Exhibit B: Medicare Eligible Retiree Premium Rates
January 1, 2026—December 31, 2026 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) | $302 | $604 |
| Advantage 65 (with RX) + Dental & Vision | $361 | $722 |
| Advantage 65 - Medical Only | $191 | $382 |
| Advantage 65 - Medical Only + Dental/Vision | $250 | $500 |
| NOT AVAILABLE TO NEW ENROLLEES | ONE PERSON | TWO PERSONS |
|---|---|---|
| Option II - Medicare Supplemental | $399 | $798 |
| Option II + Dental/Vision | $458 | $916 |
Two persons may choose the same or different Medicare-eligible plans; the total premium is the sum of each selection
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