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Medicare supplement plan premiums Premera Blue Cross Plan F (closed to new members) Plan G Age 65 or older, Under age Age 65 or older, Under age eligible by age 65, eligible eligible by age 65, eligible by disability by disability Subscriber only 1 Medicare eligible $119.05 $207.45 $101.99 $169.20 Subscriber and spouse 1 Medicare eligible $944.77 $1,033.17 $927.71 $994.92 2 Medicare eligible: 1 $320.54 $320.54 $265.23 $265.23 retired, 1 disabled 2 Medicare eligible $232.14 $408.94 $198.02 $332.44 Subscriber and children 1 Medicare eligible $738.34 $826.74 $721.28 $788.49 Subscriber, spouse,and children 1 Medicare eligible $1,564.06 $1,652.46 $1,547.00 $1,614.21 2 Medicare eligible: 1 $940.58 $940.58 $885.27 $885.27 retired, 1 disabled 2 Medicare eligible $851.43 $1,028.23 $817.31 $951.73 2

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