Zip Code* Age* Gender

Regence BlueShield Medicare Supplement Rates
Rates Effective
April 1, 2013
Plan A Plan C Plan F Plan K
Regence BlueShield $120.00 $168.00 $169.00 $91.00
Benefits Plan A Plan C Plan F Plan K
Medicare Part A Coinsurance and Hospital Benefits
Medicare Part A Deductible 50%
Medicare Part B Coinsurance or Co-payment 50%
Medicare Part B Deductible
Medicare Part B Excess Charges
Blood (First Three Pints) 50%
Hospice Care Coinsurance or Co-payment 50%
Skilled Nursing Coinsurance 50%
Foreign Travel Emergency (Up to Plan Limits)
Medicare Preventive Care Part B Coinsurance

Discounts are reflected in the premiums listed above for all payment options other than Monthly Paper Bill; there is no discount for monthly paper billing

  1. Monthly Surepay from your bank account receives a discount of $2 - a $24 savings annually
  2. Paying your bill quarterly saves you $4 - a $16 savings annually
  3. Paying your bill semi-annually saves you $10 - a $20 savings annually
  4. Paying your bill quarterly saves you $22
  1. Medigap Plan F offers a high deductible option. You must pay for Medicare-covered costs up to the high-deductible amount ($2,180 in 2015) before your Medigap policy pays anything
  2. 100% part B coinsurance except up to $20 copayment for office visits and up to $50 copayment for ER.
  3. You must also pay a separate deductible for foreign travel emergency ($250 per year).
  4. After you meet your out-of-pocket yearly limit and your yearly Part B deductible ($147 in 2015) the plan pays 100% of covered services for the rest of the calendar year (This applies only to plans K & L)
  5. Modified Plan F offers an individual assistance program, as well as coverage for preventive dental care (available in some states)
  • 2015 Out of Pocket Limit for Plan K is $4,940.
  • 2015 Out of Pocket Limit for Plan L is $2,470.