Form Number: et-2168prm

Medicare 1 = Family coverage with at least one insured family member enrolled in Medicare Parts A, B and D.
Medicare 2 = Family coverage with all insured family members enrolled in Medicare Parts A, B and D.

Health Plan Medicare Single Medicare 1 Medicare 2
Dean Health Insurance $466.36 $1,081.02 $912.16
Dean Health Insurance-Prevea360 $467.96 $1,085.64 $915.36
Group Health Cooperative of Eau Claire $459.46 $1,211.18 $898.36
Group Health Cooperative of South Central Wisconsin $473.86 $1,089.74 $927.16
HealthPartners Health Plan $452.46 $1,341.80 $884.36
Medical Associates Health Plan $367.76 $913.90 $714.96
Medicare Advantage by UnitedHealthCare $288.98 Not available $557.40
Medicare Plus by WEA Trust $364.46 $1,541.30 $708.36
MercyCare Health Plan $462.88 $1,150.22 $905.20
Network Health $538.86 $1,276.86 $1,057.16
Quartz - Community $463.12 $1,173.42 $905.68
Quartz - UW Health $411.44 $1,003.26 $802.32
Robin with HealthPartners Health Plan $452.46 $1,341.80 $884.36
Security Health Plan - Central $561.80 $1,618.28 $1,103.04
Security Health Plan - Valley $560.34 $1,613.02 $1,100.12
State Maintenance Plan (SMP)1 by WEA Trust $364.46 $1,136.24 $708.36
WEA Trust - East $452.76 $1,244.14 $884.96
WEA Trust West - Chippewa Valley $527.66 $1,495.02 $1,034.76
 WEA Trust West - Mayo Clinic Health System $504.06 $1,410.02 $987.56

1Members with Local Access Plan or SMP coverage who enroll in Medicare Parts A and B will automatically be moved to the IYC Medicare Plus plan . All other non-Medicare family members remain covered under the Local Access Plan or SMP.

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