Monthly Premiums
Health WiseHealth Wise Plus
Direct Pay Drug coverage maximum of $1,200 per calendar yearSingle$92.00$112.75
Couple$179.75$221.00
Family$218.25$267.50
Direct Pay Drug coverage maximum of $2,000 per calendar yearSingle$128.25$149.00
Couple$252.75$294.00
Family$304.75$354.25
  • Under Age 75
  • Age 75 to 84
  • Age 85 and Over
Monthly Premiums
Total HealthUltimate Health
Direct Pay Drug coverage maximum of $1,200 per calendar yearSingle$110.50
$131.00
Couple$216.00
$257.25
Family$257.75
$307.25
Direct Pay Drug coverage maximum of $2,000 per calendar yearSingle$146.25
$166.75
Couple$288.25
$329.25
Family$344.75
$394.00
Monthly Premiums
Total HealthUltimate Health
Direct Pay Drug coverage maximum of $1,200 per calendar yearSingle$156.50
$177.25
Couple$307.75
$349.25
Family$371.00
$420.75
Direct Pay Drug coverage maximum of $2,000 per calendar yearSingle$196.00
$216.25
Couple$387.50
$428.00
Family$468.00
$516.50
Monthly Premiums
Total HealthUltimate Health
Direct Pay Drug coverage maximum of $1,200 per calendar yearSingle$293.50
$314.00
Couple$581.00
$622.25
Family$704.50
$754.25
Direct Pay Drug coverage maximum of $2,000 per calendar yearSingle$341.50
$362.25
Couple$677.75
$719.50
Family$820.75
$870.75
  • 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)$230
$460
$487
30 (total days: 122)$495
$990
$1,132
45 (total days: 137)$691
$1,382
$1,612
60 (total days: 152)$903
$1,806
$2,129
75 (total days: 167)$1,134
$2,268
$2,691
90 (total days: 182)$1,379
$2,758
$3,291
105 (total days: 197)$1,642
$3,284
$3,930
120 (total days: 212)$1,921
$3,842
$4,613
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)$440
$880
$1,074
30 (total days: 122)$945
$1,890
$2,307
45 (total days: 137)$1,324
$2,648
$3,230
60 (total days: 152)$1,732
$3,464
$4,227
75 (total days: 167)$2,174
$4,348
$5,305
90 (total days: 182)$2,648
$5,296
$6,461
105 (total days: 197)$3,156
$6,312
$7,700
120 (total days: 212)$3,700
$7,400
$9,027
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)$1,193
$2,238
$2,911
30 (total days: 122)$2,559
$5,118
$6,243
45 (total days: 137)$3,581
$7,162
$8,739
60 (total days: 152)$4,689
$9,379
$11,442
75 (total days: 167)$5,883
$11,766
$14,353
90 (total days: 182)$7,163
$14,326
$17,478
105 (total days: 197)$8,537
$17,074
$20,830
120 (total days: 212)$10,011
$20,022
$24,428
Monthly Premiums
Option AOption BOption C
Single$59.25
$48.00
$36.00
Couple$118.75
$95.25
$72.00
Family$141.25
$113.75
$86.00