Zip Code* Age* Gender


Regence BlueShield Medicare Supplement Rates
Rates Effective
April 1, 2015
Plan A Plan C Plan F Plan K
Regence BlueShield $129.00 $181.00 $182.00 $98.00
Benefits Plan A Plan C Plan F Plan K
Part B Coinsurance 100 100 100 50
Skilled Nursing 100 100 100 100
Part B Excess 100
Foreign Travel 80 80 80 80
Part A Deductible 1260 630
Part B Deductible 147 147
Part B Excess Charges Not Covered Not Covered Covered Not Covered
Doctor/Hospital Choice Any Doctor or medical provider that accepts Medicare Any Doctor or medical provider that accepts Medicare Any Doctor or medical provider that accepts Medicare Any Doctor or medical provider that accepts Medicare
Office Visit No Charge after deductible; Excess Charges possible No Charge but Excess Charges possible No Charge 50% after Part B Deductible plus Excess Charges
OOP Maximum No Limit No Limit No Limit 4,940
Rx Coverage Not Covered Not Covered Not Covered Not Covered
Foreign Travel 80% 80% 80% 80%
Hospitalization No charge after Part A deductible for Days 1-60; No charge for Days 61-90; No charge for Days 91-150 (Lifetime Reserve); No charge for Additional 365 days after reserve. No charge for Days 1-60; No charge for Days 61-90; No charge for Days 91-150 (Lifetime Reserve); No charge for Additional 365 days after reserve. No charge for Days 1-60; No charge for Days 61-90; No charge for Days 91-150 (Lifetime Reserve); No charge for Additional 365 days after reserve. No charge after Part A deductible for Days 1-60; No charge for Days 61-90; No charge for Days 91-150 (Lifetime Reserve); No charge for Additional 365 days after reserve.
Outpatient Surgery No Charge after deductible; Excess Charges possible No Charge but Excess Charges possible No Charge 50% after Part B Deductible plus Excess Charges
Skilled Nursing Facility First 20 days $0; 21st thru 100th day $157.50 per day; after 100 days you pay all No Charge for first 100 days No Charge for the first 100 days First 20 days $0; 21st thru 100th day $78.75 per day; after 100 days you pay all
Hospice No Charge No Charge No Charge 50% coverage
Blood No Charge No Charge No Charge First 3 pints 50%
Physician's Services No Charge after deductible; Excess Charges possible No Charge but Excess Charges possible No Charge 50% after Part B Deductible plus Excess Charges
Emergency Room No Charge after deductible; Excess Charges possible No Charge but Excess Charges possible No Charge 50% after Part B Deductible plus Excess Charges
Ambulance Services No Charge after deductible; Excess Charges possible No Charge but Excess Charges possible No Charge 50% after Part B Deductible plus Excess Charges
Urgent Care No Charge after deductible; Excess Charges possible No Charge but Excess Charges possible No Charge 50% after Part B Deductible plus Excess Charges
Outpatient Lab/X-Ray No Charge after deductible; Excess Charges possible No Charge but Excess Charges possible No Charge 50% after Part B Deductible plus Excess Charges
Outpatient Surgery No Charge after deductible; Excess Charges possible No Charge but Excess Charges possible No Charge 50% after Part B Deductible plus Excess Charges
Outpatient Rehab Service No Charge after deductible; Excess Charges possible No Charge but Excess Charges possible No Charge 50% after Part B Deductible plus Excess Charges
Home Health Care No Charge No Charge No Charge No Charge
Durable Medical Equipment No Charge after deductible; Excess Charges possible No Charge but Excess Charges possible No Charge 50% after Part B Deductible plus Excess Charges
Hospice No Charge No Charge No Charge No Charge
Blood No Charge after Part B Deductible No Charge No Charge First 3 pints 50% after Part B Deductible

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 $250 deductible for foreign travel emergency and there is a $50,000 lifetime maximum benefit.
  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) & [Excess charges do to apply to maximum out of pocket]
  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.