Family Size 2 | Family Size 3 | ||
Monthly Income | Monthly Co-Pay | Monthly Income | Monthly Co-Pay |
$0-1,643 | $1.00 | $0-2,072 | $1.00 |
1,644 - 1,808 | 17.00 | 2,073 - 2,279 | 22.00 |
1,809 - 1,972 | 38.00 | 2,280 - 2,486 | 48.00 |
1,973 - 2,136 | 62.00 | 2,487 - 2,693 | 78.00 |
2,137 - 2,301 | 89.00 | 2,694 - 2,900 | 112.00 |
2,302 - 2,465 | 119.00 | 2,901 - 3,108 | 150.00 |
2,466 - 2,629 | 153.00 | 3,109 - 3,315 | 193.00 |
2,630 - 2,794 | 190.00 | 3,316 - 3,522 | 239.00 |
2,795 - 2,958 | 201.00 | 3.523 - 3,729 | 254.00 |
2,959 - 3,122 | 213.00 | 3,730 - 3,936 | 268.00 |
3,123 - 3,287 | 224.00 | 3,937 - 4,143 | 283.00 |
3,288 - 3,451 | 236.00 | 4,144 - 4,351 | 297.00 |
3,452 - 3,615 | 247.00 | 4,352 - 4,558 | 312.00 |
3,616 - 3,698 | 256.00 | 4,559 - 4,661 | 323.00 |
3,699 - 3,780 | 262.00 | 4,662 - 4,765 | 330.00 |
3,781 - 3,944 | 270.00 | 4,766 - 4,972 | 341.00 |
3,945 - 4,108 | 282.00 | 4,973 - 5,179 | 355.00 |
4,109 - 4,273 | 293.00 | 5,180 - 5,386 | 370.00 |
4,274 - 4,437 | 305.00 | 5,387 - 5,594 | 384.00 |
4,438 - 5,113 | 314.00 | 5,595 - 6,316 | 395.00 |
Family Size 4 | Family Size 5 | ||
Monthly Income | Monthly Co-Pay | Monthly Income | Monthly Co-Pay |
$0-2,500 | $1.00 | $0-2,928 | $1.00 |
2,501 - 2,750 | 26.00 | 2,929 - 3,221 | 31.00 |
2,751 - 3,000 | 58.00 | 3,222 - 3,514 | 67.00 |
3,001 - 3,250 | 94.00 | 3,515 - 3,807 | 110.00 |
3,251 - 3,500 | 135.00 | 3,808 - 4,100 | 158.00 |
3,501 - 3,750 | 181.00 | 4,101 - 4,393 | 212.00 |
3,751 - 4,000 | 233.00 | 4,394 - 4,685 | 272.00 |
4,001 - 4,250 | 289.00 | 4,686 - 4,978 | 338.00 |
4,251 - 4,500 | 306.00 | 4,979 - 5,271 | 359.00 |
4,501 - 4,750 | 324.00 | 5,272 - 5,564 | 379.00 |
4,751 - 5,000 | 341.00 | 5,565 - 5,857 | 400.00 |
5,001 - 5,250 | 359.00 | 5,858 - 6,150 | 420.00 |
5,251 - 5,500 | 376.00 | 6,151 - 6,442 | 441.00 |
5,501 - 5,625 | 389.00 | 6,443 - 6,589 | 456.00 |
5,626 - 5,750 | 398.00 | 6,590 - 6,735 | 466.00 |
5,751 - 6,000 | 411.00 | 6,736 - 7,028 | 482.00 |
6,001 - 6,250 | 429.00 | 7,029 - 7,321 | 502.00 |
6,251 - 6,500 | 446.00 | 7,322 - 7,614 | 523.00 |
6,501 - 6,750 | 464.00 | 7,615 - 7,907 | 543.00 |
6,751 - 7,519 | 477.00 | 7,908 - 8,722 | 559.00 |
Family Size 6 | Family Size 7 | ||
Monthly Income | Monthly Co-Pay | Monthly Income | Monthly Co-Pay |
$0-3,357 | $1.00 | $0-3,785 | $1.00 |
3,358 - 3,692 | 35.00 | 3,786 - 4,164 | 40.00 |
3,693 - 4,028 | 77.00 | 4,165 - 4,542 | 87.00 |
4,029 - 4,364 | 126.00 | 4,543 - 4,921 | 142.00 |
4,365 - 4,699 | 181.00 | 4,922 - 5,299 | 204.00 |
4,700 - 5,035 | 243.00 | 5,300 - 5,678 | 274.00 |
5,036 - 5,371 | 312.00 | 5,679 - 6,056 | 352.00 |
5,372 - 5,706 | 388.00 | 6,057 - 6,435 | 437.00 |
5,707 - 6,042 | 411.00 | 6,436 - 6,813 | 464.00 |
6,043 - 6,378 | 435.00 | 6,814 - 7,192 | 490.00 |
6,379 - 6,713 | 458.00 | 7,193 - 7,570 | 517.00 |
6,714 - 7,049 | 482.00 | 7,571 - 7,949 | 543.00 |
7,050 - 7,385 | 505.00 | 7,950 - 8,327 | 570.00 |
7,386 - 7,553 | 523.00 | 8,328 - 8,516 | 590.00 |
7,554 - 7,720 | 535.00 | 8,517 - 8,706 | 603.00 |
7,721 - 8,056 | 552.00 | 8,707 - 9,084 | 623.00 |
8,057 - 8,392 | 576.00 | 9,085 - 9,463 | 649.00 |
8,393 - 8,727 | 599.00 | 9,464 - 9,841 | 676.00 |
8,728 - 9,063 | 623.00 | 9,842 - 10,151 | 702.00 |
9,064 - 9,925 | 640.00 |
Family Size 8 | Family Size 9 | ||
Monthly Income | Monthly Co-Pay | Monthly Income | Monthly Co-Pay |
$0-4,213 | $1.00 | $0-4,642 | $1.00 |
4,214 - 4,635 | 44.00 | 4,643 - 5,106 | 49.00 |
4,636 - 5,056 | 97.00 | 5,107 - 5,570 | 107.00 |
5,057 - 5,477 | 158.00 | 5,571 - 6,034 | 174.00 |
5,478 - 5,899 | 228.00 | 6,035 - 6,498 | 251.00 |
5,900 - 6,320 | 306.00 | 6,499 - 6,963 | 337.00 |
6,321 - 6,741 | 392.00 | 6,964 - 7,427 | 432.00 |
6,742 - 7,163 | 487.00 | 7,428 - 7,891 | 536.00 |
7,164 - 7,584 | 516.00 | 7,892 - 8,355 | 569.00 |
7,585 - 8,005 | 546.00 | 8,356 - 8,819 | 601.00 |
8,006 - 8,427 | 575.00 | 8,820 - 9,283 | 634.00 |
8,428 - 8,848 | 605.00 | 9,284 - 9,748 | 666.00 |
8,849 - 9,269 | 634.00 | 9,749 - 10,212 | 699.00 |
9,270 - 9,480 | 656.00 | 10,213 - 10,444 | 723.00 |
9,481 - 9,691 | 671.00 | 10,445 - 10,602 | 739.00 |
9,692 - 10,112 | 693.00 | ||
10,113 - 10,376 | 723.00 |
Family Size 10 | |
Monthly Income | Monthly Co-Pay |
$0-5,070 | $1.00 |
5,071 - 5,577 | 53.00 |
5,578 - 6,084 | 117.00 |
6,085 - 6,591 | 190.00 |
6,592 - 7,098 | 274.00 |
7,099 - 7,605 | 368.00 |
7,606 - 8,112 | 472.00 |
8,113 - 8,619 | 586.00 |
8,620 - 9,126 | 621.00 |
9,127 - 9,633 | 657.00 |
9,634 - 10,140 | 692.00 |
10,141 - 10,647 | 728.00 |
10,648 - 10,827 | 763.00 |
Ill. Admin. Code tit. 89, § 50.320