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)$221$442$466
30 (total days: 122)$473$946$1,083
45 (total days: 137)$662$1,324$1,542
60 (total days: 152)$864$1,728$2,037
75 (total days: 167)$1,085$2,170$2,575
90 (total days: 182)$1,320$2,640$3,149
105 (total days: 197)$1,571$3,142$3,761
120 (total days: 212)$1,839$3,678$4,414
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)$414$828$1,011
30 (total days: 122)$890$1,780$2,172
45 (total days: 137)$1,247$2,494$3,042
60 (total days: 152)$1,631$3,262$3,980
75 (total days: 167)$2,047$4,094$4,995
90 (total days: 182)$2,493$4,986$6,083
105 (total days: 197)$2,971$5,942$7,250
120 (total days: 212)$3,483$6,966$8,500
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)$1,123$2,246$2,741
30 (total days: 122)$2,409$4,818$5,878
45 (total days: 137)$3,372$6,744$8,228
60 (total days: 152)$4,415$8,830$10,773
75 (total days: 167)$5,539$11,078$13,514
90 (total days: 182)$6,744$13,488$16,456
105 (total days: 197)$8,038$16,076$19,612
120 (total days: 212)$9,426$18,852$22,999
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

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