Medicaid Purchase Plan
Premium Table
Net monthly income amount:
|
The premium is:
|
Net monthly income amount:
|
The premium is:
|
From:
|
To:
|
Premium
|
From:
|
To:
|
Premium
|
|
$0 |
$25.00 |
$0.00 |
$500.01 |
$525.00 |
$500.00 |
|
$25.01 |
$50.00 |
$25.00 |
$525.01 |
$550.00 |
$525.00 |
|
$50.01 |
$75.00 |
$50.00 |
$550.01 |
$575.00 |
$550.00 |
|
$75.01 |
$100.00 |
$75.00 |
$575.01 |
$600.00 |
$575.00 |
|
$100.01 |
$125.00 |
$100.00 |
$625.01 |
$650.00 |
$625.00 |
|
$125.01 |
$150.00 |
$125.00 |
$650.01 |
$675.00 |
$650.00 |
|
$150.01 |
$175.00 |
$150.00 |
$675.01 |
$700.00 |
$675.00 |
|
$175.01 |
$200.00 |
$175.00 |
$700.01 |
$725.00 |
$700.00 |
|
$200.01 |
$225.00 |
$200.00 |
$725.01 |
$750.00 |
$725.00 |
|
$225.01 |
$250.00 |
$225.00 |
$750.01 |
$775.00 |
$750.00 |
|
$250.01 |
$275.00 |
$250.00 |
$775.01 |
$800.00 |
$775.00 |
|
$275.01 |
$300.00 |
$275.00 |
$800.01 |
$825.00 |
$800.00 |
|
$300.01 |
$325.00 |
$300.00 |
$825.01 |
$850.00 |
$825.00 |
|
$325.01 |
$350.00 |
$325.00 |
$850.01 |
$875.00 |
$850.00 |
|
$350.01 |
$375.00 |
$350.00 |
$875.01 |
$900.00 |
$875.00 |
|
$375.01 |
$400.00 |
$375.00 |
$900.01 |
$925.00 |
$900.00 |
|
$400.01 |
$425.00 |
$400.00 |
$925.01 |
$950.00 |
$925.00 |
|
$425.01 |
$450.00 |
$425.00 |
$950.01 |
$975.00 |
$950.00 |
|
$450.01 |
$475.00 |
$450.00 |
$975.01 |
$1,000.00 |
$975.00 |
|
$475.01 |
$500.00 |
$475.00 |
|
Back to Table of Contents
Next — Core Plan Covered Services and Copays
Previous — BadgerCare Plus Monthly Premium Tables
Last Revised:
February 07, 2013 |
