

$2,067

$3,101

$4,134

$6,201

6

$28,400

$2,367

$3,551

$4,734

$7,101

7

$32,000

$2,667

$4,001

$5,334

$8,001

8

$35,600

$2,967

$4,451

$5,934

$8,901

9

$39,200

$3,267

$4,901

$6,534

$9,801

10

$42,800

$3,567

$5,351

$7,134

$10,701

Each Additional Person

$3,600

$300

$450

$600

$900

• QMB limit
• Co-pays for children on BC+ begin

• BC+ ES limit for children ages 6 - 18
• Premiums for parents & relative caretakers on BC+ begin

• BC+ Standard Plan limit for children, pregnant women, and parents/relative caretakers
• BC+ PP Standard Plan Limit
• BC+ FPS limit
• QDWI limit
• Premiums for children on BC+ begin

• BC+ Benchmark Plan limit for pregnant women
• BC+ PP Benchmark Plan limit