Monthly Premiums (AMSC)
Health WiseHealth Wise
Plus
Direct pay drug coverage maximum of $1,200 per calendar year
Single$97.50$119.25
Couple$190.00$233.50
Family$230.50$282.75
Direct pay drug coverage maximum of $2,000 per calendar year
Single$135.75$157.50
Couple$267.25$310.75
Family$322.25$374.50
  • Under Age 75
  • Age 75 to 84
  • Age 85 and Over
Monthly Premiums (AMSC)
Total HealthUltimate Health
Direct pay drug coverage maximum of $1,200 per calendar year
Single$116.75$139.50
Couple$228.50$273.75
Family$272.75$327.00
Direct pay drug coverage maximum of $2,000 per calendar year
Single$154.75$176.50
Couple$304.75$348.50
Family$364.75$417.25
Monthly Premiums (AMSC)
Total HealthUltimate Health
Direct pay drug coverage maximum of $1,200 per calendar year
Single$165.50$187.50
Couple$325.25$369.25
Family$392.25$445.00
Direct pay drug coverage maximum of $2,000 per calendar year
Single$207.50$228.75
Couple$410.00$452.75
Family$495.00$546.25
Monthly Premiums (AMSC)
Total Health
Ultimate Health
Direct pay drug coverage maximum of $1,200 per calendar year
Single$310.75$332.25
Couple$615.25$658.25
Family$746.25$797.75
Direct pay drug coverage maximum of $2,000 per calendar year
Single$361.00$383.00
Couple$716.75$761.00
Family$868.00$921.00
  • Under Age 75
  • Age 75 to 84
  • Age 85 and Over
Annual Premiums (AMSC)
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)$251$502$530
30 (total days: 122)$538$1,076$1,231
45 (total days: 137)$752$1,504$1,753
60 (total days: 152)$982$1,964$2,315
75 (total days: 167)$1,233$2,466$2,927
90 (total days: 182)$1,500$3,000$3,579
105 (total days: 197)$1,785$3,570$4,274
120 (total days: 212)$2,089$4,178$5,016
Annual Premiums (AMSC)
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)$471$942$1,149
30 (total days: 122)$1,012$2,024$2,468
45 (total days: 137)$1,417$2,834$3,456
60 (total days: 152)$1,853$3,706$4,522
75 (total days: 167)$2,326$4,652$5,676
90 (total days: 182)$2,833$5,666$6,913
105 (total days: 197)$3,376$6,752$8,238
120 (total days: 212)$3,958$7,916$9,659
Annual Premiums (AMSC)
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)$1,277$2,554$3,115
30 (total days: 122)$2,738$5,476$6,680
45 (total days: 137)$3,832$7,664$9,350
60 (total days: 152)$5,017$10,034$12,242
75 (total days: 167)$6,294$12,588$15,357
90 (total days: 182)$7,664$15,328$18,700
105 (total days: 197)$9,134$18,268$22,287
120 (total days: 212)$10,711$21,422$26,136
Monthly Premiums (AMSC)
Option AOption BOption C
Single $68.75$55.25$42.00
Couple $137.75$110.75$83.50
Family $164.00$131.50$99.50
Annual Premiums (AMSC)
Age of insured personSingleFamily
0 - 29$105$209
30 - 39$108$218
40 - 49$112$224
50 - 59$133$266
60 - 65$174$348
66 - 74$242$484
75 +$349$697

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