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Medicare Supplement Monthly Two-Party Rates
These rates are effective April 1, 2005. Rates are subject to change.
Medicare Supplement Enrollment Application

When applying for a two-party contract under Blue Shield's guaranteed acceptance guidelines, both parties must qualify; otherwise, you may be subject to underwriting.
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 $180 $190 $214 $202 $230 $477 $475
67 to 69 $182 $194 $218 $206 $240 $519 $527
70 to 74 $215 $243 $287 $273 $299 $584 $578
75 to 79 $295 $303 $345 $311 $391 $698 $726
80-plus $307 $319 $373 $331 $427 $802 $854
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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 $182 $196 $222 $210 $236 $479 $463
67 to 69 $184 $200 $228 $216 $246 $503 $517
70 to 74 $217 $251 $299 $287 $307 $570 $558
75 to 79 $293 $309 $355 $325 $397 $632 $662
80-plus $301 $323 $389 $345 $433 $728 $790
 
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Region 3
San Diego County
Age Plan A Plan B Plan C Plan D Plan F Plan H Plan I
65 to 66 $182 $192 $214 $202 $230 $479 $463
67 to 69 $184 $196 $222 $210 $242 $521 $517
70 to 74 $217 $247 $289 $277 $297 $582 $546
75 to 79 $295 $311 $343 $327 $385 $654 $674
80-plus $313 $329 $377 $347 $419 $750 $822
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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 $184 $194 $222 $206 $240 $459 $451
67 to 69 $186 $198 $228 $212 $250 $503 $485
70 to 74 $219 $251 $299 $283 $305 $582 $544
75 to 79 $295 $315 $355 $335 $395 $664 $662
80-plus $305 $329 $385 $355 $431 $772 $758
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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 $180 $182 $194 $184 $202 $399 $431
67 to 69 $182 $186 $200 $190 $212 $451 $463
70 to 74 $215 $229 $269 $243 $261 $488 $490
75 to 79 $251 $273 $339 $295 $355 $584 $608
80-plus $273 $293 $375 $315 $381 $686 $716
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Region 6
Counties: 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
Age Plan A Plan B Plan C Plan D Plan F Plan H Plan I
65 to 66 $174 $176 $190 $180 $198 $403 $409
67 to 69 $178 $180 $192 $182 $206 $457 $443
70 to 74 $205 $223 $259 $243 $255 $494 $470
75 to 79 $247 $273 $339 $299 $359 $594 $578
80-plus $269 $295 $371 $321 $377 $692 $696
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*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