PPO Low Income Subsidy Premium Summary
Table for Those Receiving Extra Help
Product Description | 2010 Total Monthly Premium |
Presbyterian MediCare PPO Plan 1 | $49.00 |
| |
Plan 2 with Rx | $84.00 |
Plan 2 with Rx LIS 1 | $62.60 |
Plan 2 with Rx LIS 2 | $62.60 |
Plan 2 with Rx LIS 3_25% subsidy | $78.60 |
Plan 2 with Rx LIS 3_50% subsidy | $73.30 |
Plan 2 with Rx LIS 3_75% subsidy | $67.90 |
Plan 2 with Rx LIS 1_100% subsidy | $62.60 |
Plan 2 with Rx LIS 4 | $62.60 |
| |
Plan 3 with Rx (No Extra Help) | $105.00 |
Plan 3 with Rx LIS 1 | $83.60 |
Plan 3 with Rx LIS 2 | $83.60 |
Plan 3 with Rx LIS 3_25% subsidy | $99.60 |
Plan 3 with Rx LIS 3_50% subsidy | $94.30 |
Plan 3 with Rx LIS 3_75% subsidy | $88.90 |
Plan 3 with Rx LIS 3_100% subsidy | $83.60 |
Plan 3 with Rx LIS 4 | $83.60 |
- Your premium will generally be lower once you receive extra help from Medicare.
- The premiums listed above do not include any Part B premium.
- The premiums listed above for Plan 2 with Rx and Plan 3 with Rx are for both medical services and prescription drug benefits.
- The premiums listed above for Plan 1 are for just medical benefits and do not include prescription benefits.
[MPC000000] 10/09H3206_PPO90912B
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