Washington Apple Health Income and Resource Standards January 1, 2024 Changes Modified Adjusted Gross Income (MAGI) and SSI-related Program Standards (4/1/2023) 1 2 3 4 5 6 7 8 9 10 11+ Family (N01) $511 $658 $820 $972 $1,127 $1,284 $1,471 $1,631 $1,792 $1,951 N/A 138% FPL - New Adult (N05) $1,677 $2,268 $2,859 $3,450 $4,041 $4,632 $5,223 $5,814 $6,406 $6,997 $591 198% FPL - Pregnancy (N03/N23) and *APC (N07/ N27) $2,406 $3,253 $4,103 $4,950 $5,797 $6,647 $7,494 $8,342 $9,191 $10,039 $849 215% FPL - Children (N11/ N31) $2,612 $3,533 $4,454 $5,375 $6,296 $7,217 $8,138 $9,059 $9,980 $10,901 $921 265% FPL – Family Planning Only $3,220 $4,355 $5,490 $6,625 $7,760 $8,895 $10,030 $11,165 $12,300 $13,436 $1,135 265% FPL - CHIP T1 (N13/ N33) $20 premium $3,220 $4,355 $5,490 $6,625 $7,760 $8,895 $10,030 $11,165 $12,300 $13,436 $1,135 317% FPL - CHIP T2 (N13/ N33) $30 premium $3,852 $5,209 $6,567 $7,925 $9,283 $10,641 $11,998 $13,356 $14,714 $16,072 $1,358 Note: Include the unborn child(s) in the household size for family and pregnancy medical AU’s. *After Pregnancy Coverage Above MAGI limits include 5% income disregard except for Family-related N01. HCA 19-0096 (12/23)

SSI/CNIL Standards (1/1/24) Single Eligible Eligible Couple CNIL Income $943 $1,415 FBR (SSI Standard) $943 $1,415 1/2 FBR $472 N/A Shared Living FBR $629 $943 SSI Resources $2,000 $3,000 Medicare Standards 1/1/2024 Part A Premium: 40+ work quarters = Free Part A; <40 but >29 work quarters = $278 <30 work quarters = $505 Part B Premium $174.70 Part A Deductible: Inpatient Hospital = $1,632 per benefit period Part B Deductible $240 Part A coinsurance for Inpatient hospital $408 per day for 61st - 90th day; $816 per day for over 90 days Part A coinsurance for NF $204 per day for 21st - 100th day Substantial Gainful Activity (SGA) 1/1/24 Non-Blind $1,550 Blind $2,590 Low Income Subsidy (LIS) Resources Single $15,510 Couple $30,950 Medicare Savings Program (Includes $20 disregard) Alternate financial eligibility standards 4/1/2023 People in the Household 1 2 3 4 5 6 7 8 9 10 11+ QMB Income 100% FPL (S03) $1,235 $1,663 $2,092 $2,520 $2,948 $3,377 $3,805 $4,233 $4,662 $5,090 $429 SLMB Income 120% FPL (S05) $1,478 $1,992 $2,506 $3,020 $3,534 $4,048 $4,562 $5,076 $5,590 $6,104 $514 QI-1 Income 135% FPL (S06) $1,660 $2,239 $2,817 $3,395 $3,973 $4,552 $5,130 $5,708 6,286 $6,865 $578 QDWI 200% FPL (S04) $2,450 $3,307 $4,163 $5,020 $5,877 $6,733 $7,590 $8,447 $9,303 $10,160 $857 Medically Needy (MN) Standards 1/1/2024 MNIL Standard (1/1/24) $943 $943 $943 $943 $943 $975 $1,125 $1,242 $1,358 $1,483 $1,483 MN Resources $2,000 $3,000 $3,050 $3,100 $3,150 $3,200 $3,250 $3,300 $3,350 $3,400 +50

Washington Apple Health Income and Resource Standards January 1, 2025 Changes Modified Adjusted Gross Income (MAGI) and SSI-related Program Standards (4/1/2024) 1 2 3 4 5 6 7 8 9 10 11+ Family (N01) $511 $658 $820 $972 $1,127 $1,284 $1,471 $1,631 $1,792 $1,951 N/A 138% FPL - New Adult (N05) $1,732 $2,351 $2,969 $3,588 $4,207 $4,825 $5,444 $6,063 $6,682 $7,300 $619 215% FPL - Pregnancy (N03/N23) and *APC (N07/ N27) (As of 11/24) $2,698 $3,662 $4,626 $5,590 $6,554 $7,518 $8,482 $9,446 $10,410 $11,374 $964 215% FPL - Children (N11/ N31) $2,698 $3,662 $4,626 $5,590 $6,554 $7,518 $8,482 $9,446 $10,410 $11,374 $964 265% FPL – Family Planning Only $3,326 $4,514 $5,702 $6,890 $8,078 $9,266 $10,454 $11,642 $12,830 $14,019 $1,188 265% FPL - CHIP T1 (N13/ N33) $20 premium $3,326 $4,514 $5,702 $6,890 $8,078 $9,266 $10,454 $11,642 $12,830 $14,019 $1,188 317% FPL - CHIP T2 (N13/ N33) $30 premium $3,978 $5,400 $6,821 $8,242 $9,663 $11,084 $12,506 $13,927 $15,348 $16,769 $1,421 Note: Include the unborn child(s) in the household size for family and pregnancy medical AU’s. *After Pregnancy Coverage Above MAGI limits include 5% income disregard except for Family-related N01. HCA 19-0096 (12/24)

HCA 19-0096 (01/26) Washington Apple Health Income and Resource Standards January 1, 2026 Modified Adjusted Gross Income (MAGI) Standards Program Single Person 2-person Household 3-person Household 4-person Household 5-person Household 6-person Household 7-person Household 8-person Household 9-person Household 10-person Household 11-person+ Household Family (N01) $511 $658 $820 $972 $1,127 $1,284 $1,471 $1,631 $1,792 $1,951 N/A 138% FPL - New Adult (N05) $1,800 $2,433 $3,065 $3,697 $4,330 $4,962 $5,595 $6,228 $6,860 $7,492 $632 215% FPL - Pregnancy (N03/ N23) and *APC (N07/N27) $2,804 $3,790 $4,775 $5,760 $6,747 $7,731 $8,716 $9,703 $10,688 $11,672 $985 215% FPL - Children (N11/ N31) $2,804 $3,790 $4,775 $5,760 $6,747 $7,731 $8,716 $9,703 $10,688 $11,672 $985 265% FPL – Family Planning Only $3,456 $4,672 $5,886 $7,099 $8,316 $9,529 $10,743 $11,959 $13,173 $14,387 $1,214 265% FPL - CHIP T1 (N13/N33) $20 premium $3,456 $4,672 $5,886 $7,099 $8,316 $9,529 $10,743 $11,959 $13,173 $14,387 $1,214 317% FPL - CHIP T2 (N13/N33) $30 premium $4,134 $5,589 $7,041 $8,492 $9,947 $11,399 $12,851 $14,306 $15,758 $17,210 $1,452 Note: Include the unborn child(s) in the household size for family and pregnancy medical AU’s. *After Pregnancy Coverage Above MAGI limits include 5% income disregard except for Family-related N01.