american retirement life insurance...
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AMERICAN RETIREMENT LIFE INSURANCE COMPANY P. O. BOX 26700 • AUSTIN, TX 78755-0580 • 866-459-4272
Outline of Medicare Supplement Coverage - Benefit Plans A, F, G, and N Benefit Chart of Medicare Supplement Plans Sold for Effective Dates on or after June 1, 2010
In Colorado, it is a requirement that all plans offered by Us are available to under age 65 Medicare qualified individuals. This chart shows the benefits included in each of the standard Medicare supplement plans. Every company must make Plan A available. Some plans may not be available in Your state.
BASIC BENEFITS: • Hospitalization: Part A coinsurance plus coverage for 365 additional days after Medicare benefits end. • Medical Expenses: Part B coinsurance (generally 20% of Medicare-approved Expenses) or copayments for hospital outpatient services. Plans K, L, and N require Insureds
to pay a portion of Part B coinsurance or copayments. • Blood: First three pints of blood each year. • Hospice: Part A coinsurance.
A B C D F F* G K L M N Basic, including 100% Part B coinsurance
Basic, including 100% Part B coinsurance
Basic, including 100% Part B coinsurance
Basic, including 100% Part B coinsurance
Basic, including 100% Part B coinsurance*
Basic, including 100% Part B coinsurance
Hospitalization and Preventive Care paid at 100%; other Basic Benefits paid at 50%
Hospitalization and Preventive Care paid at 100%; other Basic Benefits paid at 75%
Basic, including 100% Part B coinsurance
Basic, including 100% Part B coinsurance, except up to $20 copayment for office visit and up to $50 copayment for ER visit
Skilled Nursing Facility coinsurance
Skilled Nursing Facility coinsurance
Skilled Nursing Facility coinsurance
Skilled Nursing Facility coinsurance
50% Skilled Nursing Facility coinsurance
75% Skilled Nursing Facility coinsurance
Skilled Nursing Facility coinsurance
Skilled Nursing Facility coinsurance
Part A Deductible
Part A Deductible
Part A Deductible
Part A Deductible
Part A Deductible
50% Part A Deductible
75% Part A Deductible
50% Part A Deductible
Part A Deductible
Part B Deductible
Part B Deductible
Part B Excess (100%)
Part B Excess (100%)
Foreign Travel Emergency
Foreign Travel Emergency
Foreign Travel Emergency
Foreign Travel Emergency
Foreign Travel Emergency
Foreign Travel Emergency
Out-of-Pocket limit $5,240; paid at 100% after reached
Out-of-Pocket limit $2,620; paid at 100% after reached
*Plan F also has an option called a high-deductible Plan F. This high-deductible Plan pays the same benefits as Plan F after one has paid a calendar year $2,240 deductible. Benefits from high-deductible Plan F will not begin until out-of-pocket expenses exceed $2,240. Out-of-pocket expenses for this deductible are expenses that would ordinarily be paid by the policy. These expenses include the Medicare Deductibles for Part A and Part B, but do not include the Plan’s separate Foreign Travel Emergency Deductible.
AR-HHDS-OCD-AA-CO PAGE 1 03/18
Annual Monthly Annual Monthly Annual Monthly Annual Monthly Annual Monthly Annual Monthly Annual Monthly Annual Monthly3,987.71 332.18 5,699.51 474.77 4,221.22 351.63 3,184.85 265.30 Under 65 4,585.87 382.00 6,554.44 545.98 4,854.39 404.37 3,662.57 305.091,674.60 139.49 2,054.20 171.12 1,446.65 120.51 1,038.17 86.48 65 1,925.78 160.42 2,362.33 196.78 1,663.64 138.58 1,193.89 99.451,674.60 139.49 2,054.20 171.12 1,446.65 120.51 1,038.17 86.48 66 1,925.78 160.42 2,362.33 196.78 1,663.64 138.58 1,193.89 99.451,749.97 145.77 2,143.73 178.57 1,517.04 126.37 1,086.88 90.54 67 2,012.47 167.64 2,465.28 205.36 1,744.60 145.33 1,249.91 104.121,824.46 151.98 2,229.19 185.69 1,584.26 131.97 1,134.09 94.47 68 2,098.13 174.77 2,563.56 213.54 1,821.90 151.76 1,304.21 108.641,897.64 158.07 2,316.65 192.98 1,653.04 137.70 1,181.32 98.40 69 2,182.30 181.79 2,664.15 221.92 1,901.00 158.35 1,358.52 113.161,968.50 163.98 2,397.92 199.75 1,716.96 143.02 1,225.80 102.11 70 2,263.76 188.57 2,757.61 229.71 1,974.50 164.48 1,409.66 117.422,027.34 168.88 2,476.44 206.29 1,778.70 148.17 1,270.47 105.83 71 2,331.43 194.21 2,847.90 237.23 2,045.51 170.39 1,461.04 121.702,086.16 173.78 2,554.95 212.83 1,840.45 153.31 1,315.14 109.55 72 2,399.09 199.84 2,938.19 244.75 2,116.51 176.31 1,512.41 125.982,145.00 178.68 2,633.46 219.37 1,902.18 158.45 1,359.81 113.27 73 2,466.76 205.48 3,028.48 252.27 2,187.51 182.22 1,563.78 130.262,203.84 183.58 2,711.97 225.91 1,963.93 163.60 1,404.48 116.99 74 2,534.43 211.12 3,118.77 259.79 2,258.53 188.14 1,615.15 134.542,264.94 188.67 2,793.26 232.68 2,027.69 168.91 1,450.60 120.83 75 2,604.68 216.97 3,212.25 267.58 2,331.85 194.24 1,668.19 138.962,317.67 193.06 2,877.30 239.68 2,092.10 174.27 1,499.18 124.88 76 2,665.32 222.02 3,308.89 275.63 2,405.91 200.41 1,724.05 143.612,371.23 197.52 2,962.74 246.80 2,157.58 179.73 1,548.58 129.00 77 2,726.91 227.15 3,407.15 283.82 2,481.21 206.69 1,780.87 148.352,428.03 202.25 3,052.61 254.28 2,226.36 185.46 1,600.41 133.31 78 2,792.24 232.59 3,510.50 292.42 2,560.31 213.27 1,840.48 153.312,485.78 207.07 3,144.11 261.90 2,296.40 191.29 1,653.19 137.71 79 2,858.66 238.13 3,615.73 301.19 2,640.86 219.98 1,901.16 158.372,544.53 211.96 3,237.25 269.66 2,367.71 197.23 1,706.93 142.19 80 2,926.21 243.75 3,722.83 310.11 2,722.86 226.81 1,962.98 163.522,610.51 217.46 3,351.84 279.21 2,454.79 204.48 1,774.52 147.82 81 3,002.08 250.07 3,854.61 321.09 2,823.00 235.16 2,040.70 169.992,677.70 223.05 3,468.71 288.94 2,543.61 211.88 1,843.48 153.56 82 3,079.35 256.51 3,989.02 332.29 2,925.15 243.66 2,120.00 176.602,748.85 228.98 3,591.45 299.17 2,636.82 219.65 1,915.73 159.58 83 3,161.19 263.33 4,130.17 344.04 3,032.34 252.59 2,203.09 183.522,821.41 235.02 3,716.80 309.61 2,732.02 227.58 1,989.55 165.73 84 3,244.61 270.28 4,274.32 356.05 3,141.83 261.71 2,287.98 190.592,895.37 241.18 3,844.81 320.27 2,829.26 235.68 2,064.96 172.01 85 3,329.68 277.36 4,421.53 368.31 3,253.65 271.03 2,374.71 197.812,974.40 247.77 3,979.84 331.52 2,930.99 244.15 2,143.47 178.55 86 3,420.56 284.93 4,576.80 381.25 3,370.63 280.77 2,464.98 205.333,055.34 254.51 4,118.48 343.07 3,035.45 252.85 2,224.12 185.27 87 3,513.64 292.69 4,736.25 394.53 3,490.77 290.78 2,557.74 213.063,138.23 261.41 4,260.83 354.93 3,142.74 261.79 2,307.00 192.17 88 3,608.97 300.63 4,899.95 408.17 3,614.14 301.06 2,653.04 221.003,219.95 268.22 4,402.63 366.74 3,249.71 270.70 2,389.78 199.07 89 3,702.93 308.45 5,063.03 421.75 3,737.16 311.31 2,748.25 228.933,300.29 274.91 4,543.56 378.48 3,356.09 279.56 2,472.28 205.94 90 3,795.33 316.15 5,225.09 435.25 3,859.51 321.50 2,843.12 236.833,378.41 281.42 4,688.11 390.52 3,464.86 288.62 2,557.37 213.03 91 3,885.18 323.64 5,391.32 449.10 3,984.59 331.92 2,940.99 244.983,458.03 288.05 4,835.66 402.81 3,575.89 297.87 2,644.27 220.27 92 3,976.72 331.26 5,561.01 463.23 4,112.27 342.55 3,040.91 253.313,532.14 294.23 4,976.41 414.53 3,681.93 306.70 2,727.60 227.21 93 4,061.96 338.36 5,722.87 476.71 4,234.22 352.71 3,136.75 261.293,607.46 300.50 5,119.66 426.47 3,789.87 315.70 2,812.44 234.28 94 4,148.58 345.58 5,887.61 490.44 4,358.36 363.05 3,234.31 269.423,684.03 306.88 5,265.46 438.61 3,899.75 324.85 2,898.82 241.47 95 4,236.63 352.91 6,055.29 504.41 4,484.71 373.58 3,333.64 277.693,757.71 313.02 5,370.78 447.39 3,977.74 331.35 2,956.80 246.30 96 4,321.37 359.97 6,176.39 514.49 4,574.41 381.05 3,400.31 283.253,832.87 319.28 5,478.19 456.33 4,057.30 337.97 3,015.93 251.23 97 4,407.79 367.17 6,299.92 524.78 4,665.90 388.67 3,468.32 288.913,909.52 325.66 5,587.76 465.46 4,138.45 344.73 3,076.25 256.25 98 4,495.95 374.51 6,425.92 535.28 4,759.22 396.44 3,537.69 294.693,987.71 332.18 5,699.51 474.77 4,221.22 351.63 3,137.78 261.38 99 4,585.87 382.00 6,554.44 545.98 4,854.39 404.37 3,608.44 300.58
Policies may be issued on an annual, semi-annual, quarterly or monthly mode. To obtain semi-annual premiums, multiply the above-quoted annual premium by 0.52. To obtain quarterly premiums, multiply the above quoted premium by 0.265.
Applicants who qualify for Household Discount multiply above rates by 0.93
COLORADOAttained Age Rates --Current Rates Effective 3/1/2018 -- Area I (803-816)
American Retirement Life Insurance CompanyMEDICARE SUPPLEMENT
Attained Age
Plan A
PREFERRED ANNUAL & MONTHLY BANK DRAFT RATES
FEMALE RATES MALE RATES
Add one-time enrollment fee of $20.00 to the first premium.
Plan F Plan G Plan NPlan A Plan F Plan G Plan N
AR-HHDS-OCD-AA-CO PAGE 2 03/18
Annual Monthly Annual Monthly Annual Monthly Annual Monthly Annual Monthly Annual Monthly Annual Monthly Annual Monthly4,386.48 365.39 6,269.46 522.25 4,643.33 386.79 3,503.33 291.83 Under 65 5,044.45 420.20 7,209.88 600.58 5,339.84 444.81 4,028.83 335.601,842.05 153.44 2,259.63 188.23 1,591.31 132.56 1,141.98 95.13 65 2,118.36 176.46 2,598.57 216.46 1,830.01 152.44 1,313.28 109.401,842.05 153.44 2,259.63 188.23 1,591.31 132.56 1,141.98 95.13 66 2,118.36 176.46 2,598.57 216.46 1,830.01 152.44 1,313.28 109.401,924.97 160.35 2,358.10 196.43 1,668.75 139.01 1,195.57 99.59 67 2,213.71 184.40 2,711.80 225.89 1,919.06 159.86 1,374.90 114.532,006.91 167.18 2,452.11 204.26 1,742.68 145.17 1,247.50 103.92 68 2,307.95 192.25 2,819.93 234.90 2,004.10 166.94 1,434.62 119.502,087.42 173.88 2,548.32 212.27 1,818.35 151.47 1,299.45 108.24 69 2,400.52 199.96 2,930.56 244.12 2,091.10 174.19 1,494.37 124.482,165.34 180.37 2,637.72 219.72 1,888.66 157.33 1,348.37 112.32 70 2,490.14 207.43 3,033.37 252.68 2,171.96 180.92 1,550.63 129.172,230.06 185.76 2,724.08 226.92 1,956.57 162.98 1,397.51 116.41 71 2,564.57 213.63 3,132.69 260.95 2,250.05 187.43 1,607.14 133.872,294.79 191.16 2,810.44 234.11 2,024.49 168.64 1,446.65 120.51 72 2,639.00 219.83 3,232.01 269.23 2,328.16 193.94 1,663.65 138.582,359.51 196.55 2,896.81 241.30 2,092.40 174.30 1,495.79 124.60 73 2,713.44 226.03 3,331.32 277.50 2,406.27 200.44 1,720.15 143.292,424.24 201.94 2,983.16 248.50 2,160.33 179.96 1,544.93 128.69 74 2,787.86 232.23 3,430.64 285.77 2,484.37 206.95 1,776.67 148.002,491.44 207.54 3,072.60 255.95 2,230.46 185.80 1,595.66 132.92 75 2,865.16 238.67 3,533.48 294.34 2,565.04 213.67 1,835.01 152.862,549.44 212.37 3,165.03 263.65 2,301.31 191.70 1,649.10 137.37 76 2,931.86 244.22 3,639.79 303.19 2,646.50 220.45 1,896.46 157.972,608.35 217.28 3,259.02 271.48 2,373.34 197.70 1,703.44 141.90 77 2,999.61 249.87 3,747.86 312.20 2,729.33 227.35 1,958.96 163.182,670.83 222.48 3,357.88 279.71 2,449.00 204.00 1,760.46 146.65 78 3,071.46 255.85 3,861.55 321.67 2,816.34 234.60 2,024.52 168.642,734.36 227.77 3,458.52 288.09 2,526.04 210.42 1,818.50 151.48 79 3,144.52 261.94 3,977.29 331.31 2,904.95 241.98 2,091.28 174.202,798.98 233.16 3,560.97 296.63 2,604.48 216.95 1,877.63 156.41 80 3,218.82 268.13 4,095.12 341.12 2,995.15 249.50 2,159.28 179.872,871.55 239.20 3,687.02 307.13 2,700.26 224.93 1,951.97 162.60 81 3,302.29 275.08 4,240.07 353.20 3,105.31 258.67 2,244.76 186.992,945.48 245.36 3,815.58 317.84 2,797.97 233.07 2,027.83 168.92 82 3,387.30 282.16 4,387.92 365.51 3,217.67 268.03 2,332.00 194.263,023.74 251.88 3,950.60 329.08 2,900.51 241.61 2,107.30 175.54 83 3,477.30 289.66 4,543.18 378.45 3,335.58 277.85 2,423.40 201.873,103.54 258.52 4,088.49 340.57 3,005.22 250.34 2,188.51 182.30 84 3,569.07 297.30 4,701.75 391.66 3,456.01 287.89 2,516.78 209.653,184.90 265.30 4,229.29 352.30 3,112.18 259.24 2,271.45 189.21 85 3,662.65 305.10 4,863.67 405.14 3,579.01 298.13 2,612.18 217.593,271.84 272.54 4,377.81 364.67 3,224.08 268.57 2,357.81 196.41 86 3,762.61 313.43 5,034.49 419.37 3,707.69 308.85 2,711.48 225.873,360.88 279.96 4,530.32 377.38 3,339.00 278.14 2,446.54 203.80 87 3,865.00 321.95 5,209.87 433.98 3,839.84 319.86 2,813.52 234.373,452.06 287.56 4,686.91 390.42 3,457.01 287.97 2,537.69 211.39 88 3,969.86 330.69 5,389.94 448.98 3,975.56 331.16 2,918.35 243.103,541.95 295.04 4,842.90 403.41 3,574.67 297.77 2,628.76 218.98 89 4,073.24 339.30 5,569.33 463.93 4,110.88 342.44 3,023.08 251.823,630.31 302.40 4,997.91 416.33 3,691.70 307.52 2,719.50 226.53 90 4,174.86 347.77 5,747.60 478.78 4,245.46 353.65 3,127.43 260.523,716.26 309.56 5,156.92 429.57 3,811.35 317.49 2,813.11 234.33 91 4,273.70 356.00 5,930.46 494.01 4,383.04 365.11 3,235.08 269.483,803.82 316.86 5,319.22 443.09 3,933.48 327.66 2,908.70 242.29 92 4,374.40 364.39 6,117.11 509.55 4,523.50 376.81 3,345.01 278.643,885.36 323.65 5,474.04 455.99 4,050.12 337.37 3,000.37 249.93 93 4,468.16 372.20 6,295.15 524.39 4,657.64 387.98 3,450.42 287.423,968.22 330.55 5,631.62 469.11 4,168.86 347.27 3,093.69 257.70 94 4,563.44 380.13 6,476.36 539.48 4,794.19 399.36 3,557.74 296.364,052.44 337.57 5,792.01 482.47 4,289.73 357.33 3,188.70 265.62 95 4,660.29 388.20 6,660.81 554.85 4,933.19 410.93 3,667.00 305.464,133.49 344.32 5,907.85 492.12 4,375.52 364.48 3,252.47 270.93 96 4,753.50 395.97 6,794.04 565.94 5,031.85 419.15 3,740.35 311.574,216.15 351.20 6,026.01 501.97 4,463.03 371.77 3,317.52 276.35 97 4,848.57 403.89 6,929.92 577.26 5,132.48 427.54 3,815.15 317.804,300.47 358.23 6,146.53 512.01 4,552.29 379.21 3,383.88 281.88 98 4,945.54 411.96 7,068.50 588.81 5,235.13 436.09 3,891.46 324.164,386.48 365.39 6,269.46 522.25 4,643.33 386.79 3,451.56 287.51 99 5,044.45 420.20 7,209.88 600.58 5,339.84 444.81 3,969.29 330.64
Policies may be issued on an annual, semi-annual, quarterly or monthly mode. To obtain semi-annual premiums, multiply the above-quoted annual premium by 0.52. To obtain quarterly premiums, multiply the above quoted premium by 0.265.
Applicants who qualify for Household Discount multiply above rates by 0.93
Attained Age Rates --Current Rates Effective 3/1/2018 -- Area I (803-816)STANDARD ANNUAL & MONTHLY BANK DRAFT RATES
MEDICARE SUPPLEMENTAmerican Retirement Life Insurance Company
COLORADO
Plan A Plan F Plan G Plan N Attained Age
Plan AFEMALE RATES MALE RATES
Add one-time enrollment fee of $20.00 to the first premium.
Plan F Plan G Plan N
AR-HHDS-OCD-AA-CO PAGE 3 03/18
Annual Monthly Annual Monthly Annual Monthly Annual Monthly Annual Monthly Annual Monthly Annual Monthly Annual Monthly
2,794.10 232.75 3,422.84 285.12 3,003.09 250.16 2,385.53 198.71 65 3,213.22 267.66 3,936.26 327.89 3,453.56 287.68 2,743.36 228.522,794.10 232.75 3,422.84 285.12 3,003.09 250.16 2,385.53 198.71 66 3,213.22 267.66 3,936.26 327.89 3,453.56 287.68 2,743.36 228.522,794.10 232.75 3,422.84 285.12 3,003.09 250.16 2,385.53 198.71 67 3,213.22 267.66 3,936.26 327.89 3,453.56 287.68 2,743.36 228.522,794.10 232.75 3,422.84 285.12 3,003.09 250.16 2,385.53 198.71 68 3,213.22 267.66 3,936.26 327.89 3,453.56 287.68 2,743.36 228.522,794.10 232.75 3,422.84 285.12 3,003.09 250.16 2,385.53 198.71 69 3,213.22 267.66 3,936.26 327.89 3,453.56 287.68 2,743.36 228.522,794.10 232.75 3,422.84 285.12 3,003.09 250.16 2,385.53 198.71 70 3,213.22 267.66 3,936.26 327.89 3,453.56 287.68 2,743.36 228.522,794.10 232.75 3,422.84 285.12 3,003.09 250.16 2,385.53 198.71 71 3,213.22 267.66 3,936.26 327.89 3,453.56 287.68 2,743.36 228.522,794.10 232.75 3,430.47 285.76 3,050.68 254.12 2,419.02 201.50 72 3,213.22 267.66 3,945.05 328.62 3,508.29 292.24 2,781.88 231.732,835.68 236.21 3,490.50 290.76 3,112.56 259.28 2,469.09 205.67 73 3,261.04 271.64 4,014.08 334.37 3,579.45 298.17 2,839.45 236.532,878.64 239.79 3,551.59 295.85 3,175.18 264.49 2,519.71 209.89 74 3,310.43 275.76 4,084.33 340.22 3,651.45 304.17 2,897.67 241.382,922.60 243.45 3,613.74 301.02 3,238.55 269.77 2,570.93 214.16 75 3,360.99 279.97 4,155.80 346.18 3,724.34 310.24 2,956.56 246.282,954.10 246.08 3,676.98 306.29 3,300.59 274.94 2,624.56 218.63 76 3,397.22 282.99 4,228.53 352.24 3,795.67 316.18 3,018.24 251.422,979.24 248.17 3,732.14 310.89 3,355.32 279.50 2,672.36 222.61 77 3,426.12 285.40 4,291.96 357.52 3,858.62 321.42 3,073.22 256.003,005.20 250.33 3,788.12 315.55 3,410.76 284.12 2,720.70 226.63 78 3,455.98 287.88 4,356.34 362.88 3,922.36 326.73 3,128.80 260.633,031.96 252.56 3,844.95 320.28 3,466.91 288.79 2,769.57 230.70 79 3,486.75 290.45 4,421.68 368.33 3,986.95 332.11 3,185.00 265.313,059.53 254.86 3,902.62 325.09 3,523.79 293.53 2,818.99 234.82 80 3,518.45 293.09 4,488.01 373.85 4,052.37 337.56 3,241.84 270.053,077.03 256.32 3,961.15 329.96 3,581.42 298.33 2,872.87 239.31 81 3,538.58 294.76 4,555.33 379.46 4,118.63 343.08 3,303.81 275.213,088.01 257.23 4,010.66 334.09 3,630.80 302.45 2,920.00 243.24 82 3,551.21 295.82 4,612.27 384.20 4,175.42 347.81 3,358.00 279.723,099.99 258.23 4,060.80 338.26 3,680.65 306.60 2,967.38 247.18 83 3,564.99 296.96 4,669.92 389.00 4,232.75 352.59 3,412.48 284.263,112.93 259.31 4,111.56 342.49 3,730.99 310.79 3,015.01 251.15 84 3,579.87 298.20 4,728.30 393.87 4,290.65 357.41 3,467.26 288.823,126.79 260.46 4,162.95 346.77 3,781.84 315.03 3,062.92 255.14 85 3,595.81 299.53 4,787.40 398.79 4,349.11 362.28 3,522.37 293.413,141.95 261.72 4,215.00 351.11 3,832.20 319.22 3,109.89 259.05 86 3,613.24 300.98 4,847.24 403.77 4,407.03 367.11 3,576.37 297.913,156.22 262.91 4,265.57 355.32 3,881.21 323.31 3,155.71 262.87 87 3,629.65 302.35 4,905.41 408.62 4,463.40 371.80 3,629.07 302.303,171.14 264.16 4,316.76 359.59 3,930.75 327.43 3,201.90 266.72 88 3,646.82 303.78 4,964.27 413.52 4,520.36 376.55 3,682.18 306.733,186.70 265.45 4,368.56 363.90 3,980.82 331.60 3,248.48 270.60 89 3,664.71 305.27 5,023.84 418.49 4,577.94 381.34 3,735.76 311.193,202.88 266.80 4,420.99 368.27 4,031.43 335.82 3,295.47 274.51 90 3,683.32 306.82 5,084.13 423.51 4,636.15 386.19 3,789.79 315.693,215.75 267.87 4,474.03 372.69 4,082.16 340.04 3,343.44 278.51 91 3,698.11 308.05 5,145.14 428.59 4,694.49 391.05 3,844.95 320.283,227.78 268.87 4,525.49 376.97 4,131.39 344.14 3,390.11 282.40 92 3,711.95 309.21 5,204.31 433.52 4,751.10 395.77 3,898.62 324.753,240.57 269.94 4,577.53 381.31 4,181.14 348.29 3,437.11 286.31 93 3,726.65 310.43 5,264.16 438.50 4,808.30 400.53 3,952.68 329.263,254.06 271.06 4,630.17 385.69 4,231.40 352.48 3,484.47 290.26 94 3,742.17 311.72 5,324.70 443.55 4,866.10 405.35 4,007.14 333.793,268.26 272.25 4,683.42 390.13 4,282.19 356.71 3,532.19 294.23 95 3,758.50 313.08 5,385.93 448.65 4,924.52 410.21 4,062.02 338.373,300.94 274.97 4,730.25 394.03 4,325.01 360.27 3,567.51 297.17 96 3,796.09 316.21 5,439.79 453.13 4,973.76 414.31 4,102.64 341.753,333.95 277.72 4,777.56 397.97 4,368.26 363.88 3,603.18 300.15 97 3,834.04 319.38 5,494.19 457.67 5,023.50 418.46 4,143.67 345.173,367.29 280.49 4,825.33 401.95 4,411.94 367.51 3,639.22 303.15 98 3,872.38 322.57 5,549.13 462.24 5,073.74 422.64 4,185.10 348.623,400.96 283.30 4,873.58 405.97 4,456.07 371.19 3,675.61 306.18 99 3,911.11 325.80 5,604.63 466.87 5,124.47 426.87 4,226.95 352.11
Policies may be issued on an annual, semi-annual, quarterly or monthly mode. To obtain semi-annual premiums, multiply the above-quoted annual premium by 0.52. To obtain quarterly premiums, multiply the above quoted premium by 0.265.
Add one-time enrollment fee of $20.00 to the first premium.Applicants who qualify for Household Discount multiply above rates by 0.93
FEMALE RATES MALE RATESPlan A Plan F Plan G Plan N Attained
AgePlan A Plan F Plan G Plan N
COLORADOAttained Age Rates --Current Rates Effective 3/1/2018 -- Area I (803-816)
STANDARD II ANNUAL & MONTHLY BANK DRAFT RATES
American Retirement Life Insurance CompanyMEDICARE SUPPLEMENT
AR-HHDS-OCD-AA-CO PAGE 4 03/18
Annual Monthly Annual Monthly Annual Monthly Annual Monthly Annual Monthly Annual Monthly Annual Monthly Annual Monthly
3,073.51 256.02 3,765.13 313.63 3,303.41 275.17 2,624.08 218.59 65 3,534.54 294.43 4,329.89 360.68 3,798.92 316.45 3,017.69 251.373,073.51 256.02 3,765.13 313.63 3,303.41 275.17 2,624.08 218.59 66 3,534.54 294.43 4,329.89 360.68 3,798.92 316.45 3,017.69 251.373,073.51 256.02 3,765.13 313.63 3,303.41 275.17 2,624.08 218.59 67 3,534.54 294.43 4,329.89 360.68 3,798.92 316.45 3,017.69 251.373,073.51 256.02 3,765.13 313.63 3,303.41 275.17 2,624.08 218.59 68 3,534.54 294.43 4,329.89 360.68 3,798.92 316.45 3,017.69 251.373,073.51 256.02 3,765.13 313.63 3,303.41 275.17 2,624.08 218.59 69 3,534.54 294.43 4,329.89 360.68 3,798.92 316.45 3,017.69 251.373,073.51 256.02 3,765.13 313.63 3,303.41 275.17 2,624.08 218.59 70 3,534.54 294.43 4,329.89 360.68 3,798.92 316.45 3,017.69 251.373,073.51 256.02 3,765.13 313.63 3,303.41 275.17 2,624.08 218.59 71 3,534.54 294.43 4,329.89 360.68 3,798.92 316.45 3,017.69 251.373,073.51 256.02 3,773.52 314.33 3,355.76 279.53 2,660.93 221.66 72 3,534.54 294.43 4,339.55 361.48 3,859.12 321.46 3,060.06 254.903,119.25 259.83 3,839.56 319.84 3,423.82 285.20 2,715.99 226.24 73 3,587.14 298.81 4,415.49 367.81 3,937.39 327.98 3,123.40 260.183,166.50 263.77 3,906.75 325.43 3,492.69 290.94 2,771.69 230.88 74 3,641.47 303.33 4,492.76 374.25 4,016.59 334.58 3,187.43 265.513,214.86 267.80 3,975.12 331.13 3,562.40 296.75 2,828.01 235.57 75 3,697.10 307.97 4,571.38 380.80 4,096.77 341.26 3,252.21 270.913,249.52 270.68 4,044.68 336.92 3,630.64 302.43 2,887.01 240.49 76 3,736.94 311.29 4,651.38 387.46 4,175.23 347.80 3,320.07 276.563,277.16 272.99 4,105.35 341.98 3,690.85 307.45 2,939.60 244.87 77 3,768.74 313.94 4,721.15 393.27 4,244.48 353.57 3,380.54 281.603,305.72 275.37 4,166.93 347.11 3,751.83 312.53 2,992.77 249.30 78 3,801.57 316.67 4,791.97 399.17 4,314.61 359.41 3,441.68 286.693,335.16 277.82 4,229.43 352.31 3,813.60 317.67 3,046.52 253.78 79 3,835.43 319.49 4,863.85 405.16 4,385.64 365.32 3,503.50 291.843,365.48 280.34 4,292.87 357.60 3,876.18 322.89 3,100.89 258.30 80 3,870.30 322.40 4,936.81 411.24 4,457.61 371.32 3,566.03 297.053,384.73 281.95 4,357.27 362.96 3,939.56 328.17 3,160.16 263.24 81 3,892.44 324.24 5,010.86 417.40 4,530.50 377.39 3,634.18 302.733,396.81 282.95 4,411.73 367.50 3,993.88 332.69 3,212.01 267.56 82 3,906.33 325.40 5,073.49 422.62 4,592.96 382.59 3,693.81 307.693,409.99 284.05 4,466.88 372.09 4,048.72 337.26 3,264.11 271.90 83 3,921.49 326.66 5,136.91 427.90 4,656.02 387.85 3,753.73 312.693,424.22 285.24 4,522.72 376.74 4,104.09 341.87 3,316.50 276.26 84 3,937.85 328.02 5,201.13 433.25 4,719.71 393.15 3,813.99 317.703,439.47 286.51 4,579.25 381.45 4,160.02 346.53 3,369.22 280.66 85 3,955.39 329.48 5,266.14 438.67 4,784.02 398.51 3,874.60 322.753,456.14 287.90 4,636.49 386.22 4,215.42 351.14 3,420.88 284.96 86 3,974.56 331.08 5,331.96 444.15 4,847.74 403.82 3,934.02 327.703,471.85 289.20 4,692.13 390.85 4,269.33 355.64 3,471.28 289.16 87 3,992.62 332.59 5,395.95 449.48 4,909.73 408.98 3,991.97 332.533,488.27 290.57 4,748.43 395.54 4,323.82 360.17 3,522.09 293.39 88 4,011.50 334.16 5,460.70 454.88 4,972.39 414.20 4,050.41 337.403,505.38 292.00 4,805.42 400.29 4,378.90 364.76 3,573.34 297.66 89 4,031.18 335.80 5,526.23 460.34 5,035.74 419.48 4,109.33 342.313,523.18 293.48 4,863.08 405.09 4,434.58 369.40 3,625.02 301.96 90 4,051.66 337.50 5,592.54 465.86 5,099.78 424.81 4,168.76 347.263,537.32 294.66 4,921.44 409.96 4,490.38 374.05 3,677.78 306.36 91 4,067.92 338.86 5,659.65 471.45 5,163.93 430.16 4,229.45 352.313,550.57 295.76 4,978.04 414.67 4,544.53 378.56 3,729.11 310.63 92 4,083.15 340.13 5,724.75 476.87 5,226.21 435.34 4,288.48 357.233,564.62 296.93 5,035.28 419.44 4,599.25 383.12 3,780.82 314.94 93 4,099.32 341.47 5,790.58 482.36 5,289.13 440.58 4,347.94 362.183,579.47 298.17 5,093.19 424.26 4,654.54 387.72 3,832.91 319.28 94 4,116.39 342.90 5,857.16 487.90 5,352.72 445.88 4,407.85 367.173,595.08 299.47 5,151.76 429.14 4,710.41 392.38 3,885.41 323.65 95 4,134.35 344.39 5,924.53 493.51 5,416.97 451.23 4,468.22 372.203,631.04 302.47 5,203.27 433.43 4,757.51 396.30 3,924.27 326.89 96 4,175.69 347.84 5,983.77 498.45 5,471.13 455.75 4,512.90 375.923,667.35 305.49 5,255.32 437.77 4,805.08 400.26 3,963.50 330.16 97 4,217.45 351.31 6,043.60 503.43 5,525.85 460.30 4,558.03 379.683,704.02 308.54 5,307.86 442.15 4,853.14 404.27 4,003.14 333.46 98 4,259.62 354.83 6,104.04 508.47 5,581.11 464.91 4,603.61 383.483,741.06 311.63 5,360.94 446.57 4,901.67 408.31 4,043.18 336.80 99 4,302.21 358.37 6,165.08 513.55 5,636.92 469.56 4,649.65 387.32
Policies may be issued on an annual, semi-annual, quarterly or monthly mode. To obtain semi-annual premiums, multiply the above-quoted annual premium by 0.52. To obtain quarterly premiums, multiply the above quoted premium by 0.265.
Applicants who qualify for Household Discount multiply above rates by 0.93Add one-time enrollment fee of $20.00 to the first premium.
Plan G Plan NPlan A Plan F Plan G Plan N Attained Age
Plan A Plan F
Attained Age Rates --Current Rates Effective 3/1/2018 -- Area I (803-816)STANDARD III ANNUAL & MONTHLY BANK DRAFT RATES
FEMALE RATES MALE RATES
American Retirement Life Insurance CompanyMEDICARE SUPPLEMENT
COLORADO
AR-HHDS-OCD-AA-CO PAGE 5 03/18
Annual Monthly Annual Monthly Annual Monthly Annual Monthly Annual Monthly Annual Monthly Annual Monthly Annual Monthly4,421.15 368.28 6,319.02 526.37 4,680.04 389.85 3,531.02 294.13 Under 65 5,084.33 423.52 7,266.88 605.33 5,382.05 448.32 4,060.68 338.251,856.62 154.66 2,277.49 189.71 1,603.90 133.60 1,151.01 95.88 65 2,135.11 177.85 2,619.11 218.17 1,844.47 153.64 1,323.66 110.261,856.62 154.66 2,277.49 189.71 1,603.90 133.60 1,151.01 95.88 66 2,135.11 177.85 2,619.11 218.17 1,844.47 153.64 1,323.66 110.261,940.18 161.62 2,376.74 197.98 1,681.94 140.11 1,205.02 100.38 67 2,231.21 185.86 2,733.25 227.68 1,934.23 161.12 1,385.77 115.432,022.78 168.50 2,471.49 205.88 1,756.46 146.31 1,257.36 104.74 68 2,326.19 193.77 2,842.21 236.76 2,019.94 168.26 1,445.97 120.452,103.91 175.26 2,568.46 213.95 1,832.72 152.67 1,309.72 109.10 69 2,419.50 201.54 2,953.73 246.05 2,107.63 175.57 1,506.19 125.472,182.46 181.80 2,658.56 221.46 1,903.59 158.57 1,359.04 113.21 70 2,509.83 209.07 3,057.35 254.68 2,189.12 182.35 1,562.89 130.192,247.70 187.23 2,745.62 228.71 1,972.04 164.27 1,408.56 117.33 71 2,584.85 215.32 3,157.45 263.02 2,267.85 188.91 1,619.85 134.932,312.92 192.67 2,832.66 235.96 2,040.50 169.97 1,458.09 121.46 72 2,659.86 221.57 3,257.56 271.35 2,346.57 195.47 1,676.81 139.682,378.15 198.10 2,919.70 243.21 2,108.94 175.67 1,507.62 125.58 73 2,734.88 227.82 3,357.66 279.69 2,425.29 202.03 1,733.75 144.422,443.39 203.53 3,006.75 250.46 2,177.40 181.38 1,557.15 129.71 74 2,809.91 234.07 3,457.77 288.03 2,504.02 208.58 1,790.71 149.172,511.13 209.18 3,096.88 257.97 2,248.10 187.27 1,608.27 133.97 75 2,887.80 240.55 3,561.41 296.67 2,585.32 215.36 1,849.51 154.062,569.60 214.05 3,190.05 265.73 2,319.50 193.21 1,662.13 138.46 76 2,955.03 246.15 3,668.55 305.59 2,667.42 222.20 1,911.45 159.222,628.98 218.99 3,284.77 273.62 2,392.10 199.26 1,716.90 143.02 77 3,023.32 251.84 3,777.49 314.66 2,750.91 229.15 1,974.45 164.472,691.94 224.24 3,384.41 281.92 2,468.36 205.61 1,774.36 147.80 78 3,095.74 257.88 3,892.08 324.21 2,838.61 236.46 2,040.53 169.982,755.98 229.57 3,485.86 290.37 2,546.01 212.08 1,832.89 152.68 79 3,169.39 264.01 4,008.74 333.93 2,927.91 243.90 2,107.81 175.582,821.11 235.00 3,589.12 298.97 2,625.07 218.67 1,892.47 157.64 80 3,244.27 270.25 4,127.48 343.82 3,018.82 251.47 2,176.35 181.292,894.26 241.09 3,716.17 309.56 2,721.61 226.71 1,967.40 163.88 81 3,328.40 277.26 4,273.59 355.99 3,129.85 260.72 2,262.51 188.472,968.75 247.30 3,845.75 320.35 2,820.09 234.91 2,043.85 170.25 82 3,414.07 284.39 4,422.61 368.40 3,243.10 270.15 2,350.43 195.793,047.64 253.87 3,981.82 331.69 2,923.43 243.52 2,123.96 176.93 83 3,504.80 291.95 4,579.10 381.44 3,361.95 280.05 2,442.56 203.463,128.08 260.57 4,120.80 343.26 3,028.98 252.31 2,205.80 183.74 84 3,597.28 299.65 4,738.92 394.75 3,483.33 290.16 2,536.68 211.313,210.09 267.40 4,262.72 355.08 3,136.78 261.29 2,289.41 190.71 85 3,691.60 307.51 4,902.13 408.35 3,607.30 300.49 2,632.83 219.313,297.71 274.70 4,412.43 367.56 3,249.57 270.69 2,376.45 197.96 86 3,792.36 315.90 5,074.28 422.69 3,737.00 311.29 2,732.91 227.653,387.45 282.17 4,566.14 380.36 3,365.40 280.34 2,465.87 205.41 87 3,895.56 324.50 5,251.05 437.41 3,870.20 322.39 2,835.76 236.223,479.35 289.83 4,723.96 393.51 3,484.34 290.25 2,557.76 213.06 88 4,001.24 333.30 5,432.55 452.53 4,006.99 333.78 2,941.42 245.023,569.94 297.38 4,881.17 406.60 3,602.93 300.12 2,649.54 220.71 89 4,105.43 341.98 5,613.36 467.59 4,143.37 345.14 3,046.97 253.813,659.02 304.80 5,037.43 419.62 3,720.88 309.95 2,741.00 228.33 90 4,207.87 350.52 5,793.03 482.56 4,279.02 356.44 3,152.15 262.573,745.63 312.01 5,197.68 432.97 3,841.48 320.00 2,835.35 236.18 91 4,307.48 358.81 5,977.34 497.91 4,417.70 367.99 3,260.66 271.613,833.90 319.36 5,361.28 446.59 3,964.57 330.25 2,931.69 244.21 92 4,408.98 367.27 6,165.47 513.58 4,559.26 379.79 3,371.45 280.843,916.07 326.21 5,517.32 459.59 4,082.14 340.04 3,024.08 251.91 93 4,503.47 375.14 6,344.92 528.53 4,694.46 391.05 3,477.70 289.693,999.58 333.16 5,676.14 472.82 4,201.82 350.01 3,118.14 259.74 94 4,599.52 383.14 6,527.56 543.75 4,832.09 402.51 3,585.86 298.704,084.47 340.24 5,837.79 486.29 4,323.63 360.16 3,213.91 267.72 95 4,697.14 391.27 6,713.47 559.23 4,972.18 414.18 3,695.99 307.884,166.16 347.04 5,954.56 496.01 4,410.11 367.36 3,278.19 273.07 96 4,791.08 399.10 6,847.74 570.42 5,071.63 422.47 3,769.91 314.034,249.48 353.98 6,073.65 505.93 4,498.31 374.71 3,343.75 278.53 97 4,886.90 407.08 6,984.70 581.83 5,173.06 430.92 3,845.31 320.314,334.46 361.06 6,195.12 516.05 4,588.28 382.20 3,410.63 284.11 98 4,984.64 415.22 7,124.39 593.46 5,276.52 439.53 3,922.22 326.724,421.15 368.28 6,319.02 526.37 4,680.04 389.85 3,478.84 289.79 99 5,084.33 423.52 7,266.88 605.33 5,382.05 448.32 4,000.67 333.26
Policies may be issued on an annual, semi-annual, quarterly or monthly mode. To obtain semi-annual premiums, multiply the above-quoted annual premium by 0.52. To obtain quarterly premiums, multiply the above quoted premium by 0.265.
Applicants who qualify for Household Discount multiply above rates by 0.93
COLORADOAttained Age Rates --Current Rates Effective 3/1/2018 -- Area II (800-802)
American Retirement Life Insurance CompanyMEDICARE SUPPLEMENT
PREFERRED ANNUAL & MONTHLY BANK DRAFT RATES
FEMALE RATES MALE RATES
Add one-time enrollment fee of $20.00 to the first premium.
Plan A Plan F Plan G Plan NPlan A Plan FPlan G Plan N Attained Age
AR-HHDS-OCD-AA-CO PAGE 6 03/18
Annual Monthly Annual Monthly Annual Monthly Annual Monthly Annual Monthly Annual Monthly Annual Monthly Annual Monthly4,863.27 405.11 6,950.92 579.01 5,148.04 428.83 3,884.13 323.55 Under 65 5,592.76 465.88 7,993.57 665.86 5,920.25 493.16 4,466.74 372.082,042.28 170.12 2,505.24 208.69 1,764.28 146.96 1,266.11 105.47 65 2,348.62 195.64 2,881.03 239.99 2,028.93 169.01 1,456.03 121.292,042.28 170.12 2,505.24 208.69 1,764.28 146.96 1,266.11 105.47 66 2,348.62 195.64 2,881.03 239.99 2,028.93 169.01 1,456.03 121.292,134.21 177.78 2,614.42 217.78 1,850.14 154.12 1,325.52 110.42 67 2,454.33 204.45 3,006.57 250.45 2,127.65 177.23 1,524.34 126.982,225.06 185.35 2,718.64 226.46 1,932.10 160.94 1,383.10 115.21 68 2,558.82 213.15 3,126.44 260.43 2,221.93 185.09 1,590.56 132.492,314.31 192.78 2,825.31 235.35 2,016.00 167.93 1,440.70 120.01 69 2,661.45 221.70 3,249.10 270.65 2,318.39 193.12 1,656.80 138.012,400.70 199.98 2,924.43 243.60 2,093.95 174.43 1,494.93 124.53 70 2,760.81 229.98 3,363.09 280.15 2,408.04 200.59 1,719.17 143.212,472.46 205.96 3,020.18 251.58 2,169.24 180.70 1,549.42 129.07 71 2,843.33 236.85 3,473.20 289.32 2,494.62 207.80 1,781.83 148.432,544.22 211.93 3,115.92 259.56 2,244.55 186.97 1,603.89 133.60 72 2,925.85 243.72 3,583.32 298.49 2,581.22 215.02 1,844.48 153.652,615.97 217.91 3,211.68 267.53 2,319.84 193.24 1,658.38 138.14 73 3,008.38 250.60 3,693.42 307.66 2,667.82 222.23 1,907.13 158.862,687.74 223.89 3,307.42 275.51 2,395.14 199.52 1,712.85 142.68 74 3,090.89 257.47 3,803.54 316.83 2,754.41 229.44 1,969.78 164.082,762.25 230.10 3,406.58 283.77 2,472.91 205.99 1,769.10 147.37 75 3,176.59 264.61 3,917.56 326.33 2,843.84 236.89 2,034.47 169.472,826.56 235.45 3,509.06 292.30 2,551.45 212.54 1,828.35 152.30 76 3,250.54 270.77 4,035.42 336.15 2,934.16 244.42 2,102.59 175.152,891.87 240.89 3,613.26 300.98 2,631.31 219.19 1,888.60 157.32 77 3,325.65 277.03 4,155.23 346.13 3,026.00 252.07 2,171.89 180.922,961.14 246.66 3,722.87 310.11 2,715.19 226.18 1,951.81 162.59 78 3,405.31 283.66 4,281.28 356.63 3,122.47 260.10 2,244.57 186.973,031.57 252.53 3,834.45 319.41 2,800.61 233.29 2,016.17 167.95 79 3,486.31 290.41 4,409.60 367.32 3,220.70 268.28 2,318.60 193.143,103.22 258.50 3,948.03 328.87 2,887.57 240.53 2,081.72 173.41 80 3,568.69 297.27 4,540.24 378.20 3,320.71 276.62 2,393.98 199.423,183.68 265.20 4,087.79 340.51 2,993.76 249.38 2,164.14 180.27 81 3,661.24 304.98 4,700.95 391.59 3,442.84 286.79 2,488.76 207.313,265.64 272.03 4,230.32 352.39 3,102.10 258.40 2,248.25 187.28 82 3,755.48 312.83 4,864.87 405.24 3,567.42 297.17 2,585.48 215.373,352.40 279.26 4,380.01 364.85 3,215.78 267.87 2,336.35 194.62 83 3,855.26 321.14 5,037.01 419.58 3,698.15 308.06 2,686.81 223.813,440.88 286.63 4,532.89 377.59 3,331.88 277.55 2,426.39 202.12 84 3,957.01 329.62 5,212.81 434.23 3,831.66 319.18 2,790.34 232.443,531.08 294.14 4,688.99 390.59 3,450.46 287.42 2,518.35 209.78 85 4,060.76 338.26 5,392.33 449.18 3,968.03 330.54 2,896.11 241.253,627.47 302.17 4,853.66 404.31 3,574.53 297.76 2,614.09 217.75 86 4,171.59 347.49 5,581.72 464.96 4,110.70 342.42 3,006.20 250.423,726.19 310.39 5,022.75 418.40 3,701.94 308.37 2,712.47 225.95 87 4,285.11 356.95 5,776.16 481.15 4,257.22 354.63 3,119.34 259.843,827.28 318.81 5,196.35 432.86 3,832.77 319.27 2,813.53 234.37 88 4,401.36 366.63 5,975.80 497.78 4,407.69 367.16 3,235.56 269.523,926.94 327.11 5,369.30 447.26 3,963.22 330.14 2,914.49 242.78 89 4,515.98 376.18 6,174.69 514.35 4,557.71 379.66 3,351.67 279.194,024.91 335.27 5,541.16 461.58 4,092.97 340.94 3,015.10 251.16 90 4,628.64 385.57 6,372.34 530.82 4,706.92 392.09 3,467.37 288.834,120.20 343.21 5,717.45 476.26 4,225.63 351.99 3,118.89 259.80 91 4,738.23 394.69 6,575.08 547.70 4,859.46 404.79 3,586.72 298.774,217.28 351.30 5,897.40 491.25 4,361.03 363.27 3,224.86 268.63 92 4,849.87 403.99 6,782.01 564.94 5,015.19 417.77 3,708.60 308.934,307.68 358.83 6,069.04 505.55 4,490.35 374.05 3,326.49 277.10 93 4,953.83 412.65 6,979.41 581.38 5,163.91 430.15 3,825.47 318.664,399.55 366.48 6,243.75 520.10 4,622.00 385.01 3,429.96 285.72 94 5,059.47 421.45 7,180.32 598.12 5,315.30 442.76 3,944.46 328.574,492.92 374.26 6,421.57 534.92 4,756.00 396.18 3,535.30 294.49 95 5,166.85 430.40 7,384.81 615.15 5,469.40 455.60 4,065.59 338.664,582.78 381.75 6,550.01 545.62 4,851.11 404.10 3,606.00 300.38 96 5,270.19 439.01 7,532.52 627.46 5,578.79 464.71 4,146.91 345.444,674.42 389.38 6,681.01 556.53 4,948.14 412.18 3,678.12 306.39 97 5,375.58 447.79 7,683.17 640.01 5,690.36 474.01 4,229.84 352.354,767.91 397.17 6,814.63 567.66 5,047.10 420.42 3,751.69 312.52 98 5,483.10 456.74 7,836.82 652.81 5,804.17 483.49 4,314.44 359.394,863.27 405.11 6,950.92 579.01 5,148.04 428.83 3,826.73 318.77 99 5,592.76 465.88 7,993.57 665.86 5,920.25 493.16 4,400.73 366.58
Policies may be issued on an annual, semi-annual, quarterly or monthly mode. To obtain semi-annual premiums, multiply the above-quoted annual premium by 0.52. To obtain quarterly premiums, multiply the above quoted premium by 0.265.
Applicants who qualify for Household Discount multiply above rates by 0.93
Attained Age Rates --Current Rates Effective 3/1/2018 -- Area II (800-802)STANDARD ANNUAL & MONTHLY BANK DRAFT RATES
MEDICARE SUPPLEMENTAmerican Retirement Life Insurance Company
COLORADO
Plan FFEMALE RATES MALE RATES
Plan G Plan N Attained Age
Plan A Plan F
Add one-time enrollment fee of $20.00 to the first premium.
Plan G Plan NPlan A
AR-HHDS-OCD-AA-CO PAGE 7 03/18
Annual Monthly Annual Monthly Annual Monthly Annual Monthly Annual Monthly Annual Monthly Annual Monthly Annual Monthly
3,097.81 258.05 3,794.89 316.11 3,329.51 277.35 2,644.83 220.31 65 3,562.48 296.75 4,364.12 363.53 3,828.94 318.95 3,041.55 253.363,097.81 258.05 3,794.89 316.11 3,329.51 277.35 2,644.83 220.31 66 3,562.48 296.75 4,364.12 363.53 3,828.94 318.95 3,041.55 253.363,097.81 258.05 3,794.89 316.11 3,329.51 277.35 2,644.83 220.31 67 3,562.48 296.75 4,364.12 363.53 3,828.94 318.95 3,041.55 253.363,097.81 258.05 3,794.89 316.11 3,329.51 277.35 2,644.83 220.31 68 3,562.48 296.75 4,364.12 363.53 3,828.94 318.95 3,041.55 253.363,097.81 258.05 3,794.89 316.11 3,329.51 277.35 2,644.83 220.31 69 3,562.48 296.75 4,364.12 363.53 3,828.94 318.95 3,041.55 253.363,097.81 258.05 3,794.89 316.11 3,329.51 277.35 2,644.83 220.31 70 3,562.48 296.75 4,364.12 363.53 3,828.94 318.95 3,041.55 253.363,097.81 258.05 3,794.89 316.11 3,329.51 277.35 2,644.83 220.31 71 3,562.48 296.75 4,364.12 363.53 3,828.94 318.95 3,041.55 253.363,097.81 258.05 3,803.35 316.82 3,382.28 281.74 2,681.95 223.41 72 3,562.48 296.75 4,373.86 364.34 3,889.63 324.01 3,084.25 256.923,143.91 261.89 3,869.90 322.36 3,450.89 287.46 2,737.47 228.03 73 3,615.50 301.17 4,450.39 370.72 3,968.52 330.58 3,148.09 262.243,191.53 265.85 3,937.63 328.00 3,520.30 293.24 2,793.60 232.71 74 3,670.26 305.73 4,528.27 377.21 4,048.34 337.23 3,212.64 267.613,240.27 269.91 4,006.54 333.74 3,590.56 299.09 2,850.37 237.44 75 3,726.32 310.40 4,607.52 383.81 4,129.16 343.96 3,277.93 273.053,275.20 272.82 4,076.65 339.59 3,659.34 304.82 2,909.84 242.39 76 3,766.48 313.75 4,688.16 390.52 4,208.24 350.55 3,346.31 278.753,303.07 275.15 4,137.80 344.68 3,720.03 309.88 2,962.84 246.80 77 3,798.53 316.42 4,758.47 396.38 4,278.03 356.36 3,407.26 283.833,331.85 277.54 4,199.87 349.85 3,781.49 315.00 3,016.43 251.27 78 3,831.63 319.17 4,829.85 402.33 4,348.71 362.25 3,468.89 288.963,361.52 280.01 4,262.87 355.10 3,843.75 320.18 3,070.61 255.78 79 3,865.75 322.02 4,902.30 408.36 4,420.31 368.21 3,531.20 294.153,392.08 282.56 4,326.82 360.42 3,906.81 325.44 3,125.41 260.35 80 3,900.89 324.94 4,975.84 414.49 4,492.85 374.25 3,594.21 299.403,411.49 284.18 4,391.71 365.83 3,970.70 330.76 3,185.14 265.32 81 3,923.21 326.80 5,050.47 420.70 4,566.31 380.37 3,662.92 305.123,423.66 285.19 4,446.61 370.40 4,025.46 335.32 3,237.39 269.67 82 3,937.21 327.97 5,113.60 425.96 4,629.27 385.62 3,723.01 310.133,436.95 286.30 4,502.20 375.03 4,080.72 339.92 3,289.92 274.05 83 3,952.49 329.24 5,177.52 431.29 4,692.83 390.91 3,783.40 315.163,451.30 287.49 4,558.47 379.72 4,136.54 344.57 3,342.73 278.45 84 3,968.98 330.62 5,242.24 436.68 4,757.02 396.26 3,844.14 320.223,466.66 288.77 4,615.45 384.47 4,192.90 349.27 3,395.85 282.87 85 3,986.66 332.09 5,307.77 442.14 4,821.84 401.66 3,905.23 325.313,483.47 290.17 4,673.15 389.27 4,248.74 353.92 3,447.92 287.21 86 4,005.98 333.70 5,374.11 447.66 4,886.05 407.01 3,965.11 330.293,499.29 291.49 4,729.22 393.94 4,303.09 358.45 3,498.73 291.44 87 4,024.18 335.21 5,438.61 453.04 4,948.55 412.21 4,023.53 335.163,515.83 292.87 4,785.97 398.67 4,358.00 363.02 3,549.93 295.71 88 4,043.21 336.80 5,503.87 458.47 5,011.70 417.47 4,082.42 340.073,533.08 294.31 4,843.41 403.46 4,413.52 367.65 3,601.58 300.01 89 4,063.05 338.45 5,569.91 463.97 5,075.54 422.79 4,141.82 345.013,551.02 295.80 4,901.53 408.30 4,469.63 372.32 3,653.67 304.35 90 4,083.69 340.17 5,636.75 469.54 5,140.08 428.17 4,201.72 350.003,565.29 296.99 4,960.34 413.20 4,525.87 377.01 3,706.86 308.78 91 4,100.08 341.54 5,704.40 475.18 5,204.76 433.56 4,262.88 355.103,578.63 298.10 5,017.39 417.95 4,580.45 381.55 3,758.60 313.09 92 4,115.42 342.81 5,769.99 480.64 5,267.52 438.78 4,322.38 360.053,592.80 299.28 5,075.09 422.76 4,635.61 386.15 3,810.71 317.43 93 4,131.72 344.17 5,836.35 486.17 5,330.95 444.07 4,382.32 365.053,607.76 300.53 5,133.45 427.62 4,691.34 390.79 3,863.22 321.81 94 4,148.93 345.61 5,903.47 491.76 5,395.03 449.41 4,442.70 370.083,623.50 301.84 5,192.49 432.53 4,747.64 395.48 3,916.12 326.21 95 4,167.03 347.11 5,971.35 497.41 5,459.79 454.80 4,503.55 375.153,659.73 304.86 5,244.41 436.86 4,795.12 399.43 3,955.28 329.47 96 4,208.70 350.58 6,031.08 502.39 5,514.39 459.35 4,548.57 378.903,696.33 307.90 5,296.86 441.23 4,843.07 403.43 3,994.83 332.77 97 4,250.79 354.09 6,091.38 507.41 5,569.53 463.94 4,594.07 382.693,733.30 310.98 5,349.82 445.64 4,891.50 407.46 4,034.79 336.10 98 4,293.29 357.63 6,152.30 512.49 5,625.23 468.58 4,640.00 386.513,770.63 314.09 5,403.32 450.10 4,940.42 411.54 4,075.14 339.46 99 4,336.23 361.21 6,213.82 517.61 5,681.48 473.27 4,686.40 390.38
Policies may be issued on an annual, semi-annual, quarterly or monthly mode. To obtain semi-annual premiums, multiply the above-quoted annual premium by 0.52. To obtain quarterly premiums, multiply the above quoted premium by 0.265.
Add one-time enrollment fee of $20.00 to the first premium.Applicants who qualify for Household Discount multiply above rates by 0.93
Attained Age
Plan A Plan F Plan G Plan NFEMALE RATES MALE RATES
Plan A Plan F Plan G Plan N
COLORADOAttained Age Rates --Current Rates Effective 3/1/2018 -- Area II (800-802)
STANDARD II ANNUAL & MONTHLY BANK DRAFT RATES
American Retirement Life Insurance CompanyMEDICARE SUPPLEMENT
AR-HHDS-OCD-AA-CO PAGE 8 03/18
Annual Monthly Annual Monthly Annual Monthly Annual Monthly Annual Monthly Annual Monthly Annual Monthly Annual Monthly
3,407.59 283.85 4,174.38 347.73 3,662.47 305.08 2,909.31 242.35 65 3,918.73 326.43 4,800.54 399.88 4,211.84 350.85 3,345.70 278.703,407.59 283.85 4,174.38 347.73 3,662.47 305.08 2,909.31 242.35 66 3,918.73 326.43 4,800.54 399.88 4,211.84 350.85 3,345.70 278.703,407.59 283.85 4,174.38 347.73 3,662.47 305.08 2,909.31 242.35 67 3,918.73 326.43 4,800.54 399.88 4,211.84 350.85 3,345.70 278.703,407.59 283.85 4,174.38 347.73 3,662.47 305.08 2,909.31 242.35 68 3,918.73 326.43 4,800.54 399.88 4,211.84 350.85 3,345.70 278.703,407.59 283.85 4,174.38 347.73 3,662.47 305.08 2,909.31 242.35 69 3,918.73 326.43 4,800.54 399.88 4,211.84 350.85 3,345.70 278.703,407.59 283.85 4,174.38 347.73 3,662.47 305.08 2,909.31 242.35 70 3,918.73 326.43 4,800.54 399.88 4,211.84 350.85 3,345.70 278.703,407.59 283.85 4,174.38 347.73 3,662.47 305.08 2,909.31 242.35 71 3,918.73 326.43 4,800.54 399.88 4,211.84 350.85 3,345.70 278.703,407.59 283.85 4,183.68 348.50 3,720.52 309.92 2,950.16 245.75 72 3,918.73 326.43 4,811.24 400.78 4,278.59 356.41 3,392.68 282.613,458.30 288.08 4,256.90 354.60 3,795.97 316.20 3,011.21 250.83 73 3,977.04 331.29 4,895.44 407.79 4,365.37 363.64 3,462.90 288.463,510.68 292.44 4,331.39 360.81 3,872.33 322.56 3,072.96 255.98 74 4,037.28 336.31 4,981.11 414.93 4,453.18 370.95 3,533.89 294.373,564.30 296.91 4,407.20 367.12 3,949.62 329.00 3,135.40 261.18 75 4,098.95 341.44 5,068.27 422.19 4,542.07 378.35 3,605.71 300.363,602.73 300.11 4,484.32 373.54 4,025.27 335.31 3,200.82 266.63 76 4,143.13 345.12 5,156.96 429.58 4,629.06 385.60 3,680.94 306.623,633.37 302.66 4,551.58 379.15 4,092.03 340.87 3,259.12 271.48 77 4,178.38 348.06 5,234.32 436.02 4,705.84 392.00 3,747.99 312.213,665.04 305.30 4,619.85 384.83 4,159.64 346.50 3,318.07 276.39 78 4,214.78 351.09 5,312.83 442.56 4,783.59 398.47 3,815.78 317.853,697.67 308.02 4,689.15 390.61 4,228.12 352.20 3,377.67 281.36 79 4,252.32 354.22 5,392.53 449.20 4,862.33 405.03 3,884.32 323.563,731.29 310.82 4,759.49 396.47 4,297.50 357.98 3,437.94 286.38 80 4,290.99 357.44 5,473.42 455.94 4,942.13 411.68 3,953.64 329.343,752.63 312.59 4,830.89 402.41 4,367.77 363.84 3,503.66 291.85 81 4,315.53 359.48 5,555.52 462.77 5,022.94 418.41 4,029.20 335.633,766.03 313.71 4,891.27 407.44 4,427.99 368.85 3,561.14 296.64 82 4,330.93 360.77 5,624.96 468.56 5,092.20 424.18 4,095.31 341.143,780.64 314.93 4,952.41 412.54 4,488.80 373.92 3,618.91 301.45 83 4,347.73 362.17 5,695.27 474.42 5,162.11 430.00 4,161.74 346.673,796.42 316.24 5,014.32 417.69 4,550.19 379.03 3,676.99 306.29 84 4,365.88 363.68 5,766.47 480.35 5,232.72 435.89 4,228.55 352.243,813.33 317.65 5,076.99 422.91 4,612.19 384.20 3,735.44 311.16 85 4,385.33 365.30 5,838.55 486.35 5,304.02 441.83 4,295.75 357.843,831.81 319.19 5,140.46 428.20 4,673.61 389.31 3,792.72 315.93 86 4,406.58 367.07 5,911.52 492.43 5,374.66 447.71 4,361.63 363.323,849.22 320.64 5,202.14 433.34 4,733.39 394.29 3,848.60 320.59 87 4,426.60 368.74 5,982.47 498.34 5,443.40 453.44 4,425.88 368.683,867.42 322.16 5,264.57 438.54 4,793.80 399.32 3,904.93 325.28 88 4,447.54 370.48 6,054.26 504.32 5,512.87 459.22 4,490.67 374.073,886.39 323.74 5,327.74 443.80 4,854.87 404.41 3,961.74 330.01 89 4,469.35 372.30 6,126.91 510.37 5,583.10 465.07 4,556.00 379.513,906.13 325.38 5,391.67 449.13 4,916.60 409.55 4,019.04 334.79 90 4,492.06 374.19 6,200.43 516.50 5,654.10 470.99 4,621.89 385.003,921.81 326.69 5,456.37 454.52 4,978.47 414.71 4,077.54 339.66 91 4,510.08 375.69 6,274.83 522.69 5,725.23 476.91 4,689.17 390.613,936.50 327.91 5,519.13 459.74 5,038.50 419.71 4,134.45 344.40 92 4,526.98 377.10 6,347.00 528.71 5,794.28 482.66 4,754.62 396.063,952.08 329.21 5,582.59 465.03 5,099.17 424.76 4,191.78 349.18 93 4,544.90 378.59 6,419.99 534.79 5,864.04 488.47 4,820.54 401.553,968.54 330.58 5,646.79 470.38 5,160.47 429.87 4,249.53 353.99 94 4,563.82 380.17 6,493.81 540.93 5,934.54 494.35 4,886.96 407.083,985.85 332.02 5,711.73 475.79 5,222.41 435.03 4,307.74 358.83 95 4,583.73 381.82 6,568.50 547.16 6,005.77 500.28 4,953.89 412.664,025.72 335.34 5,768.85 480.54 5,274.63 439.38 4,350.82 362.42 96 4,629.57 385.64 6,634.18 552.63 6,065.82 505.28 5,003.43 416.794,065.97 338.70 5,826.55 485.35 5,327.38 443.77 4,394.32 366.05 97 4,675.86 389.50 6,700.52 558.15 6,126.49 510.34 5,053.47 420.954,106.63 342.08 5,884.81 490.20 5,380.66 448.21 4,438.26 369.71 98 4,722.62 393.39 6,767.52 563.73 6,187.76 515.44 5,104.00 425.164,147.69 345.50 5,943.65 495.11 5,434.46 452.69 4,482.65 373.40 99 4,769.85 397.33 6,835.20 569.37 6,249.63 520.59 5,155.05 429.42
Policies may be issued on an annual, semi-annual, quarterly or monthly mode. To obtain semi-annual premiums, multiply the above-quoted annual premium by 0.52. To obtain quarterly premiums, multiply the above quoted premium by 0.265.
Applicants who qualify for Household Discount multiply above rates by 0.93Add one-time enrollment fee of $20.00 to the first premium.
Plan F Plan G Plan NPlan A Plan F Plan G Plan N Attained Age
Plan A
Attained Age Rates --Current Rates Effective 3/1/2018 -- Area II (800-802)STANDARD III ANNUAL & MONTHLY BANK DRAFT RATES
FEMALE RATES MALE RATES
American Retirement Life Insurance CompanyMEDICARE SUPPLEMENT
COLORADO
AR-HHDS-OCD-AA-CO PAGE 9 03/18
Locate appropriate Area according to the Applicant's ZIP Code in the ZIP Code chart below. COLORADO ZIP CODES: Area 3-digit ZIP Codes Area I 803-816 Area II 800-802
AR-HHDS-OCD-AA-CO PAGE 10 03/18
PREMIUM INFORMATION Your premium will increase each year because of the increase in Your attained age. We, American Retirement Life Insurance Company, can also raise Your premium if (a) We change the rates which apply to all policies of this form issued by Us and in-force in Your state; (b) coverage under Medicare changes; or (c) You move to a different ZIP Code location. We will send You a written notice at least thirty (30) days in advance when We change the premium rates for all policies of this form issued by Us and in-force in Your state.
There will be a one-time enrollment fee of $20 added to the first premium.
DISCLOSURES Use this Outline to compare benefits and premiums among policies.
READ YOUR POLICY VERY CAREFULLY This is only an Outline describing Your policy’s most important features. The policy is Your insurance contract. You must read the policy itself to understand all of the rights and duties of both You and American Retirement Life Insurance Company.
30-DAY RIGHT TO RETURN POLICY If You find that You are not satisfied with Your policy, You may return it to American Retirement Life Insurance Company, P. O. Box 26580, Austin, TX 78755-0580. If You send the policy back to Us within thirty (30) days after You receive it, We will treat the policy as if it had never been issued and return all of Your premiums.
POLICY REPLACEMENT If You are replacing another health insurance policy, do NOT cancel it until You have actually received Your new policy and are sure You want to keep it.
NOTICE This policy may not fully cover all of Your medical costs. Neither American Retirement Life Insurance Company nor its agents are connected with Medicare. This Outline of Coverage does not give all the details of Medicare coverage. Contact Your local Social Security Office or consult the Medicare and You for more details.
COMPLETE ANSWERS ARE VERY IMPORTANT When You fill out the application for the new policy, be sure to answer truthfully and completely all questions about Your medical and health history. We may cancel Your policy and refuse to pay any claims if You leave out or falsify important medical information.
Review the application carefully before You sign it. Be certain that all information has been properly recorded.
RENEWABILITY This policy is guaranteed renewable for life.
HOUSEHOLD DISCOUNT Affiliate means an insurance company that is under common ownership or control with American Retirement Life Insurance Company and that is a member of the same insurance holding company system.
Household Discount is a discount that is available when more than one member of Your household enrolls or is enrolled in a Medicare Supplement policy provided by or through an Affiliate of American Retirement Life Insurance Company. Household is defined as a condominium unit, a single family home, or an apartment unit within an apartment complex.
The household premium discount will be removed if the other Medicare Supplement policyholder whose policy status entitles You to the discount no longer resides with You or no longer has a Medicare Supplement policy through an Affiliate of American Retirement Life Insurance Company. However, if that person becomes deceased, Your discount will still apply. The addition or removal of the discount will occur on the billing cycle following the date We learn Your eligibility has changed.
AR-HHDS-OCD-AA-CO PAGE 11 03/18
PLAN A MEDICARE (PART A) – HOSPITAL SERVICES – PER BENEFIT PERIOD
*A benefit period begins on the first day You receive service as an inpatient in a hospital and ends after You have been out of the hospital and have not received skilled care in any other facility for 60 days in a row.
SERVICES MEDICARE PAYS PLAN A PAYS YOU PAY HOSPITALIZATION* Semi-private room and board, general nursing, and miscellaneous services and supplies First 60 days 61st thru 90th day 91st day and after:
– while using 60 lifetime reserve days – once lifetime reserve days are used, additional
365 days
– beyond the additional 365 days
All but $1,340 All but $335 per day All but $670 per day $0 $0
$0 $335 per day $670 per day 100% of Medicare Eligible Expenses $0
$1,340 (Part A Deductible) $0 $0 $0** All costs
SKILLED NURSING FACILITY CARE * You must meet Medicare’s requirements, including having been in a hospital for at least 3 days and entering a Medicare-approved facility within 30 days after leaving the hospital First 20 days 21st thru 100th day 101st day and after
All approved amounts All but $167.50 per day $0
$0 $0 $0
$0 Up to $167.50 per day All costs
BLOOD First 3 pints Additional amounts
$0 100%
3 pints $0
$0 $0
HOSPICE CARE You must meet Medicare’s requirements, including a doctor’s certification of terminal illness
All but very limited copayment/coinsurance for outpatient drugs and inpatient respite care
Medicare copayment/coinsurance
$0
**NOTICE: When Your Medicare Part A hospital benefits are exhausted, We, the insurer, stand in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy’s “Core Benefits.” During this time, the hospital is prohibited from billing You for the balance based on any difference between its billed charges and the amount Medicare would have paid.
AR-HHDS-OCD-AA-CO PAGE 12 03/18
PLAN A MEDICARE (PART B) – MEDICAL SERVICES – PER CALENDAR YEAR
*Once You have been billed $183 of Medicare-approved amounts for covered services (which are noted with an asterisk), Your Part B Deductible will have been met for the calendar year.
SERVICES MEDICARE PAYS PLAN A PAYS YOU PAY MEDICAL EXPENSES – IN OR OUT OF THE HOSPITAL AND OUTPATIENT HOSPITAL TREATMENT such as physician’s services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment First $183 of Medicare-approved amounts* Remainder of Medicare-approved amounts
$0 Generally 80%
$0 Generally 20%
$183 (Part B Deductible) $0
PART B EXCESS CHARGES (above Medicare-approved amounts)
$0
$0
All costs
BLOOD First 3 pints Next $183 of Medicare-approved amounts* Remainder of Medicare-approved amounts
$0 $0 80%
All costs $0 20%
$0 $183 (Part B Deductible) $0
CLINICAL LABORATORY SERVICES Tests for diagnostic services
100%
$0
$0
PARTS A & B
SERVICES MEDICARE PAYS PLAN A PAYS YOU PAY
HOME HEALTH CARE MEDICARE- APPROVED SERVICES Medically-necessary skilled care services and medical supplies – Durable medical equipment First $183 of Medicare-approved amounts* Remainder of Medicare-approved amounts
100% $0 80%
$0 $0 20%
$0 $183 (Part B Deductible) $0
AR-HHDS-OCD-AA-CO PAGE 13 03/18
PLAN F MEDICARE (PART A) – HOSPITAL SERVICES – PER BENEFIT PERIOD
*A benefit period begins on the first day You receive service as an inpatient in a hospital and ends after You have been out of the hospital and have not received skilled care in any other facility for 60 days in a row.
SERVICES MEDICARE PAYS PLAN F PAYS YOU PAY HOSPITALIZATION* Semi-private room and board, general nursing, and miscellaneous services and supplies First 60 days 61st thru 90th day 91st day and after:
– while using 60 lifetime reserve days – once lifetime reserve days are used, additional
365 days
– beyond the additional 365 days
All but $1,340 All but $335 per day All but $670 per day $0 $0
$1,340 (Part A Deductible) $335 per day $670 per day 100% of Medicare Eligible Expenses $0
$0 $0 $0 $0** All costs
SKILLED NURSING FACILITY CARE * You must meet Medicare’s requirements, including having been in a hospital for at least 3 days and entering a Medicare-approved facility within 30 days after leaving the hospital First 20 days 21st thru 100th day 101st day and after
All approved amounts All but $167.50 per day $0
$0 Up to $167.50 per day $0
$0 $0 All costs
BLOOD First 3 pints Additional amounts
$0 100%
3 pints $0
$0 $0
HOSPICE CARE You must meet Medicare’s requirements, including a doctor’s certification of terminal illness
All but very limited copayment/coinsurance for outpatient drugs and inpatient respite care
Medicare copayment/coinsurance
$0
**NOTICE: When Your Medicare Part A hospital benefits are exhausted, We, the insurer, stand in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy’s “Core Benefits.” During this time, the hospital is prohibited from billing You for the balance based on any difference between its billed charges and the amount Medicare would have paid.
AR-HHDS-OCD-AA-CO PAGE 14 03/18
PLAN F MEDICARE (PART B) – MEDICAL SERVICES – PER CALENDAR YEAR
*Once You have been billed $183 of Medicare-approved amounts for covered services (which are noted with an asterisk), Your Part B Deductible will have been met for the calendar year.
SERVICES MEDICARE PAYS PLAN F PAYS YOU PAY MEDICAL EXPENSES – IN OR OUT OF THE HOSPITAL AND OUTPATIENT HOSPITAL TREATMENT such as physician’s services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment First $183 of Medicare-approved amounts* Remainder of Medicare-approved amounts
$0 Generally 80%
$183 (Part B Deductible) Generally 20%
$0 $0
PART B EXCESS CHARGES (above Medicare-approved amounts)
$0
100%
$0
BLOOD First 3 pints Next $183 of Medicare-approved amounts* Remainder of Medicare-approved amounts
$0 $0 80%
All costs $183 (Part B Deductible) 20%
$0 $0 $0
CLINICAL LABORATORY SERVICES Tests for diagnostic services
100%
$0
$0
PARTS A & B
SERVICES MEDICARE PAYS PLAN F PAYS YOU PAY
HOME HEALTH CARE MEDICARE- APPROVED SERVICES Medically-necessary skilled care services and medical supplies – Durable medical equipment First $183 of Medicare-approved amounts* Remainder of Medicare-approved amounts
100% $0 80%
$0 $183 (Part B Deductible) 20%
$0 $0 $0
AR-HHDS-OCD-AA-CO PAGE 15 03/18
PLAN F MEDICARE (PART B) – MEDICAL SERVICES – PER CALENDAR YEAR (CONT’D.)
OTHER BENEFITS – NOT COVERED BY MEDICARE
SERVICES MEDICARE PAYS PLAN F PAYS YOU PAY
FOREIGN TRAVEL – NOT COVERED BY MEDICARE Medically-necessary emergency care services beginning during the first 60 days of each trip outside the USA First $250 each calendar year Remainder of charges
$0 $0
$0 80% to a lifetime maximum benefit of $50,000
$250 20% and amounts over the $50,000 lifetime maximum
AR-HHDS-OCD-AA-CO PAGE 16 03/18
PLAN G MEDICARE (PART A) – HOSPITAL SERVICES – PER BENEFIT PERIOD
*A benefit period begins on the first day You receive service as an inpatient in a hospital and ends after You have been out of the hospital and have not received skilled care in any other facility for 60 days in a row.
SERVICES MEDICARE PAYS PLAN G PAYS YOU PAY HOSPITALIZATION* Semi-private room and board, general nursing, and miscellaneous services and supplies First 60 days 61st thru 90th day 91st day and after:
– while using 60 lifetime reserve days – once lifetime reserve days are used, additional
365 days
– beyond the additional 365 days
All but $1,340 All but $335 per day All but $670 per day $0 $0
$1,340 (Part A Deductible) $335 per day $670 per day 100% of Medicare Eligible Expenses $0
$0 $0 $0 $0** All costs
SKILLED NURSING FACILITY CARE * You must meet Medicare’s requirements, including having been in a hospital for at least 3 days and entering a Medicare-approved facility within 30 days after leaving the hospital First 20 days 21st thru 100th day 101st day and after
All approved amounts All but $167.50 per day $0
$0 Up to $167.50 per day $0
$0 $0 All costs
BLOOD First 3 pints Additional amounts
$0 100%
3 pints $0
$0 $0
HOSPICE CARE You must meet Medicare’s requirements, including a doctor’s certification of terminal illness
All but very limited copayment/coinsurance for outpatient drugs and inpatient respite care
Medicare copayment/coinsurance
$0
**NOTICE: When Your Medicare Part A hospital benefits are exhausted, We, the insurer, stand in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy’s “Core Benefits.” During this time, the hospital is prohibited from billing You for the balance based on any difference between its billed charges and the amount Medicare would have paid.
AR-HHDS-OCD-AA-CO PAGE 17 03/18
PLAN G MEDICARE (PART B) – MEDICAL SERVICES – PER CALENDAR YEAR
*Once You have been billed $183 of Medicare-approved amounts for covered services (which are noted with an asterisk), Your Part B Deductible will have been met for the calendar year.
SERVICES MEDICARE PAYS PLAN G PAYS YOU PAY MEDICAL EXPENSES – IN OR OUT OF THE HOSPITAL AND OUTPATIENT HOSPITAL TREATMENT such as physician’s services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment First $183 of Medicare-approved amounts* Remainder of Medicare-approved amounts
$0 Generally 80%
$0 Generally 20%
$183 (Part B Deductible) $0
PART B EXCESS CHARGES (above Medicare-approved amounts)
$0
100%
$0
BLOOD First 3 pints Next $183 of Medicare-approved amounts* Remainder of Medicare-approved amounts
$0 $0 80%
All costs $0 20%
$0 $183 (Part B Deductible) $0
CLINICAL LABORATORY SERVICES Tests for diagnostic services
100%
$0
$0
PARTS A & B
SERVICES MEDICARE PAYS PLAN G PAYS YOU PAY
HOME HEALTH CARE MEDICARE- APPROVED SERVICES Medically-necessary skilled care services and medical supplies – Durable medical equipment First $183 of Medicare-approved amounts* Remainder of Medicare-approved amounts
100% $0 80%
$0 $0 20%
$0 $183 (Part B Deductible) $0
AR-HHDS-OCD-AA-CO PAGE 18 03/18
PLAN G MEDICARE (PART B) – MEDICAL SERVICES – PER CALENDAR YEAR (CONT’D.)
OTHER BENEFITS – NOT COVERED BY MEDICARE
SERVICES MEDICARE PAYS PLAN G PAYS YOU PAY
FOREIGN TRAVEL – NOT COVERED BY MEDICARE Medically-necessary emergency care services beginning during the first 60 days of each trip outside the USA First $250 each calendar year Remainder of charges
$0 $0
$0 80% to a lifetime maximum benefit of $50,000
$250 20% and amounts over the $50,000 lifetime maximum
AR-HHDS-OCD-AA-CO PAGE 19 03/18
PLAN N MEDICARE (PART A) – HOSPITAL SERVICES – PER BENEFIT PERIOD
*A benefit period begins on the first day You receive service as an inpatient in a hospital and ends after You have been out of the hospital and have not received skilled care in any other facility for 60 days in a row.
SERVICES MEDICARE PAYS PLAN N PAYS YOU PAY HOSPITALIZATION* Semi-private room and board, general nursing, and miscellaneous services and supplies First 60 days 61st thru 90th day 91st day and after:
– while using 60 lifetime reserve days – once lifetime reserve days are used, additional
365 days
– beyond the additional 365 days
All but $1,340 All but $335 per day All but $670 per day $0 $0
$1,340 (Part A Deductible) $335 per day $670 per day 100% of Medicare Eligible Expenses $0
$0 $0 $0 $0** All costs
SKILLED NURSING FACILITY CARE * You must meet Medicare’s requirements, including having been in a hospital for at least 3 days and entering a Medicare-approved facility within 30 days after leaving the hospital First 20 days 21st thru 100th day 101st day and after
All approved amounts All but $167.50 per day $0
$0 Up to $167.50 per day $0
$0 $0 All costs
BLOOD First 3 pints Additional amounts
$0 100%
3 pints $0
$0 $0
HOSPICE CARE You must meet Medicare’s requirements, including a doctor’s certification of terminal illness
All but very limited copayment/coinsurance for outpatient drugs and inpatient respite care
Medicare copayment/coinsurance
$0
**NOTICE: When Your Medicare Part A hospital benefits are exhausted, We, the insurer, stand in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy’s “Core Benefits.” During this time, the hospital is prohibited from billing You for the balance based on any difference between its billed charges and the amount Medicare would have paid.
AR-HHDS-OCD-AA-CO PAGE 20 03/18
PLAN N MEDICARE (PART B) – MEDICAL SERVICES – PER CALENDAR YEAR
*Once You have been billed $183 of Medicare-approved amounts for covered services (which are noted with an asterisk), Your Part B Deductible will have been met for the calendar year.
SERVICES MEDICARE PAYS PLAN N PAYS YOU PAY MEDICAL EXPENSES – IN OR OUT OF THE HOSPITAL AND OUTPATIENT HOSPITAL TREATMENT such as physician’s services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment First $183 of Medicare-approved amounts* Remainder of Medicare-approved amounts
$0 Generally 80%
$0 Balance, other than up to $20 per office visit and up to $50 per emergency room visit. The copayment of up to $50 is waived if the Insured is admitted to any hospital and the emergency visit is covered as a Medicare Part A expense
$183 (Part B Deductible) Up to $20 per office visit and up to $50 per emergency room visit. The copayment of up to $50 is waived if the Insured is admitted to any hospital and the emergency visit is covered as a Medicare Part A expense
PART B EXCESS CHARGES (above Medicare-approved amounts)
$0
$0
All costs
BLOOD First 3 pints Next $183 of Medicare-approved amounts* Remainder of Medicare-approved amounts
$0 $0 80%
All costs $0 20%
$0 $183 (Part B Deductible) $0
CLINICAL LABORATORY SERVICES Tests for diagnostic services
100%
$0
$0
AR-HHDS-OCD-AA-CO PAGE 21 03/18
PLAN N MEDICARE (PART B) – MEDICAL SERVICES – PER CALENDAR YEAR (CONT’D.)
PARTS A & B
SERVICES MEDICARE PAYS PLAN N PAYS YOU PAY
HOME HEALTH CARE MEDICARE- APPROVED SERVICES Medically-necessary skilled care services and medical supplies – Durable medical equipment First $183 of Medicare-approved amounts* Remainder of Medicare-approved amounts
100% $0 80%
$0 $0 20%
$0 $183 (Part B Deductible) $0
OTHER BENEFITS – NOT COVERED BY MEDICARE
SERVICES MEDICARE PAYS PLAN N PAYS YOU PAY
FOREIGN TRAVEL – NOT COVERED BY MEDICARE Medically-necessary emergency care services beginning during the first 60 days of each trip outside the USA First $250 each calendar year Remainder of charges
$0 $0
$0 80% to a lifetime maximum benefit of $50,000
$250 20% and amounts over the $50,000 lifetime maximum
AR-HHDS-OCD-AA-CO PAGE 22 03/18