CoverRx Income Guidelines
In order to qualify for CoverRx, applicants must earn within 250 percent of the federal poverty level (FPL) — $58,875 for a family of four.
Co-pays for prescriptions are based on a member's household income, as outlined below.
| Persons in Household |
Below FPL |
FPL to 149% FPL |
150% to 250% FPL |
| 1 |
$11,490 |
$11,491 - $17,235 |
$17,236 - $28,725 |
| 2 |
$15,510 |
$15,511 - $23,265 |
$23,266 - $38,775 |
| 3 |
$19,530 |
$19,531 - $29,295 |
$29,296 - $48,825 |
| 4 |
$23,550 |
$23,551 - $35,325 |
$35,326 - $58,875 |
| 5 |
$27,570 |
$27,571 - $41,355 |
$41,356 - $68,925 |
| 6 |
$31,590 |
$31,591 - $47,385 |
$47,386 - $78,975 |
| 7 |
$35,610 |
$35,611 - $53,415 |
$53,416 - $89,025 |
| 8 |
$39,630 |
$39,631 - $59,445 |
$59,446 - $99,075 |
For families with more than eight persons, add $4,020 for each additional person to calculate the low co-pay level.
Rates effective as of 3/1/13.
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