| Rates effective 1/1/2012 |
Plan A |
Plan F |
High Ded. Plan F |
Plan N |
| Ages 65-69 |
$140 |
$185 |
$70 |
$138 |
| Ages 70-74 |
$179 |
$236 |
$89 |
$175 |
| Age 75+ |
$210 |
$278 |
$105 |
$208 |
| Benefits |
Plan A |
Plan F |
High Ded. Plan F |
Plan N |
| Medicare Part A Coinsurance and Hospital Benefits |
 |
|
|
|
| Medicare Part A Deductible |
|
|
|
|
| Medicare Part B Coinsurance or Co-payment |
|
|
|
3 |
| 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 |
|
|
|
|
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