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18.2.1 MHN Income Standards – MAGI Income Limits (w/5%) and CHIP Premium Amounts Page 4

MAGI income max with 5% -CHIP 75, UWHS, MPW POV, MHK, & AEG- FPL included and CHIP premium amounts 4/1/2025-6/30/2025 # of Persons 1 2 3 4 5 6 7 8 9 10 11 #300% of Poverty SMHB & CHIP 75 3978 5376 6774 8172 9570 10968 12366 13764 15162 16559 17957 Premium 141 192 242 293 343 393 444 494 545 595 646 225% of Poverty CHIP 74 2935 3966 4997 6029 7060 8091 9122 10154 11185 12216 13247 Premium 58 78 99 119 141 161 181 203 223 243 264 #201% of Poverty UWHS 2687 3631 4575 5520 6464 7408 8352 9296 10240 11185 12129 #196% of Poverty MPW & MHK under 1 2622 3543 4464 5386 6307 7228 8149 9071 9992 10913 11834 185% of Poverty CHIP 73 2413 3261 4109 4957 5805 6653 7501 8349 9197 10044 10892 Premium 18 24 30 36 43 49 55 62 68 74 80 153%* of Poverty CHIP 4M 1996 2697 3398 4100 4801 5502 6203 6905 7606 8307 9008 150% of Poverty CHIP 71 & 72 1957 2644 3332 4019 4707 5394 6082 6769 7457 8144 8832 #148% of Poverty MHK 1996 2697 3398 4100 4801 5502 6203 6905 7606 8307 9008 141% of Poverty MPW HIF 1839 2486 3132 3778 4424 5071 5717 6363 7009 7656 8302 #133% of Poverty AEG 1800 2433 3065 3698 4330 4963 5595 6228 6860 7493 8125 110%* of Poverty 1435 1939 2443 2947 3451 3955 4460 4964 5468 5972 6476 MHF/MPW MHF 141 241 301 353 400 445 490 532 574 616 658 100% of Poverty (without 5%) 1305 1763 2221 2680 3138 3596 4055 4513 4971 5430 5888 *Income Ranges for CHIP 4M-Ages 1 through 5=148%-153% and ages 6 through 18=110%-153%; #=5% disregard applied at this level. # of Persons 12 13 14 15 16 17 18 19 20 21 22 #300% of Poverty SMHB & CHIP 75 19355 20753 22151 23549 24947 26345 27743 29141 30539 31937 33334 Premium 696 746 797 847 898 948 999 1049 1100 1150 1200 225% of Poverty CHIP 74 14279 15310 16341 17372 18404 19435 20466 21497 22529 23560 24591 Premium 285 305 326 346 367 388 408 429 450 470 490 #201% of Poverty UWHS 13073 14017 14961 15905 16850 17794 18738 19682 20626 21570 22515 #196% of Poverty MPW & MHK under 1 12756 13677 14598 15519 16441 17362 18283 19204 20126 21047 21968 185% of Poverty CHIP 73 11740 12588 13436 14284 15132 15980 16828 17676 18524 19372 20219 Premium 87 93 99 105 112 118 124 131 137 143 149 153%* of Poverty CHIP 4M 9710 10411 11112 11813 12515 13216 13917 14618 15320 16021 16722 150% of Poverty CHIP 71 & 72 9519 10207 10894 11582 12269 12957 13644 14332 15019 15707 16394 #148% of Poverty MHK 9710 10411 11112 11813 12515 13216 13917 14618 15320 16021 16722 141% of Poverty MPW HIF 8948 9594 10241 10887 11533 12179 12826 13472 14118 14764 15411 #133% of Poverty AEG 8758 9390 10023 10655 11288 11920 12553 13185 13818 14450 15083 110%* of Poverty 6980 7485 7989 8493 8997 9501 10005 10510 11014 11518 12022 MHF/MPW MHF 700 742 784 826 868 910 952 994 1036 1078 1120 100% of Poverty (without 5%) 6346 6805 7263 7721 8180 8638 9096 9555 10013 10471 10930 *Income Ranges for CHIP 4M-Ages 1 through 5=148%-153% and ages 6 through 18=110%-153%; #=5% disregard applied at this level.

Revised (04/25)