| Family Size | Level 1 Copay ($25) | Level 2 Copay ($40) | Level 3 Copay ($55) | Level 4 Copay ($70) | No Discount |
|---|---|---|---|---|---|
| 1 | $0-$14,580 | $14,580- $19,391.40 | $19,391.41- $24,202.80 | $24,202.81- $29,160 | $29,160 – Up |
| 2 | $0-$19,720 | $19,7200 -$26,227.60 | $26,227.61- $32,735.20 | $32,725.21- $39,440 | $39,440 – Up |
| 3 | $0-$24,860 | $24,869.01- $33,063.80 | $33,063.81- $41, 267.60 | $41,267.61 – $49,720 | $49,720 – Up |
| 4 | $0-$30,000 | $30,000-$39,000 | $39,900.01- $49,800 | $49,800.01 – $60,000 | $60,000 – Up |
| 5 | $0-$35,1400 | $35,140.01- $46,736.20 | $46,736.21- $58,332.40 | $58,332.41 – $70,280 | $70,280 – Up |
| 6 | $0-$40,280 | $40,280.01- $53,572.40 | $53,572.41- $66,864,80 | $66,864.81 – $80,560 | $80,560 – Up |
| 7 | $0- $45,420 | $45,420.01- $60,408.60 | $60,408.61 – $75,397.20 | $75,397.21 – $90,840 | $90,840 – Up |
| 8 | $0-$50,569 | $50,560.01 – $67,277.80 | $67,244.81- $83,829.60 | $83,929.61 – $101,120 | $101,120 – Up |
Understanding the Chart: This chart follows IFPG (Federal Poverty Guidelines) set by the U.S. Census Bureau to assess financial eligibility for various Federal programs. IFPG establishes annual income thresholds, indicating the levels and copays in which an individual or family is recognized. The income amounts vary based on family size.
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