| Plans | One Person |
Two Persons ** |
Advantage 65 |
$220 |
$440 |
Advantage 65 + Dental/Vision |
$253 |
$506 |
Advantage 65 - Medical Only* |
$137 |
$274 |
Advantage 65 - Medical Only+ Dental/Vision* |
$170 |
$340 |
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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 |
$236 |
$472 |
Option II - Medicare Supplemental |
$285 |
$570 |
Option II + Dental/Vision |
$318 |
$636 |
** 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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