| Rates effective 1/1/2012 |
Plan A |
Plan F |
Plan G |
| Age 65 + |
$120.13 |
$176.66 |
$160.76 |
| 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 |
|
|
|
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