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Medicare Supplement Monthly Rates

Effective April 1, 2005
Region 1
Los Angeles and Orange Counties
(except for Los Angeles County zip codes
91711, 91759, 91765, 91766, 91767, 93535, 93544, 93563 and 93591)
 Age Plan A  Plan B Plan C  Plan D  Plan F  Plan H  Plan I
 65 to 66  $93  $98  $110  $104  $118  $241  $240
 67 to 69  $94  $100  $112  $106  $123  $262  $266
 70 to 74  $120  $134  $156  $149  $162  $302  $299
 75 to 79  $160  $164  $185  $168  $208  $359  $373
 80-plus  $166  $172  $199  $178  $226  $411  $437
 64 or younger*  $423  $633  $655  $561  $738  $862  $1,056
 
*Those 64 or younger who do not have End Stage Renal Disease may apply for Blue Shield of California Medicare Supplement coverage as described in Blue Shield’s Guaranteed Acceptance Guide. Blue Shield of California does not offer coverage to those 64 or younger unless they qualify for guaranteed acceptance.
 
If you choose to use our Easy$Pay method of automatic monthly deductions from your bank or savings account, you will save $2 per month on your plan dues.
 
**Savings due to increased efficiencies from administering Medicare Supplement plans under this program/service are passed on to the subscriber. 
 
Region 2
Riverside and San Bernardino Counties
and the following zip codes in Los Angeles County:
91711, 91759, 91765, 91766, 91767, 93535, 93544, 93563 and 93591
 Age Plan A  Plan B Plan C  Plan D  Plan F  Plan H  Plan I
 65 to 66  $94  $101  $114  $108  $121  $242  $234
 67 to 69  $95  $103  $117  $111  $126  $254  $261
 70 to 74  $121  $138  $162  $156  $166  $295  $289
 75 to 79  $159  $167  $190  $175  $211  $326  $341
 80-plus  $163  $174  $207  $185  $229  $374  $405
 64 or younger*  $425  $638  $674  $567  $744  $798  $949
 
*Those 64 or younger who do not have End Stage Renal Disease may apply for Blue Shield of California Medicare Supplement coverage as described in Blue Shield’s Guaranteed Acceptance Guide. Blue Shield of California does not offer coverage to those 64 or younger unless they qualify for guaranteed acceptance.
 
If you choose to use our Easy$Pay method of automatic monthly deductions from your bank or savings account, you will save $2 per month on your plan dues.
 
**Savings due to increased efficiencies from administering Medicare Supplement plans under this program/service are passed on to the subscriber. 
 
Region 3
San Diego County
 Age Plan A  Plan B Plan C  Plan D  Plan F  Plan H  Plan I
 65 to 66  $94  $99  $110  $104  $118  $242  $234
 67 to 69  $95  $101  $114  $108  $124  $263  $261
 70 to 74  $121  $136  $157  $151  $161  $301  $283
 75 to 79  $160  $168  $184  $176  $205  $337  $347
 80-plus  $169  $177  $201  $186  $222  $385  $421
 64 or younger*  $440  $621  $622  $567  $744  $870  $1,056
 
*Those 64 or younger who do not have End Stage Renal Disease may apply for Blue Shield of California Medicare Supplement coverage as described in Blue Shield’s Guaranteed Acceptance Guide. Blue Shield of California does not offer coverage to those 64 or younger unless they qualify for guaranteed acceptance.
 
If you choose to use our Easy$Pay method of automatic monthly deductions from your bank or savings account, you will save $2 per month on your plan dues.
 
**Savings due to increased efficiencies from administering Medicare Supplement plans under this program/service are passed on to the subscriber. 
 
Region 4
Kern, Santa Barbara and Ventura Counties
 Age Plan A  Plan B Plan C  Plan D  Plan F  Plan H  Plan I
 65 to 66  $95  $100  $114  $106  $123  $232  $228
 67 to 69  $96  $102  $117  $109  $128  $254  $245
 70 to 74  $122  $138  $162  $154  $165  $301  $282
 75 to 79  $160  $170  $190  $180  $210  $342  $341
 80-plus  $165  $177  $205  $190  $228  $396  $389
 64 or younger*  $429  $585  $629  $598  $744  $830  $1,006
 
*Those 64 or younger who do not have End Stage Renal Disease may apply for Blue Shield of California Medicare Supplement coverage as described in Blue Shield’s Guaranteed Acceptance Guide. Blue Shield of California does not offer coverage to those 64 or younger unless they qualify for guaranteed acceptance.
 
If you choose to use our Easy$Pay method of automatic monthly deductions from your bank or savings account, you will save $2 per month on your plan dues.
 
**Savings due to increased efficiencies from administering Medicare Supplement plans under this program/service are passed on to the subscriber. 
 
Region 5
San Joaquin, Sonoma and Stanislaus Counties
 Age Plan A  Plan B Plan C  Plan D  Plan F  Plan H  Plan I
 65 to 66  $93  $94  $100  $95  $104  $202  $218
 67 to 69  $94  $96  $103  $98  $109  $228  $234
 70 to 74  $120  $127  $147  $134  $143  $254  $255
 75 to 79  $138  $149  $182  $160  $190  $302  $314
 80-plus  $149  $159  $200  $170  $203  $353  $368
 64 or younger*  $328  $516  $565  $426  $598  $684  $789
 
 
 
*Those 64 or younger who do not have End Stage Renal Disease may apply for Blue Shield of California Medicare Supplement coverage as described in Blue Shield’s Guaranteed Acceptance Guide. Blue Shield of California does not offer coverage to those 64 or younger unless they qualify for guaranteed acceptance.
 
If you choose to use our Easy$Pay method of automatic monthly deductions from your bank or savings account, you will save $2 per month on your plan dues.
 
**Savings due to increased efficiencies from administering Medicare Supplement plans under this program/service are passed on to the subscriber. 
 
Region 6
Alameda, Alpine, Amador, Butte, Calaveras, Colusa, Contra Costa, Del Note, El Dorado, Fresno, Glenn, Humboldt, Imperial, Inyo, Kings, Lake, Lassen, Madera, Marin, Mariposa, Mendocino, Merced, Modoc, Mono, Monterey, Napa, Nevada, Placer, Plumas, Sacramento, San Benito, San Francisco, San Luis Obispo, San Mateo, Santa Clara, Santa Cruz, Shasta, Sierra, Siskiyou, Solano, Sutter, Tehama, Trinity, Tulare, Tuolomne, Yolo and Yuba Counties
 Age Plan A  Plan B Plan C  Plan D  Plan F  Plan H  Plan I
 65 to 66  $90  $91  $98  $93  $102  $204  $207
 67 to 69  $92  $93  $99  $94  $106  $231  $224
 70 to 74  $115  $124  $142  $134  $140  $257  $245
 75 to 79  $136  $149  $182  $162  $192  $307  $299
 80-plus  $147  $160  $198  $173  $201  $356  $358
 64 or younger*  $315  $485  $535  $380  $598  $642  $789
 
 
*Those 64 or younger who do not have End Stage Renal Disease may apply for Blue Shield of California Medicare Supplement coverage as described in Blue Shield’s Guaranteed Acceptance Guide. Blue Shield of California does not offer coverage to those 64 or younger unless they qualify for guaranteed acceptance.
 
If you choose to use our Easy$Pay method of automatic monthly deductions from your bank or savings account, you will save $2 per month on your plan dues.
 
**Savings due to increased efficiencies from administering Medicare Supplement plans under this program/service are passed on to the subscriber. 
 
 
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Copyright © 2005 Oleg Skurskiy Authorized Independent Agent, CA License 0E50389