| Rates effective 10/1/2011 |
Plan A |
Plan F |
Plan G |
| Male / 65yr / Non-tobacco |
$95.98 |
$133.54 |
$113.05 |
| Female / 65yr / Non-tobacco |
$83.50 |
$116.18 |
$98.35 |
| Male / 65yr / Tobacco |
$110.32 |
$153.49 |
$129.94 |
| Female / 65yr / Tobacco |
$95.98 |
$133.54 |
$113.05 |
| Benefits |
Plan A |
Plan F |
Plan G |
| Medicare Part A Coinsurance and Hospital Benefits |
 |
|
|
| Medicare Part A Deductible |
|
|
|
| Medicare Part B Coinsurance or Co-payment |
|
|
|
| Medicare Part B Deductible |
|
|
|
| Medicare Part B Excess Charges |
|
|
|
| Blood (First Three Pints) |
|
|
|
| Hospice Care Coinsurance or Co-payment |
|
|
|
| Skilled Nursing Coinsurance |
|
|
|
| Foreign Travel Emergency (Up to Plan Limits)3 |
|
|
|
| Medicare Preventive Care Part B Coinsurance |
|
|
|
Download Request 
