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United Commercial Travelers of America

Medicare Supplement Rates

Rates effective 6/1/2010	Plan A	Plan F	Plan G	Plan N
Male / 65yr / Non-tobacco / zip codes 970-972	$1,545.05	$2,263.22	$1,884.37	$1,584.25
Female / 65yr / Non-tobacco / zip codes 970-972	$1,344.09	$1,966.73	$1,638.94	$1,376.71
Male / 65yr / Tobacco / zip codes 970-972	$1,932.14	$2,828.20	$2,357.11	$1,979.74
Female / 65yr / Tobacco / zip codes 970-972	$1,680.12	$2,459.23	$2,049.09	$1,721.46
Male / 65yr / Non-tobacco / zip codes 973-979	$1,358.90	$1,990.54	$1,657.34	$1,393.38
Female / 65yr / Non-tobacco / zip codes 973-979	$1,182.15	$1,729.77	$1,441.48	$1,210.84
Male / 65yr / Tobacco / zip codes 973-979	$1,699.35	$2,487.45	$2,073.12	$1,741.22
Female / 65yr / Tobacco / zip codes 973-979	$1,477.70	$2,162.94	$1,802.21	$1,514.06
Benefits	Plan A	Plan F	Plan G	Plan N
Medicare Part A Coinsurance and Hospital Benefits
Medicare Part A Deductible
Medicare Part B Coinsurance or Co-payment				2
Medicare Part B Deductible
Medicare Part B Excess Charges
Blood (First Three Pints)
Hospice Care Coinsurance or Co-payment
Skilled Nursing Coinsurance
Foreign Travel Emergency (Up to Plan Limits)3
Medicare Preventive Care Part B Coinsurance
2010 out-of-pocket limit4

MODAL FACTORS: Semi-Annual – 0.51500 / Quarterly – 0.26250 / Direct Monthly – 0.10000 / Monthly EFT – 0.08333

¹Medigap Plan F offers a high deductible option. You must pay for Medicare-covered costs up to the high-deductible amount ($2,000 in 2010) before your Medigap policy pays anything
²100% part B coinsurance except up to $20 copayment for office visits and up to $50 copayment for ER.
³You must also pay a separate deductible for foreign travel emergency ($250 per year).
⁴After you meet your out-of-pocket yearly limit and your yearly Part B deductible ($155 in 2010) the plan pays 100% of covered services for the rest of the calendar year