Form Number: et-2169prm

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 $992.24 $912.16
Dean Health Insurance-Prevea360 $467.96 $996.42 $915.36
Group Health Cooperative of Eau Claire $459.46 $1,103.44 $898.36
Group Health Cooperative of South Central Wisconsin $473.86 $1,000.80 $927.16
HealthPartners Health Plan $452.46 $1,215.02 $884.36
Medical Associates Health Plan $367.76 $834.58 $714.96
Medicare Advantage by UnitedHealthCare $288.98 Not available $557.40
Medicare Plus by WEA Trust $364.46 $1,375.60 $708.36
MercyCare Health Plan $462.88 $1,051.38 $905.20
Network Health $538.86 $1,171.00 $1,057.16
Quartz - Community $463.12 $1,071.40 $905.68
Quartz - UW Health $411.44 $917.64 $802.32
Robin with HealthPartners Health Plan $452.46 $1,215.02 $884.36
Security Health Plan - Central $561.80 $1,468.40 $1,103.04
Security Health Plan - Valley $560.34 $1,463.66 $1,100.12
State Maintenance Plan (SMP)1 by WEA Trust $364.46 $1,027.28 $708.36
WEA Trust - East $452.76 $1,130.92 $884.96
WEA Trust West - Chippewa Valley $527.66 $1,357.44 $1,034.76
 WEA Trust West - Mayo Clinic Health System $504.06 $1,280.96 $987.56

1Members with Local Access HDHP or SMP HDHP 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 will remain covered under the Local Access HDHP or SMP HDHP.
 

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