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

MAGI income max with 5% -CHIP 75, UWHS, MPW POV, MHK, & AEG- FPL included and CHIP premium amounts 7/1/2024-3/31/2025 # of Persons 1 2 3 4 5 6 7 8 9 10 11 #300% of Poverty SMHB & CHIP 75 3828 5196 6563 7930 9298 10665 12033 13400 14768 16135 17502 Premium 141 192 242 293 343 393 444 494 545 595 646 225% of Poverty CHIP 74 2824 3833 4842 5850 6859 7868 8877 9885 10894 11903 12912 Premium 58 78 99 119 141 161 181 203 223 243 264 #201% of Poverty UWHS 2586 3509 4433 5356 6280 7204 8127 9051 9974 10898 11821 #196% of Poverty MPW & MHK under 1 2523 3424 4325 5226 6128 7029 7930 8831 9732 10633 11535 185% of Poverty CHIP 73 2322 3152 3981 4810 5640 6469 7299 8128 8958 9787 10616 Premium 18 24 30 36 43 49 55 62 68 74 80 153%* of Poverty CHIP 4M 1921 2607 3293 3978 4664 5350 6036 6722 7408 8094 8780 150% of Poverty CHIP 71 & 72 1883 2555 3228 3900 4573 5245 5918 6590 7263 7935 8608 #148% of Poverty MHK 1921 2607 3293 3978 4664 5350 6036 6722 7408 8094 8780 141% of Poverty MPW HIF 1770 2402 3034 3666 4299 4931 5563 6195 6827 7459 8092 #133% of Poverty AEG 1732 2351 2970 3588 4207 4826 5445 6063 6682 7301 7919 110%* of Poverty 1381 1874 2367 2860 3353 3846 4340 4833 5326 5819 6312 MHF/MPW MHF 141 241 301 353 400 445 490 532 574 616 658 100% of Poverty (without 5%) 1255 1704 2152 2600 3049 3497 3945 4394 4842 5290 5739 *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 18870 20237 21605 22972 24339 25707 27074 28442 29809 31177 32544 Premium 696 746 797 847 898 948 999 1049 1100 1150 1200 225% of Poverty CHIP 74 13920 14929 15938 16947 17955 18964 19973 20982 21990 22999 24008 Premium 285 305 326 346 367 388 408 429 450 470 490 #201% of Poverty UWHS 12745 13669 14592 15516 16439 17363 18286 19210 20134 21057 21981 #196% of Poverty MPW & MHK under 1 12436 13337 14238 15139 16040 16941 17843 18744 19645 20546 21447 185% of Poverty CHIP 73 11446 12275 13105 13934 14763 15593 16422 17252 18081 18911 19740 Premium 87 93 99 105 112 118 124 131 137 143 149 153%* of Poverty CHIP 4M 9466 10152 10838 11524 12210 12896 13582 14268 14954 15640 16326 150% of Poverty CHIP 71 & 72 9280 9953 10625 11298 11970 12643 13315 13988 14660 15333 16005 #148% of Poverty MHK 9466 10152 10838 11524 12210 12896 13582 14268 14954 15640 16326 141% of Poverty MPW HIF 8724 9356 9988 10620 11252 11884 12517 13149 13781 14413 15045 #133% of Poverty AEG 8538 9157 9775 10394 11013 11632 12250 12869 13488 14106 14725 110%* of Poverty 6805 7299 7792 8285 8778 9271 9764 10258 10751 11244 11737 MHF/MPW MHF 700 742 784 826 868 910 952 994 1036 1078 1120 100% of Poverty (without 5%) 6187 6635 7084 7532 7980 8429 8877 9325 9774 10222 10670 *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 (07/24)