Exhibit B: Medicare Eligible Retiree Premium Rates
January 1, 2024—December 31, 2024 Monthly Premium Rates for Medicare Eligible Participants
The table below is best viewed at horizontal orientation on your device.
| PLAN | ONE PERSON | TWO PERSONS |
|---|---|---|
| Advantage 65 (with RX) | $295 | $590 |
| Advantage 65 (with RX) + Dental & Vision | $330 | $660 |
| Advantage 65 - Medical Only | $177 | $354 |
| Advantage 65 - Medical Only + Dental/Vision | $212 | $424 |
| NOT AVAILABLE TO NEW ENROLLEES | ONE PERSON | TWO PERSONS |
|---|---|---|
| Option II - Medicare Supplemental | $385 | $770 |
| Option II + Dental/Vision | $420 | $840 |
Two persons may choose the same or different Medicare-eligible plans; the total premium is the sum of each selection
Human Resources
