This plan is for you...
Use the chart below to determine which plan best fits your needs.
| IF YOU NEED: |
CONVENTIONAL
$67/month* |
PREMIER
$99/month* |
PREMIER PLUS
$121/month* |
| Medical benefits only |
This is the plan for you |
|
|
| Medical benefits w/Prescription drug coverage |
|
This is the plan for you |
|
| Medical benefits w/prescription drug coverage including coverage in the gap, plus dental and hearing aid benefits, and out-of-pocket maximum for durable medical equipment |
|
|
This is the plan for you |
* For detailed side-by-side comparison of benefits and costs, see the Summary of Benefits under Member resources.
Last modified: October 1, 2011
H3811_MA4003_2012 CMS Approved 10/14/2011