Monthly Premiums (AMSC)
Health WiseHealth Wise
Plus
Direct pay drug coverage maximum of $1,200 per calendar year
Single$95.50$116.75
Couple$186.00$228.75
Family$225.75$277.00
Direct pay drug coverage maximum of $2,000 per calendar year
Single$133.00$154.25
Couple$261.75$304.50
Family$315.75$366.75
  • 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$114.25$136.75
Couple$223.75$268.25
Family$267.25$320.25
Direct pay drug coverage maximum of $2,000 per calendar year
Single$151.50$173.00
Couple$298.50$314.50
Family$357.25$408.75
Monthly Premiums (AMSC)
Total HealthUltimate Health
Direct pay drug coverage maximum of $1,200 per calendar year
Single$162.00$183.75
Couple$318.50$361.75
Family$384.25$436.00
Direct pay drug coverage maximum of $2,000 per calendar year
Single$203.25$224.00
Couple$401.75$443.50
Family$485.00$535.00
Monthly Premiums (AMSC)
Total Health
Ultimate Health
Direct pay drug coverage maximum of $1,200 per calendar year
Single$304.50$325.50
Couple$602.75$644.75
Family$731.00$781.50
Direct pay drug coverage maximum of $2,000 per calendar year
Single$353.75$375.25
Couple$702.25$745.50
Family$850.25$902.25
  • 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)$239$479$506
30 (total days: 122)$513$1,025$1,174
45 (total days: 137)$717$1,435$1,672
60 (total days: 152)$937$1,873$2,209
75 (total days: 167)$1,176$2,353$2,792
90 (total days: 182)$1,431$2,863$3,415
105 (total days: 197)$1,703$3,407$4,078
120 (total days: 212)$1,993$3,988$4,786
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)$449$897$1,096
30 (total days: 122)$965$1,930$2,355
45 (total days: 137)$1,352$2,704$3,298
60 (total days: 152)$1,768$3,537$4,415
75 (total days: 167)$2,220$4,439$5,416
90 (total days: 182)$2,703$5,406$6,596
105 (total days: 197)$3,221$6,443$7,860
120 (total days: 212)$3,777$7,553$9,215
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)$1,218$2,435$2,972
30 (total days: 122)$2,612$5,224$6,373
45 (total days: 137)$3,656$7,312$8,921
60 (total days: 152)$4,787$9,574$11,681
75 (total days: 167)$6,005$12,011$14,653
90 (total days: 182)$7,312$14,624$17,842
105 (total days: 197)$8,715$17,430$21,264
120 (total days: 212)$10,220$20,440$24,936
Monthly Premiums (AMSC)
Option AOption BOption C
Single$61.50$49.50$37.50
Couple$123.25$99.25$74.75
Family$146.75$117.75$89.00

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