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Example 3: Tracy and Dave’s annual income is $53,936, which is $2,000 more than 240% of the FPL for a FTG of two. Because Tracy is 63 years old, only Dave is eligible for SeniorCare. For the 12-month benefit period Dave’s spenddown amount is $2,000. Tracy and Dave pay for their covered prescription drugs at retail price. Only covered prescription drugs purchased for Dave count toward the spenddown requirement. After Dave has met the $2,000 spenddown, he has a $850 deductible. Only covered prescription drugs purchased for Dave count toward his deductible. After Dave meets his deductible, he purchases covered prescription drugs at the copayment amounts for the remainder of his benefit period. This page last updated in Release Number: 26-01 Release Date: 02/13/2026 Effective Date: 02/01/2026 39.12 Five Percent Copay Limit Tiers 2026 Per-Member Copay Limits Status Assistance Group Income Tier as Percentage of the Federal Poverty Level 0- 50% >50- 100% >100- 150% >150- 200% >200- 250% >250- 300% >300- 350% >350- 400% >400- 450% >450- 500% >500% Individual $0 $26 $53 $79 $106 $132 $159 $186 $212 $239 $265 Prorated (split between counted spouses) $0 $13 $26.50 $39.50 $53 $66 $79.50 $93 $106 $119.50 $132.50 This page last updated in Release Number: 26-01 Release Date: 02/13/2026 Effective Date: 02/01/2026 39.13 VA Allowance Rates The chart below can be used to identify the value of the exempt portion of a VA payment if both the VA benefit type is known and the payment indicates the member is eligible for A&A or housebound allowance, but does not list an amount for the allowance. The following rates are effective December 1, 2025 – November 31, 2026. VA INCOME TYPE AID & ATTENDANCE AMOUNT HOUSEBOUND ALLOWANCE AMOUNT Veteran’s pension (see note) up to $971 up to $323 Surviving spouse pension (see note) up to $583 up to $217 Veteran’s disability compensation Benefit could include A&A for the spouse. Amount depends on veteran's disability rating. N/A Surviving spouse dependency and indemnity compensation (DIC) $421.00 $197.22 Surviving parent DIC $458 N/A