| Rates effective through 12/31/2012 |
Plan A |
Plan F |
High Ded. Plan F |
Plan N |
| Ages 65-69* |
$108 |
$174 |
$40 |
$122 |
| Ages 70-74 |
$124 |
$198 |
$45 |
$139 |
| Age 75-79 |
$141 |
$227 |
$52 |
$159 |
| Age 80+ |
$142 |
$228 |
$52 |
$160 |
| 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 |
|
|
|
|
*The 65- to 69-year-old rate applies to persons on Medicare by reason of disability who are under age 65.
Rates are for Automatic Funds Transfer (AFT). Paper billing is $5 per month extra.
Download Request 
