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Eligibility
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Summary of Benefits
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Monthly Premiums
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Qualifying Rates
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Medicare Carve-Out
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Application/Forms
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Important Notices
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Monthly Premiums: 

Click on one of the plan designs and you will be redirected to the premiums associated with that plan. 

Regular Plan Medicare Carve Out Low Income Premium Program
Female
Male
Female
Male
50% Reduction Male
50% Reduction Female
75% Reduction Male
75% Reduction Female
All rates effective July 1, 2008 through December 31, 2008.
Female 500 1000 2000 5000 7500 10000
Attained Age Plan Plan Plan Plan Plan Plan
             
 0 - 18 $130 $116 $98 $77 $68 $61
19 $204 $182 $153 $121 $107 $96
20 $204 $182 $153 $121 $107 $96
21 $204 $182 $153 $121 $107 $96
22 $204 $182 $153 $121 $107 $96
23 $204 $182 $154 $121 $107 $96
24 $204 $182 $154 $121 $108 $96
25 $213 $190 $160 $126 $112 $100
26 $222 $198 $167 $132 $117 $105
27 $231 $206 $174 $137 $122 $109
28 $239 $213 $180 $142 $126 $113
29 $246 $219 $185 $146 $129 $116
30 $254 $226 $191 $151 $134 $120
31 $261 $233 $196 $155 $138 $123
32 $269 $240 $202 $159 $141 $127
33 $279 $249 $210 $165 $147 $132
34 $289 $258 $218 $171 $152 $136
35 $300 $267 $226 $178 $158 $141
36 $311 $278 $235 $184 $164 $147
37 $322 $288 $243 $192 $170 $152
38 $333 $297 $252 $198 $175 $157
39 $345 $307 $260 $205 $181 $163
40 $356 $318 $268 $211 $187 $168
41 $368 $328 $278 $218 $194 $174
42 $380 $339 $286 $226 $200 $180
43 $393 $350 $296 $233 $207 $185
44 $405 $361 $305 $240 $213 $191
45 $417 $372 $315 $248 $220 $197
46 $430 $384 $324 $256 $227 $203
47 $444 $396 $335 $264 $234 $210
48 $451 $402 $340