|
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 |
1101.82 |
137.73 |
1239.54 |
1377.27 |
Self and Child(ren) |
204.69 |
818.77 |
102.35 |
921.11 |
1023.46 |
Self, Spouse & Child(ren) |
330.69 |
1322.78 |
165.35 |
1488.12 |
1653.47 |
|
|
|
|
|
|
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 |
1111.41 |
1234.90 |
Self With, Spouse Without & Child(ren) |
232.15 |
928.60 |
116.07 |
1044.68 |
1160.75 |
|
|
|
|
|
|
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 |