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Regence BlueCross BlueShield of Oregon Medicare Supplement Plan Information
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Regence BlueCross BlueShield of Oregon Medicare Supplement Rates (other premiums and payment options available) Effective January 1, 2012 Bridge Plan A Bridge Plan C Bridge Plan F Bridge Plan K Age 65 & under $117 $143 $144 $78 Age 66 $121 $150 $151 $81 Age 67 $127 $159 $160 $86 Age 68 $132 $166 $167 $90 Age 69 $137 $173 $174 $95 Age 70 $143 $181 $183 $98 Benefits Plan A Plan C Plan F Plan K Medicare Part A Coinsurance and Hospital Benefits Medicare Part A Deductible   50% Medicare Part B Coinsurance or Co-payment 50% Medicare Part B Deductible     Medicare Part B Excess Charges       Blood (First Three Pints) 50% Hospice Care Coinsurance or Co-payment 50% Skilled Nursing Coinsurance   50% Foreign Travel Emergency (Up to Plan Limits)3     Medicare Preventive Care Part B Coinsurance

1. Medigap Plan F offers a high deductible option. You must pay for Medicare-covered costs up to the high-deductible amount ($2,070 in 2012) before your Medigap policy pays anything
2. 100% part B coinsurance except up to $20 copayment for office visits and up to $50 copayment for ER.
3. You must also pay a separate deductible for foreign travel emergency ($250 per year).
4. After you meet your out-of-pocket yearly limit and your yearly Part B deductible ($140 in 2012) the plan pays 100% of covered services for the rest of the calendar year (This applies only to plans K & L)
5. Modified Plan F offers an individual assistance program, as well as coverage for preventive dental care (available in some states)

• 2012 Out of Pocket Limit for Plan K is $4,660.
• 2012 Out of Pocket Limit for Plan L is $2,330.