| Rates effective January 1, 2012 |
Plan A |
Plan F |
High Ded. F |
Plan K |
Plan M |
| 67 & under - Region 1 (View brochure to see your Region) |
$78.00 |
$111.00 |
$46.00 |
$59.00 |
$94.00 |
| 67 & under - Region 2 (View brochure to see your Region) |
$82.00 |
$117.00 |
$48.00 |
$62.00 |
$98.00 |
| 67 & under - Region 3 (View brochure to see your Region) |
$83.00 |
$119.00 |
$49.00 |
$63.00 |
$100.00 |
| Benefits |
Plan A |
Plan F |
High Ded. F |
Plan K |
Plan M |
| Medicare Part A Coinsurance and Hospital Benefits |
 |
|
|
|
|
| Medicare Part A Deductible |
|
|
|
50% |
50% |
| Medicare Part B Coinsurance or Co-payment |
|
|
|
50% |
|
| Medicare Part B Deductible |
|
|
|
|
|
| Medicare Part B Excess Charges |
|
|
|
|
|
| Blood (First Three Pints) |
|
|
|
50% |
|
| Hospice Care Coinsurance or Co-payment |
|
|
|
50% |
|
| Skilled Nursing Coinsurance |
|
|
|
50% |
|
| Foreign Travel Emergency (Up to Plan Limits)3 |
|
|
|
|
|
| Medicare Preventive Care Part B Coinsurance |
|
|
|
|
|
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