2017 Means Test
Fall 2017 Means Test Application
for Annuitants Who Retired Before August 23rd, 1989.
Changes can be effective as soon as January 1st, 2018
2017 MEANS TEST PROGRAM SUMMARY
The enclosed IRS form 4506T allows the Chicago Benefits Office to obtain Federal tax records to determine your eligibility for Means Test program.
If your combined total household adjusted gross income is at or below 250% of the Federal Poverty Guidelines, you may be eligible for one of the following limits on your monthly rate for retiree health benefits from the City of Chicago:
- Monthly rate capped at 25% of income where total household adjusted gross income is greater than 200% up to and including 250% of federal poverty level.
- Monthly rate capped at 20% of income where total household adjusted gross income is greater than 150% up to and including 200% of federal poverty level.
- Monthly rate capped at 15% of income where total household adjusted gross income is greater than 100% up to and including 150% of federal poverty level.
- Monthly rate capped at 10% of income where total household adjusted gross income is less than or equal to 100% of federal poverty level.