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Presbyterian Senior Care (HMO) Low Income Subsidy Premium Summary

Table for Those Receiving Extra Help

 Product Description

 2010 Total Monthly Premium

Presbyterian Senior Care (HMO) Plan 1

 $0.00

 

 

Plan 2 with Rx

 $0.00

Plan 2 with Rx LIS 1

  $0.00

Plan 2 with Rx LIS 2 

 $0.00

Plan 2 with Rx LIS 3_25% subsidy

 $0.00

Plan 2 with Rx LIS 3_50% subsidy 

  $0.00

Plan 2 with Rx LIS 3_75% subsidy

  $0.00

Plan 2 with Rx LIS 1_100% subsidy 

  $0.00

Plan 2 with Rx LIS 4 

  $0.00

 

 

Plan 3 with Rx (No Extra Help)

 $57.00

Plan 3 with Rx LIS 1 

  $35.60

Plan 3 with Rx LIS 2

 $35.60

Plan 3 with Rx LIS 3_25% subsidy

 $51.60

Plan 3 with Rx LIS 3_50% subsidy

 $46.30

Plan 3 with Rx LIS 3_75% subsidy

 $40.90

Plan 3 with Rx LIS 3_100% subsidy

 $35.60

Plan 3 with Rx LIS 4

 $35.60

  • 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.

 

[MPC090961]                   10/09 H3204_P90912B