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"Medicare & You", Centers for Medicaid & Medicare Services (2019)

Includes the Designated Participating Providers and Preventive Benefits Rider. National averages are subject to change, October 2018.

Premiums are based upon coverage available in your state.

Arizona resident limitations

New York resident limitations

In CO: This policy does not include coverage of pediatric dental services as required under The Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010. Coverage of pediatric dental services is available for purchase in the State of Colorado and can be purchased as a stand-alone plan. Please contact Connect for Health Colorado to purchase either plan that includes pediatric dental coverage or an Exchange-certified stand-alone dental plan that includes pediatric dental coverage.

Insurance Certificate C250A (ID: C250E; PA: C250Q); Insurance Policy P150 (FL: P150FL; GA: P150GA; NY: P150NY; OK: P150OK; TN: P150TN; TX: P150TX); B438/B439 and B424 (ID:B424C)/B426 Riders.