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Page | 9 Income Chart Name: Plan First 200% Federal Poverty Level (FPL) Income Limits – All Localities Effective Date: January 13, 2026

Household Size 200% FPL Yearly Amount 200% FPL Monthly Amount 205% FPL (200% FPL + 5% FPL Disregard) 1 $31,920 $2,660 $2,727 2 $43,280 $3,607 $3,697 3 $54,640 $4,554 $4,668 4 $66,000 $5,500 $5,638 5 $77,360 $6,447 $6,608 6 $88,720 $7,394 $7,579 7 $100,080 $8,340 $8,549 8 $111,440 $9,287 $9,519 Each additional, add $11,360 $947 $971

Income Chart Name: MAGI Adults 133% Federal Poverty Level (FPL) Income Limits – All Localities Effective Date: January 13, 2026

Household Size 133% FPL Yearly Amount 133% FPL Monthly Amount 138% FPL (133% FPL + 5% FPL Disregard) 1 $21,227 $1,769 $22,025 2 $28,782 $2,399 $29,864 3 $36,336 $3,028 $37,702 4 $43,890 $3,658 $45,540 5 $51,445 $4,288 $53,379 6 $58,999 $4,917 $61,217 7 $66,554 $5,547 $69,056 8 $74,108 $6,176 $76,894 Each additional, add $7,555 $630 $7,839