Application (PDF) | Plan Overview & Rates | Medicare and You | Choose Medigap

Rates effective January 1, 2011	Plan A	Plan F	High Ded. F	Plan K	Plan M
65 & under - Region 1 (View brochure to see your Region)	$74.00	$106.00	$44.00	$56.00	$89.00
65 & under - Region 2 (View brochure to see your Region)	$78.00	$111.00	$46.00	$59.00	$93.00
65 & under - Region 3 (View brochure to see your Region)	$79.00	$113.00	$46.00	$60.00	$95.00
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
2011 out-of-pocket limit4				$4,640

²100% part B coinsurance except up to $20 copayment for office visits and up to $50 copayment for ER. 
³You must also pay a separate deductible for foreign travel emergency ($250 per year). 
⁴After you meet your out-of-pocket yearly limit and your yearly Part B deductible ($162 in 2011) the plan pays 100% of covered services for the rest of the calendar year (This applies only to plans K & L)