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PPO Low Income Subsidy Premium Summary

Table for Those Receiving Extra Help

 Product Description

 2009 Total Premium

Medicare PPO Plan 1 (No Extra Help)

 $49.00
   
Medicare PPO Plan 2 with Rx

 $84.00
Medicare PPO Plan 2 with Rx LIS 1

 $63.40
Medicare PPO Plan 2 with Rx LIS 2 

 $63.40

Medicare PPO Plan 2 with Rx LIS 3_25% subsidy

 $78.90
Medicare PPO Plan 2 with Rx LIS 3_50% subsidy 

 $73.30
Medicare PPO Plan 2 with Rx LIS 3_75% subsidy

 $68.60

Medicare PPO Plan 2 with Rx LIS 3_100% subsidy 

 $63.40

Medicare PPO Plan 2 with Rx LIS 4 

 $63.40
   
Plan 3 with Rx

 $105.00

Medicare PPO Plan 3 with Rx LIS 1 

 $84.40
Medicare PPO Plan 3 with Rx LIS 2

$84.40
Medicare PPO Plan 3 with Rx LIS 3_25% subsidy

$99.90
Medicare PPO Plan 3 with Rx LIS 3_50% subsidy

$94.70
Medicare PPO Plan 3 with Rx LIS 3_75% subsidy

$89.60
Medicare PPO Plan 3 with Rx LIS 3_100% subsidy

$84.40

Medicare PPO Plan 3 with Rx LIS 4

$84.40
  • 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 and do not include prescription benefits.