Jeremy lives alone and applies for the subsidy. He receives $1,155 per month in Social
Security benefits before the Medicare Part B premium deduction and a private pension
of $450 per month before taxes. Assume that his countable resources are below the
limit. Jeremy's countable income is:
Income Type

Income Calculation

Social Security

$13,860 (12 x $1,155)

Private pension

+$5,400 (12 x $450)


$19,260


 $240 (12 x the $20 general income exclusion)


Total Countable Unearned Income = $19,020

Assume that the applicable FPL for a oneperson family is $14,580. (We used the 2023
FPL rates for this example. For the current FPL rates, see HI 03001.020C.3.). We determine the subsidy income limits as follows:
$14,580 x 135% = $19,683
$14,580 x 140% = $20,412
$14,580 x 145% = $21,141
$14,580 x 150% = $21,870
Analysis: Jeremy’s countable income is greater than 135% of the poverty guideline, but it is
less than 140% of the poverty guideline. Therefore, Jeremy is eligible for a 75% premium
subsidy. Assuming Jeremy’s Part D premium is $35 per month, his subsidy covers $26.25
(75%) of his monthly premium. Jeremy is required to pay $8.75 per month for the 25%
of the premium not covered by the subsidy, assuming there are no late enrollment fees.