Retiree Tier II Pre-Medicare & Medicare-Eligible

Monthly Rates for 2024

Retiree Tier II — Plan A Survivor Tier II — Plan A

MEDICARE MEDICARE MEDICARE NO SURVIVOR
PLAN A NO MEDICARE PLAN A
RETIREE ONLY SPOUSE ONLY BOTH MEDICARE MEDICARE

Retiree Only $106.88 $49.62 n/a n/a Survivor

$873.50 $216.41
Only
Retiree + Spouse $980.38 $923.12 $323.29 $266.03
Survivor +
$1,082.77 $459.16
Retiree + Child $316.15 $292.38 n/a n/a Child

Retiree + Children $698.30 $735.70 n/a n/a Survivor +

$1,464.92 $902.49
Children
Retiree + Family $1,571.81 $1,609.20 $1,009.37 $952.11

Retiree Tier II — Plan B Survivor Tier II — Plan B

MEDICARE MEDICARE MEDICARE NO SURVIVOR
PLAN B NO MEDICARE PLAN B
RETIREE ONLY SPOUSE ONLY BOTH MEDICARE MEDICARE

Retiree Only $0.00 $0.00 n/a n/a Survivor

$701.38 $205.68
Only
Retiree + Spouse $701.37 $701.38 $205.68 $205.68
Survivor +
$869.41 $413.16
Retiree + Child $168.03 $207.48 n/a n/a Child

Retiree + Children $474.88 $586.41 n/a n/a Survivor +

$1,176.26 $792.09
Children
Retiree + Family $1,176.26 $1,287.79 $792.09 $792.09