| Rates effective 10/1/2011 |
Plan A |
Plan F |
Plan G |
| 65+ Monthly Rates (Bank draft) |
$149.92 |
$208.75 |
$175.72 |
| Benefits |
Plan A |
Plan F |
Plan G |
| Medicare Part A Coinsurance and Hospital Benefits |
 |
|
|
| Medicare Part A Deductible |
|
|
|
| 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 |
|
|
|
Download Census 
