Type of
Participant​
Type of Plan​ Not Medicare Primary​ Medicare Primary*​
​Under Age 26 Age 26​-64​ ​Age 65 and Above​ ​All Ages
​Benefit
Recipient ​
​Managed Care Health Plan
(OAP or HMO)
​$103.79 $259.46 ​$362.23 ​$108.11
​College Choice Health Plan ​$121.99 ​$304.96 ​$431.11 ​$110.45
​Dependent
Beneficiary ​
​Managed Care Health Plan
(OAP or HMO)
​$415.14 ​$1,037.86 ​$1,448.93 ​$431.99
​College Choice Health Plan ​$487.94 ​$1,219.86 ​$1,724.44 ​$441.79

 

* This rate applies to plan participants enrolled in both Medicare Parts A and B, or participants enrolled in Medicare Part A only and whose Part B benefits are reduced. Send a copy of your Medicare card to the CMS Group Insurance Division, Medicare Coordination of Benefits (MCOB) Unit at 801 S. 7th Street, P.O. Box 19208, Springfield, IL 62794-9208.  If you or your dependent is actively working and eligible for Medicare, or you have additional questions about this requirement, contact the MCOB Unit (toll-free) 800-442-1300, or directly at 217-782-7007.

 

 

Updated 01/19/2017