| Income Range (as a percent of the federal poverty guidelines) |
Co-payment (as a percentage of adjusted gross income) |
| 0-74.99% |
$0/month |
| 75.00-99.99% |
$5/month |
| 100.00-104.99% |
2.61% |
| 105.00-109.99% |
2.61% |
| 110.00-114.99% |
2.61% |
| 115.00-119.99% |
2.61% |
| 120.00-124.99% |
2.91% |
| 125.00-129.99% |
2.91% |
| 130.00-134.99% |
2.91% |
| 135.00-139.99% |
2.91% |
| 140.00-144.99% |
3.21% |
| 145.00-149.99% |
3.21% |
| 150.00-154.99% |
3.21% |
| 155.00-159.99% |
3.84% |
| 160.00-164.99% |
3.84% |
| 165.00-169.99% |
4.46% |
| 170.00-174.99% |
4.76% |
| 175.00-179.99% |
5.05% |
| 180.00-184.99% |
5.65% |
| 185.00-189.99% |
5.95% |
| 190.00-194.99% |
6.24% |
| 195.00-199.99% |
6.84% |
| 200.00-204.99% |
7.58% |
| 205.00-209.99% |
8.33% |
| 210.00-214.99% |
9.20% |
| 215.00-219.99% |
10.07% |
| 220.00-224.99% |
10.94% |
| 225.00-229.99% |
11.55% |
| 230.00-234.99% |
12.16% |
| 235.00-239.99% |
12.77% |
| 240.00-244.99% |
13.38% |
| 245.00-249.99% |
14.00% |
| 250% |
ineligible |
Official Publication of the State of Minnesota
Revisor of Statutes