| Rates effective 10/1/2011 |
Plan A |
Plan B |
Plan C |
Plan D |
Plan F |
Plan N |
| Male/65yr - Non-Tobacco |
$93.12 |
$103.24 |
$126.50 |
$106.59 |
$129.55 |
$86.57 |
| Male/65yr - Tobacco |
$107.09 |
$118.72 |
$145.47 |
$122.58 |
$148.98 |
$99.55 |
| Female/65yr - Non-Tobacco |
$80.97 |
$89.77 |
$110.00 |
$92.69 |
$112.65 |
$75.28 |
| Female/65yr - Tobacco |
$93.12 |
$103.24 |
$126.50 |
$106.59 |
$129.55 |
$86.57 |
| Benefits |
Plan A |
Plan B |
Plan C |
Plan D |
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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