SeniorCare Annual Income Limits

Your annual income determines your level of coverage in SeniorCare and how much SeniorCare will cover. See the table below for out-of-pocket expenses and benefits for each level of participation.

SeniorCare 2016 Annual Income Limits and Out of Pocket Expenses by Level of Participation
Level 1 Income Limits Level 1 Out-of-Pocket Expenses

Income at or below 160% of the FPL

Individual: $19,008
Couple: $25,632

  • No deductible or spenddown.
  • $5 copay for each covered generic prescription drug.
  • $15 copay for each covered brand name prescription drug.
Level 2 Income Limits Level 2 Out-of-Pocket Expenses
Income between 160% and 200% of the FPL

Individual: $19,009-$23,760
Couple: $25,633-$32,040
  • $500 deductible per person.
  • Pay the SeniorCare rate for covered drugs until the $500 deductible is met.
  • After $500 deductible is met, pay a $5 copay for each covered generic prescription drug and a $15 copay for each covered brand name prescription drug.
Level 2B Income Limits Level 2B Out-of-Pocket Expenses

Income between 200% and 240% of the FPL

Individual: $23,761-$28,512
Couple: $32,041-$38,448

  • $850 deductible per person.
  • Pay the SeniorCare rate for covered drugs until the $850 deductible is met.
  • After $850 deductible is met, pay a $5 copay for each covered generic prescription drug and a $15 copay for each covered brand name prescription drug.
Level 3 Income Limits Level 3 Out-of-Pocket Expenses

Income more than 240% of the FPL

Individual: $28,513 or greater
Couple: $38,449 or greater

  • Pay retail price for covered drugs during spenddown.
  • After the spenddown is met, meet an $850 deductible per person.
  • Pay the SeniorCare rate for covered drugs until the $850 deductible is met.
  • After $850 deductible is met, pay a $5 co-pay for each covered generic prescription drug and a $15 co-pay for each covered brand name prescription drug.

These income limits are effective February 1, 2016. The amounts are based on the 2016 federal guidelines which may change each year.

Last Revised: April 7, 2016