Premera Blue Cross provide Medicare Advantage plans to people who live in Washington state.
The company’s headquarters are in Mountlake Terrace, WA. They have been in operation, together with their predecessors, since the 1930s in Washington and since the 1950s in Alaska. In Alaska, the company’s plans are offered under Blue Cross Blue Shield licenses.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
When individuals qualify for Medicare, they can choose to get their benefits through either original Medicare (Part A and Part B) or through a Medicare Part C plan, also called a Medicare Advantage plan.
Medicare contracts private insurance companies to provide Medicare Advantage plans. These offer the same basic coverage as original Medicare, together with additional benefits. Many plans also offer prescription drug coverage.
People must still pay the standard Medicare monthly premiums plus the Medicare Advantage plan premium to the insurance company.
The plan provider may apply different rules and restrictions, affecting how someone gets healthcare or their amount of out-of-pocket costs. With some plans, members must use in-network healthcare providers.
Learn more about the pros and cons of Medicare Advantage here.
Some of the most common Medicare Advantage Plans include:
- Health Maintenance Organization (HMO) plans
- Preferred Provider Organization plans
- Private Fee-for-Service plans
- Special Needs Plans
Other, less common Medicare Advantage plan types include HMO Point-of-Service and Medicare savings account plans.
A person who enrolls in a Medicare Advantage plan must continue to pay the original Medicare Part B premium in addition to any incurred through the Medicare Advantage plan. For 2021, the original Medicare Part B premium is $148.50.
Premera are a nonprofit healthcare company who began life in 1945 as Washington Hospital Service. In 1969, their name changed to Blue Cross of Washington and Alaska. In 1998, it changed to Premera Blue Cross.
They provide health insurance services to around 2 million people under the Blue Cross license in Washington state, except Clark County. They provide health insurance services to people under the Blue Cross and Blue Shield licenses in Alaska.
Premera Blue Cross are a member of the Blue Cross Blue Shield Association, a federation of 38 health insurance companies across the United States.
Premera offer 10 HMO plans. These are as follows:
- Premera Blue Cross Medicare Advantage Core
- Premera Blue Cross Medicare Advantage Core Plus
- Premera Blue Cross Medicare Advantage
- Premera Blue Cross Medicare Advantage Classic
- Premera Blue Cross Medicare Advantage Total Health
- Premera Blue Cross Medicare Advantage Peak + Rx
- Premera Blue Cross Medicare Advantage Sound + Rx
- Premera Blue Cross Medicare Advantage Alpine
- Premera Blue Cross Medicare Advantage Charter + Rx
- Premera Blue Cross Medicare Advantage Classic Plus
Because all Medicare Advantage plans must offer coverage equivalent to that of original Medicare (parts A and B), all Premera plans include coverage for inpatient hospital, clinic, and skilled nursing facility stays, as well as outpatient services such as doctor’s visits, ambulance services, mental health services, preventive services, and durable medical equipment.
Additional benefits
Premera Medicare Advantage plans also include additional benefits, such as:
- Silver & Fit fitness programs
- gym memberships
- round-the-clock nurse line access
Depending on the plan, a person may choose prescription drug coverage with a mail-order pharmacy or routine dental coverage.
Premera’s Medicare Advantage plans are available in several counties in Washington state, including:
- Cowlitz
- Island
- King
- Kitsap
- Lewis
- Pierce
- San Juan
- Skagit
- Snohomish
- Spokane
- Stevens
- Thurston
- Walla Walla
- Whatcom
However, not all plans may be available in every county.
Location can also affect plan costs, including premiums, deductibles, copays, and coinsurances.
The following table shows some costs in 2021 for Premera Blue Cross Medicare Advantage HMO plans:
| Plan | Monthly premium | Specialist copay | Optional benefits | Maximum annual out-of-pocket limit |
|---|---|---|---|---|
| Core | $12 | $45 office $40 telehealth | dental $22.50 monthly | $6,300 |
| Core Plus | $75 | $30 office $25 telehealth | N/A | $5,000 |
| Advantage | $0 | $45 office $40 telehealth | dental $22.50 monthly | $6,300 |
| Classic | $55 | $30 office $25 telehealth | N/A | $5,000 |
| Total Health | $24 | $30 office $25 telehealth | N/A | $5,000 |
| Peak + Rx | $0 | $50 office $45 telehealth | dental $22.50 monthly | $6,700 |
| Sound + Rx | $40 | $50 office $45 telehealth | N/A | $6,500 |
| Alpine | $42 | $50 office $45 telehealth | N/A | $6,500 |
| Charter | $151 | $35 office $30 telehealth | N/A | $4,900 |
| Classic Plus | $191 | $40 office $35 telehealth | N/A | $5,000 |
There are several federal and state programs that may help with various healthcare costs.
These include the following:
- Medicaid: This is a joint federal and state program that may provide assistance for people with limited resources and income.
- Extra Help: This federal program may help with the costs of Medicare prescription drugs. It is designed for people with a limited income.
- Medicare savings programs: These federally funded and state-administered programs may help with the costs of premiums, deductibles, coinsurance, and copays.
- Program of All-Inclusive Care for the Elderly: This is a comprehensive joint Medicare and Medicaid program that may help people with their healthcare needs in their community. It can replace original Medicare (parts A and B) and Medicare Advantage plans.
The State Health Insurance Assistance Program (SHIP) is a free and impartial service that helps people with their Medicare questions. The SHIP is staffed by trained volunteers who can help people with their health insurance questions.
People can find their local SHIP office here or by calling 877-839-2675.
Premera Blue Cross provide Medicare Advantage plans to people living in Washington state. These all-in-one plans cover at least the same healthcare services as original Medicare, plus some added benefits.
Costs vary depending on the level of cover the plan provides and the person’s location.