2012 plan information
Find your Body Mass Index, or BMI, by finding your height in the far left column, then matching your height with your approximate weight in pounds. Your BMI is at the top of that column. If your BMI is not on the BMI chart because it is less than 15 or greater than 40, you're in Tier 3.
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| Tier | Tier 2 | Tier 1 | Tier 2 | Tier 3 | ||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BMI | 15 | 16 | 17 | 18 | 19 | 20 | 21 | 22 | 23 | 24 | 25 | 26 | 27 | 28 | 29 | 30 | 31 | 32 | 33 | 34 | 35 | 36 | 37 | 38 | 39 | 40 |
| Height | Your Weight in Pounds | |||||||||||||||||||||||||
| 4'10 | 72 | 74 | 77 | 79 | 82 | 85 | 87 | 90 | 93 | 96 | 99 | 102 | 105 | 134 | 139 | 143 | 148 | 153 | 158 | 163 | 167 | 173 | 177 | 182 | 186 | 191 |
| 4'11" | 74 | 77 | 84 | 89 | 94 | 99 | 104 | 109 | 114 | 119 | 124 | 128 | 133 | 138 | 143 | 148 | 153 | 158 | 163 | 169 | 173 | 179 | 183 | 189 | 193 | 198 |
| 5'0" | 77 | 79 | 87 | 92 | 97 | 102 | 107 | 112 | 118 | 123 | 128 | 133 | 138 | 143 | 148 | 153 | 158 | 163 | 168 | 174 | 179 | 184 | 189 | 194 | 199 | 204 |
| 5'1" | 79 | 82 | 90 | 95 | 100 | 106 | 111 | 116 | 122 | 127 | 132 | 137 | 143 | 148 | 153 | 158 | 164 | 169 | 174 | 180 | 185 | 190 | 195 | 201 | 206 | 211 |
| 5'2" | 82 | 85 | 93 | 98 | 104 | 109 | 115 | 120 | 126 | 131 | 136 | 142 | 147 | 153 | 158 | 164 | 169 | 175 | 180 | 186 | 191 | 196 | 202 | 207 | 213 | 218 |
| 5'3" | 85 | 87 | 96 | 102 | 107 | 113 | 118 | 124 | 130 | 135 | 141 | 146 | 152 | 158 | 163 | 169 | 175 | 180 | 186 | 191 | 197 | 203 | 208 | 214 | 220 | 225 |
| 5'4" | 87 | 90 | 99 | 105 | 110 | 116 | 122 | 128 | 134 | 140 | 145 | 151 | 157 | 163 | 169 | 174 | 180 | 186 | 192 | 197 | 204 | 209 | 215 | 221 | 227 | 232 |
| 5'5" | 90 | 93 | 102 | 108 | 114 | 120 | 126 | 132 | 138 | 144 | 150 | 156 | 162 | 168 | 174 | 180 | 186 | 192 | 198 | 204 | 210 | 216 | 222 | 228 | 234 | 240 |
| 5'6" | 93 | 96 | 105 | 112 | 118 | 124 | 130 | 136 | 142 | 148 | 155 | 161 | 167 | 173 | 179 | 186 | 192 | 198 | 204 | 210 | 216 | 223 | 229 | 235 | 241 | 247 |
| 5'7" | 96 | 99 | 109 | 115 | 121 | 127 | 134 | 140 | 146 | 153 | 159 | 166 | 172 | 178 | 185 | 191 | 198 | 204 | 211 | 217 | 223 | 230 | 236 | 242 | 249 | 255 |
| 5'8" | 99 | 102 | 112 | 118 | 125 | 131 | 138 | 144 | 151 | 158 | 164 | 171 | 177 | 184 | 190 | 197 | 203 | 210 | 216 | 223 | 230 | 236 | 243 | 249 | 256 | 262 |
| 5'9" | 102 | 105 | 115 | 122 | 128 | 135 | 142 | 149 | 155 | 162 | 169 | 176 | 182 | 189 | 196 | 203 | 209 | 216 | 223 | 230 | 236 | 243 | 250 | 257 | 263 | 270 |
| 5'10" | 105 | 108 | 118 | 125 | 132 | 139 | 146 | 153 | 160 | 167 | 174 | 181 | 188 | 195 | 202 | 209 | 216 | 222 | 229 | 236 | 243 | 250 | 257 | 264 | 271 | 278 |
| 5'11" | 108 | 112 | 122 | 129 | 136 | 143 | 150 | 157 | 165 | 172 | 179 | 186 | 193 | 200 | 208 | 215 | 222 | 229 | 236 | 243 | 250 | 257 | 265 | 272 | 279 | 286 |
| 6'0" | 111 | 115 | 125 | 133 | 140 | 147 | 154 | 162 | 169 | 177 | 184 | 191 | 199 | 206 | 213 | 221 | 228 | 235 | 242 | 250 | 258 | 265 | 272 | 279 | 287 | 294 |
| 6'1" | 114 | 118 | 129 | 136 | 144 | 151 | 159 | 166 | 174 | 182 | 189 | 197 | 204 | 212 | 219 | 227 | 235 | 242 | 250 | 257 | 265 | 272 | 280 | 288 | 295 | 302 |
| 6'2" | 117 | 121 | 132 | 140 | 148 | 155 | 163 | 171 | 179 | 186 | 194 | 202 | 210 | 218 | 225 | 233 | 241 | 249 | 256 | 264 | 272 | 280 | 287 | 295 | 303 | 311 |
| 6'3" | 120 | 125 | 136 | 144 | 152 | 160 | 168 | 176 | 184 | 192 | 200 | 208 | 216 | 224 | 232 | 240 | 248 | 256 | 264 | 272 | 279 | 287 | 295 | 303 | 311 | 319 |
| 6'4" | 123 | 128 | 140 | 148 | 156 | 164 | 172 | 180 | 189 | 197 | 205 | 213 | 221 | 230 | 238 | 246 | 254 | 263 | 271 | 279 | 287 | 295 | 304 | 312 | 320 | 328 |
MyBlue Medigap offers access to any hospital, doctor or other health care provider in the U.S. or its territories that accepts Medicare assignment. The plan does not require members to use a specified provider network. MyBlue Medigap is a Medigap plan administered by Blue Care Network. Certain factors may affect the monthly premium cost: geographic location of the applicant’s residence, age, gender, height, weight and whether the applicant uses tobacco. Neither Blue Care Network nor agents authorized to sell Blue Care Network policies are connected with Medicare.
page modified 12/08/2011