at a glance
- Premera Blue Cross offers Medicare Advantage plans to residents of Washington state.
- Most of Premera’s plans include prescription drug coverage.
- Premera serves over 2 million people and is the largest health plan provider in the Pacific Northwest.
Medicare Advantage, or Medicare Part C, is an optional plan that can replace your original Medicare coverage (parts A and B).
Part C provides a bundled package that includes additional services beyond those you’ll get from original Medicare. These may include prescription medications and dental coverage, among others.
In 2018, roughly
Medicare Advantage plans are sold through private insurance companies. These plans must provide at least the same coverage as original Medicare. Beyond that, different insurers offer a variety of plan options, depending on where you live and how much you want to pay.
Premera Blue Cross offers a variety of HMO plans to residents of Washington state. Keep reading to learn about the specific Medicare Advantage options offered by Premera in 2021.
You can choose from among several different types of Medicare Advantage plans to replace your original Medicare.
The types of Medicare Advantage plans include:
- Health Maintenance Organization (HMO)
- Preferred Provider Organization (PPO)
- Private Fee-For-Service (PFFS)
- Special Needs Plan (SNP)
- Medicare savings account (MSA)
However, Premera offers only HMO plans through its Medicare Advantage program. We’ll go over the details of what these plans offer next.
Premera HMO plans
With the Premera HMO Medicare Advantage plans, you’ll be asked to choose a primary care doctor who will oversee your care. You’ll have the option of seeing specialists, when needed, within the plan’s network of providers.
If you need to see someone outside your provider’s network, coverage will not apply and you’ll have to pay all costs. Emergency services are the exception.
All of Premera’s plans include prescription drug coverage.
With original Medicare (Part A and Part B), you have to choose a separate Medicare Part D prescription drug plan. If you don’t sign up for drug coverage when you’re first eligible for Medicare, you’ll usually pay a penalty if you choose to add coverage later.
Premera doesn’t currently offer stand-alone Medicare Part D plans. However, most of its Medicare Advantage HMO plans include some level of prescription drug coverage.
Although Premera Blue Cross offers private insurance services in both Alaska and Washington, its Medicare Advantage plans are limited to Washington residents only. And even in Washington, plan availability varies by county.
Premera offers Medicare Advantage plans in the following Washington counties in 2021:
- San Juan
- Walla Walla
If you’re a Washington resident, you can enter your ZIP code here to see which Premera Medicare Advantage plans are offered in your area.
All Medicare Advantage (Part C) plans must offer the basic services covered under original Medicare (parts A and B).
Typically, Medicare Advantage plans include additional services, as well. These may vary based on the plan you choose.
Each Medicare Advantage plan that Premera Blue Cross offers covers the following standard services:
- inpatient hospital stays
- limited skilled nursing care
- outpatient doctor’s visits
- common lab tests
- preventive care and vaccines
- mental health services
- physical and occupational therapy
- durable medical equipment
- emergency and urgent care
- some transportation services for medical care
- optional prescription drug coverage
- fitness programs and gym memberships
- 24/7 nurse line access
Routine dental coverage is available for an additional cost, depending on the plan you choose. Each Premera Medicare Advantage plan also includes coverage for fitness programs.
Plan availability and prices vary. There are multiple tiers of plans, and not every plan is offered in every county. Plans typically include a monthly premium, deductible, copayments, and coinsurances.
The following table shows some of the costs for a few of Premera’s Medicare Advantage plans in the most populous counties in Washington (King, Pierce, and Snohomish).
|Premera Blue Cross Medicare Advantage (HMO)||Premera Blue Cross Medicare Advantage Classic Plus (HMO)||Premera Blue Cross Medicare Advantage Peak + Rx (HMO)|
|Annual medical deductible||$0||$0||$0|
|Primary care copayment||$15 in office, $10 telehealth||$10 in office, $5 telehealth||$15 in office, $10 telehealth|
|Specialist copayment||$45 in office visit, $40 telehealth||$40 in office visit, $35 telehealth||$50 in office visit, $45 telehealth|
|Prescription drug deductible (waived on tier 1 and tier 2)||$180||$180||$160|
Medicare Advantage (Part C) is a healthcare plan offered through private insurance providers. Part C combines all the elements of original Medicare — inpatient care through Medicare Part A and outpatient care through Medicare Part B — plus extra products and services like prescription coverage.
Plan availability and prices vary based on your location and the services you want included. You can tailor Medicare Advantage plans to fit your specific healthcare needs and budget.
Additional coverage and services will cost more. Plus, your plan might limit which providers, services, and products you can choose from.
You can compare several different Medicare Advantage plans in your area using Medicare’s plan comparison tool.
- Medicare Advantage plans offer an option for bundled healthcare services that go beyond original Medicare.
- In Washington state, Premera Blue Cross offers several HMO Medicare Advantage plans.
- Plan offerings and prices vary by county. Be sure to review what’s available in your area, and consider which plans will meet your healthcare needs and your budget.