| |
|
Member |
|
Member |
|
|
| |
|
Premium |
Subsidy |
Premium |
Subsidy |
Total |
| |
|
20% |
80% |
10% |
90% |
Premium |
| Without Medicare |
|
|
|
|
|
| |
Self |
$ 149.45 |
$ 597.81 |
$ 74.73 |
$ 672.53 |
$ 747.26 |
| |
Self and Spouse |
$ 275.45 |
$ 1,101.82 |
$ 137.73 |
$ 1,239.54 |
$ 1,377.27 |
| |
Self and Child(ren) |
$ 204.69 |
$ 818.77 |
$ 102.35 |
$ 921.11 |
$ 1,023.46 |
| |
Self, Spouse & Child(ren) |
$ 330.69 |
$ 1,322.78 |
$ 165.35 |
$ 1,488.12 |
$ 1,653.47 |
| |
|
|
|
|
|
|
| With Medicare |
|
|
|
|
|
| |
Self |
$ 50.91 |
$ 203.63 |
$ 25.45 |
$ 229.09 |
$ 254.54 |
| |
Self and Spouse |
$ 96.88 |
$ 387.50 |
$ 48.44 |
$ 435.94 |
$ 484.38 |
| |
Self and Child(ren) |
$ 102.47 |
$ 409.87 |
$ 51.23 |
$ 461.11 |
$ 512.34 |
| |
Self, Spouse & Child(ren) |
$ 148.44 |
$ 593.74 |
$ 74.22 |
$ 667.96 |
$ 742.18 |
| |
|
|
|
|
|
|
| One With and One Without Medicare |
|
|
|
|
| |
Self Without & Spouse With |
$ 195.42 |
$ 781.68 |
$ 97.71 |
$ 879.39 |
$ 977.10 |
| |
Self With & Spouse Without |
$ 176.91 |
$ 707.64 |
$ 88.45 |
$ 796.10 |
$ 884.55 |
| |
Self Without, Spouse With & Child(ren) |
$ 246.98 |
$ 987.92 |
$ 123.49 |
$ 1,111.41 |
$ 1,234.90 |
| |
Self With, Spouse Without & Child(ren) |
$ 232.15 |
$ 928.60 |
$ 116.07 |
$ 1,044.68 |
$ 1,160.75 |
| |
|
|
|
|
|
|
| |
|
|
|
|
|
|
| Parent Coverage |
|
|
|
|
|
| |
Parent under 65 |
$ 126.00 |
$ 504.01 |
$ 63.00 |
$ 567.01 |
$ 630.01 |
| |
Parent over 65 |
$ 45.97 |
$ 183.87 |
$ 22.99 |
$ 206.85 |
$ 229.84 |
