| Effective January 1, 2012 |
Bridge
Plan A |
Bridge
Plan C |
Bridge
Plan F |
Bridge
Plan K |
| Age 65 & under |
$117 |
$143 |
$144 |
$78 |
| Age 66 |
$121 |
$150 |
$151 |
$81 |
| Age 67 |
$127 |
$159 |
$160 |
$86 |
| Age 68 |
$132 |
$166 |
$167 |
$90 |
| Age 69 |
$137 |
$173 |
$174 |
$95 |
| Age 70 |
$143 |
$181 |
$183 |
$98 |
| Benefits |
Plan A |
Plan C |
Plan F |
Plan K |
| Medicare Part A Coinsurance and Hospital Benefits |
 |
|
|
|
| Medicare Part A Deductible |
|
|
|
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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