| Plans | One Person |
Two Persons ** |
Advantage 65 |
$277 |
$554 |
Advantage 65 + Dental/Vision |
$308 |
$616 |
Advantage 65 - Medical Only* |
$126 |
$252 |
Advantage 65 - Medical Only+ |
$157 |
$314 |
Dental/Vision* |
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*These plans do not include prescription drug coverage |
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| NOT AVAILABLE TO NEW ENROLLEES | ||
Option I - Medicare Complementary |
$237 |
$474 |
Option II - Medicare Supplemental |
$319 |
$638 |
Option II + Dental/Vision |
$350 |
$700 |
** Two persons may choose the same plan or different Medicare-eligible plans; the total premium is the sum of each selection. |
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Important: Timely payment of the total premium is the State retiree group member's responsibility whether the premium is withheld from a retirement benefit or billed directly by the health plan. Failure to pay premiums within 31 days of the due date will result in termination of coverage. |
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