Application (PDF) | Plan Description & Rate Sheet | Medicare and You | Choose Medigap

Rates effective 1/1/2012	Plan A	Plan F	Plan G	Plan M
Male / 65yr / Non-tobacco / zip codes 970-972	$79.89	$115.79	$94.97	$90.44
Female / 65yr / Non-tobacco / zip codes 970-972	$75.89	$109.99	$90.21	$85.91
Male / 65yr / Tobacco / zip codes 970-972	$91.83	$133.09	$109.16	$113.95
Female / 65yr / Tobacco / zip codes 970-972	$87.23	$126.42	$103.69	$98.75
Male / 65yr / Non-tobacco / zip codes 973-979	$76.70	$111.16	$91.17	$86.82
Female / 65yr / Non-tobacco / zip codes 973-979	$72.86	$105.59	$86.60	$82.47
Male / 65yr / Tobacco / zip codes 973-979	$88.16	$127.76	$104.79	$99.79
Female / 65yr / Tobacco / zip codes 973-979	$83.74	$121.36	$99.54	$94.80
Benefits	Plan A	Plan F	Plan G	Plan M
Medicare Part A Coinsurance and Hospital Benefits
Medicare Part A Deductible				50%
Medicare Part B Coinsurance or Co-payment
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

**** If you and the person you are living with on the same application, you are each eligible for a 7% discount from the normal rate/ If the person you are living with currently has a Mutual of Omaha plan, you are eligible for a 7% discount from the normal rate****