| Rates effective January 1, 2011 |
Plan A |
Plan B |
Plan C |
Plan D |
Plan F |
Plan G |
Plan N |
| Male/65yr Preferred (970-972) |
$88.75 |
$103.64 |
$123.96 |
$108.68 |
$128.52 |
$111.43 |
$89.94 |
| Female/65yr Preferred (970-972) |
$77.26 |
$90.09 |
$107.81 |
$94.42 |
$111.75 |
$96.87 |
$78.20 |
| Male/65yr Standard (970-972) |
$98.68 |
$115.14 |
$137.74 |
$120.65 |
$142.78 |
$131.45 |
$99.94 |
| Female/65yr Standard (970-972) |
$85.76 |
$100.17 |
$119.86 |
$104.98 |
$124.11 |
$107.66 |
$86.84 |
| Male/65yr Preferred (973-979) |
$83.53 |
$97.54 |
$116.67 |
$102.29 |
$120.96 |
$104.88 |
$84.90 |
| Female/65yr Preferred (973-979) |
$72.71 |
$84.79 |
$101.47 |
$88.87 |
$105.18 |
$91.17 |
$73.60 |
| Male/65yr Standard (973-979) |
$92.87 |
$108.36 |
$129.63 |
$113.55 |
$134.38 |
$116.52 |
$94.06 |
| Female/65yr Standard (973-979) |
$80.72 |
$94.28 |
$112.81 |
$98.80 |
$116.81 |
$101.32 |
$81.75 |
| Benefits |
Plan A |
Plan B |
Plan C |
Plan D |
Plan F |
Plan G |
Plan N |
| Medicare Part A Coinsurance and Hospital Benefits |
 |
|
|
|
|
|
|
| Medicare Part A Deductible |
|
|
|
|
|
|
|
| Medicare Part B Coinsurance or Co-payment |
|
|
|
|
|
|
2 |
| 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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