The premium schedule is based on the federal poverty guidelines and will be revised annually to reflect adjustments in the federal poverty guidelines. Premium contributions are based on the countable income amount calculated to determine eligibility and the number of household members to be enrolled.
MONTHLY PREMIUM CONTRIBUTION PER RECIPIENT
Family
Size 101-125% 126-150%
First Individual $10.30 $16.80
Each Added
individual $ 3.45 $ 5.65
10- 144 C.M.R. ch. 103, § V-5.5