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)
​$126.68 $316.71​ ​$438.60 ​$132.27
​College Choice Health Plan ​$139.25 ​$348.11 ​$408.87 ​$113.28
​Dependent
Beneficiary ​
​Managed Care Health Plan
(OAP or HMO)
​$506.74 ​$1,266.84 ​$1,754.40 ​$529.10
​College Choice Health Plan ​$556.98 ​$1,392.45 ​$1,635.48 ​$453.11

 * This rate applies to benefit recipients enrolled in Medicare Parts A and B, or benefit recipients enrolled in Medicare Part A only and whose Part B benefits are reduced. If you or your dependent is actively working and eligible for Medicare, or you have additional questions about this requirement, contact the CMS Group Insurance Division, Medicare Coordination of Benefits (COB) Unit.

 
 
 
Updated 06/09/2017