- Premera Blue Cross offers Medicare Advantage plans to residents of Washington state.
- Medicare Advantage plans can replace your original Medicare coverage to provide additional services, all in a bundled package.
- Costs vary based on the coverage you choose and where you live.
- All of Premera’s plans offer prescription drug coverage.
Medicare Advantage, or Medicare Part C, offers optional plans 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 include prescription medications and dental coverage.
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 Health Maintenance Organization (HMO) plans to residents of Washington state. Keep reading to learn about the specific Medicare Advantage options offered by Premera.
Though 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 for 2020:
- Walla Walla
If you’re a Washington resident, you can click here to see which Medicare Advantage plans are offered in your area.
You can choose from among several different types of Medicare Advantage (Part C) plans to replace your original Medicare. These plans vary in coverage and restrictions placed on coverage.
The types of Medicare Advantage plans include:
But Premera offers only HMO plans through its Medicare Advantage program. We’ll go over these types of plans next.
Premera Medicare Advantage 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.
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.
The Medicare Advantage HMO plans offered by Premera in 2020 include:
- Premera Blue Cross Medicare Advantage
- Premera Blue Cross Medicare Advantage Alpine
- Premera Blue Cross Medicare Advantage Charter + Rx
- Premera Blue Cross Medicare Advantage Classic
- Premera Blue Cross Medicare Advantage Classic Plus
- Premera Blue Cross Medicare Advantage Core
- Premera Blue Cross Medicare Advantage Core Plus
- Premera Blue Cross Medicare Advantage Peak + Rx
- Premera Blue Cross Medicare Advantage Sound + Rx
- Premera Blue Cross Medicare Advantage Total Health
Premera doesn’t currently offer stand-alone Medicare Part D plans. But each of its Medicare Advantage HMO plans includes some level of prescription drug coverage.
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
- prescription medications
- fitness programs and gym memberships
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)|
|Primary care copayment||$15||$10||$15|
|Prescription deductible (waived on tier 1 and tier 2)||$300||$200||$160|
Medicare Part C, or Medicare Advantage, 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.
When should I enroll?
You can sign up for a Medicare Advantage plan during specific enrollment periods.
You first need to enroll in Medicare parts A and B. Then, you can enroll in Medicare Advantage during open enrollment periods.
Medicare’s open enrollment period is from October 15 through December 7. Medicare Advantage open enrollment is from January 1 through March 31.
Medicare Part D is Medicare’s prescription drug program. This optional program offered by private insurance companies.
Each plan has a formulary, which is a list of basic drugs that the plan covers. The formulary usually includes two medications for each class of prescription drug. For example, it might have two medications (generic or brand name) for blood pressure or diabetes.
If your prescription isn’t on the formulary, you could ask for an exception. You can also talk with your doctor about trying an alternative medication that’s covered.
Formulary lists are updated by Medicare plans every year. You’ll save the most money on your medications by using prescription drugs from your plan’s formulary.
- 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.
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