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Premera Blue Cross Medicare Review

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UPDATED: Nov 30, 2018

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Washington state-based healthcare nonprofit Premera offers individual, group, and Medicare plans to customers in the Pacific Northwest. The company operates as a licensee of Blue Cross Blue Shield in Washington and Alaska.

About Premera Blue Cross

The company that would eventually become Premera was founded in Washington as Washington Hospital Service. In 1959, service was expanded to add Alaska; ten years later the company was licensed as a Blue Cross Blue Shield company and began operating under the name Blue Cross of Washington and Alaska.

In 1998 the company merged with Medical Services Corporation, and the name was changed to Premera Blue Cross which is used today in both states. Premera also has a subsidiary, LifeWise, which provides health care plans to members in Oregon.

Premera Blue Cross abandoned plans to convert to a for-profit and operates today as a nonprofit health care provider. Their plans include major medical for individuals, families, and groups, dental plans, and both Medicare Advantage and Medicare Supplement options. The headquarters is located in Mountlake Terrace, WA.

Plan availability varies from state to state as well as from county to county. Currently, Medicare Advantage plans are only offered in Washington and only in a handful of counties.

Medicare Plans

Premera’s Medicare offerings include Advantage plans as well as Supplement, but the company does not offer Part D coverage as a standalone plan. Part D is included with the Premera Medicare Advantage plans rather that purchased individually.

Medicare Advantage

Medicare Advantage plans are offered in King, Pierce, Snohomish, Thurston, and Spokane counties. Plan availability varies by county; for the purpose of this review, we selected King county as a sample.

There are three Advantage plans listed, all of which are HMO plans.

Premera Blue Cross Medicare Advantage. This base plan is a zero-premium plan, which means you do not pay anything beyond your Medicare Part A & B premiums. The plan has a $15 copay for primary care office visits, a $45 copay for specialist visits, and a $50 copay for urgent care. The copay for hospitalization is $450 per day for the first four days, after which there is no further copay.

This plan includes prescription coverage with a $340 deductible that is applied to tiers three and up. Copays start at $5 for generics from preferred pharmacies. There is no dental or vision coverage on this plan.

Premera Blue Cross Medicare Advantage Classic. This plan is the next step up in terms of premiums, and it has copays of $15 for primary care office visits and $50 for specialists and urgent care. The hospital copay is the same as the base plan.

Prescription coverage under this plan has a $275 deductible for tiers three and up and copays that start at $4 for tier one. This plan includes dental and vision coverage and also includes a fitness membership.

Premera Blue Cross Medicare Advantage Classic Plus. The most expensive plan on the list, the Classic Plus has a $10 primary care office visit copay and a $40 specialist copay. The urgent care copay is $40, and the hospital copay is $350 for the first four days.

This plan has the lowest prescription deductible at $200, which again only applies to tiers three and up. Copays are similar to the Classic plan, starting at $4 for tier one. Like the Classic, this plan also includes dental, vision, and a fitness membership.

Medicare Supplement

Premera offers Medicare Supplement plans using the standardized letter-coded system. For our sample county, they offer a total of five plans out of the 11 possible lettered options.

Plan A is the base plan, offered by all companies that choose to write Medicare Supplement. It covers coinsurance amounts for Parts A & B as well as paying for the first three pints of blood each year.

Plan F is offered at both the standard level as well as with the high deductible option. This plan covers all out of pocket costs that are not paid for under Medicare, which makes it the most comprehensive plan available. The high deductible version, with an annual deductible of $2,240, is an option for making this plan more affordable while providing a pre-determined out-of-pocket cost.

Also offered are plans G and N, which offer in-between coverage choices for those looking to balance coverage and cost.

Rates

As previously mentioned, Premera does have one Medicare Advantage plan that has no additional premium beyond the base Medicare cost. For our sample area, the Classic plan was quoted at $75 a month and the Classic Plus at $166.

These rates are quite reasonable, but we did note that the Plus plan has gone up since our last review by nearly $30 a month. For the difference between the Classic and Classic Plus, the increased cost appears to be a little much.

Medicare Supplement rates from Premera are on the high side. Plan A was quoted at $177 a month and Plan N, although it covers more, came in lower at $175 a month. The least expensive plan offered is the high deductible Plan F, at $94 a month. With no deductible, that plan was quoted at more than double, $221 a month.

All of these rates have increased since our last review, which is not unusual. We are unable to compare them to companies outside of this specific area, but the overall impression is of generally higher rates than we have seen elsewhere, particularly for lower-end plans.

Claims

Like all healthcare companies, Premera handles most claims directly with the providers, and it should be rare for a customer to need to be involved in filing and handling of claims.

We did take a look through the forms offered online for members, however, we were unable to locate any claims forms. These are frequently available online for situations where reimbursement might be necessary such as foreign travel coverage or some out of network situations. Premera does not seem to have these for download, however.

Ratings and Consumer Reviews

The Better Business Bureau (BBB) rates Premera Blue Cross an A+, with 23 complaints on file in the past three years and three closed in the past 12 months. That complaint volume has gone down since the time of our last look at Premera’s Medicare plans. As always, it is worth noting that this complaint volume applies to all Premera plans and customers, not just Medicare.

There are 58 reviews on Yelp, with an overall 1.5-star rating – again this reflects all of the company’s business and not only Medicare. Many of the complaints relate to long hold times for customer service and difficulty with getting medications and services covered. We did find one review that relates directly to Medicare Advantage – it was a similar complaint about coverage as well as difficulty with network care. There are also a handful of positive reviews here.

Overall, the complaint volume for this company is low, and the complaints seem to focus mainly on difficulty reaching the customer service department. We found no major red flags for this company.

The Bottom Line

Premera has a decent selection of plans, although we found them to be somewhat on the expensive side compared to what we have seen from other companies, particularly for Medicare Supplement – bearing in mind they should only be directly compared to plans in the same area. There does not seem to be any major concerns here besides the fairly common issue of understaffed and overworked customer service lines. Premera is worth keeping on your list when comparison shopping for Medicare plans.

For a list of companies that we recommend, visit our Best Insurance Companies page.

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About Eric Stauffer

Author: Eric StaufferI am a former insurance agent and banker turned consumer advocate. My priority is to help educate individuals and families about the different types of insurance they need, and assist them in finding the best place to get it.

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