Monthly Premiums
Health Wise Health Wise Plus
Direct Pay Drug coverage maximum of $1,200 per calendar yearSingle$94.00$115.00
Couple $183.50 $225.50
Family $222.50 $273.00
Direct Pay Drug coverage maximum of $2,000 per calendar yearSingle$131.00$152.00
Couple$258.00$300.00
Family $311.00 $361.50
  • Under Age 75
  • Age 75 to 84
  • Age 85 and Over
Monthly Premiums
Total Health Ultimate Health
Direct Pay Drug coverage maximum of $1,200 per calendar yearSingle $112.75$133.75
Couple $220.50$262.50
Family $263.00$313.75
Direct Pay Drug coverage maximum of $2,000 per calendar yearSingle $149.25$170.25
Couple $294.25$336.00
Family $352.00$402.25
Monthly Premiums
Total Health Ultimate Health
Direct Pay Drug coverage maximum of $1,200 per calendar yearSingle $159.75$181.00
Couple $314.25$356.50
Family $378.75$429.50
Direct Pay Drug coverage maximum of $2,000 per calendar yearSingle $200.00$220.75
Couple $395.50$437.00
Family $477.75$527.25
Monthly Premiums
Total Health Ultimate Health
Direct Pay Drug coverage maximum of $1,200 per calendar yearSingle $299.50$320.50
Couple $593.00$635.25
Family $719.25$770.00
Direct Pay Drug coverage maximum of $2,000 per calendar yearSingle $348.50$369.75
Couple $691.75$734.50
Family $837.75 $889.00
  • Under Age 75
  • Age 75 to 84
  • Age 85 and Over
Annual Premiums
Additional days for a single trip (over 92-day base travel included with the Total Health and Ultimate Health options)Under age 75
SingleCoupleFamily
15 (total days: 107)$241$482$511
30 (total days: 122)$518$1,036$1,186
45 (total days: 137)$724$1,448$1,689
60 (total days: 152)$947$1,894$2,231
75 (total days: 167)$1,188$2,376$2,820
90 (total days: 182)$1,446$2,892$3,449
105 (total days: 197)$1,720$3,440$4,119
120 (total days: 212)$2,014$4,028$4,834
Annual Premiums
Additional days for a single trip (over 92-day base travel included with the Total Health and Ultimate Health options)Age 75 to 84
SingleCoupleFamily
15 (total days: 107)$461$922$1,125
30 (total days: 122)$991$1,982$2,418
45 (total days: 137)$1,388$2,776$3,386
60 (total days: 152)$1,816$3,632$4,430
75 (total days: 167)$2,279$4,558$5,560
90 (total days: 182)$2,775$5,550$6,772
105 (total days: 197)$3,307$6,614$8,070
120 (total days: 212)$3,878$7,756$9,461
Annual Premiums
Additional days for a single trip (over 92-day base travel included with the Total Health and Ultimate Health options)Age 85 and over
SingleCoupleFamily
15 (total days: 107)$1,251$2,502$3,051
30 (total days: 122)$2,682$5,364$6,544
45 (total days: 137)$3,754$7,508$9,159
60 (total days: 152)$4,915$9,830$11,992
75 (total days: 167)$6,165$12,330$15,044
90 (total days: 182)$7,507$15,014$18,318
105 (total days: 197)$8,947$17,894$21,832
120 (total days: 212)$10,493$20,986$25,602
Monthly Premiums
Option AOption BOption C
Single $66.25$53.50$40.25
Couple $132.75$106.50$80.50
Family $157.75$127.00$96.00
Annual Premiums
Age of insured personSingleFamily
0 - 29$105$209
30 - 39$109$218
40 - 49$112$224
50 - 59$133$266
60 - 65$174$348
66 - 74$242$484
75 +$349$697