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Premera Blue Cross Review

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Eric Stauffer is a former insurance agent and banker turned consumer advocate. His priority is to help educate individuals and families about the different types of insurance they need, and assist them in finding the best...

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UPDATED: Nov 30, 2018

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Offering a range of insurance plans under the Blue Cross Blue Shield name, Premera Blue Cross has served the Pacific Northwest for 85 years. The Washington state-based insurer provides coverage in three states through affiliated companies.

About Premera

Premera traces its roots back to 1933, with the founding of the Spokane Medical Service Bureau and Medical Service Corporation. In 1945, Washington Hospital Service was founded; the company began serving Alaska in 1952, and in 1969 adopted the name Blue Cross Blue Shield of Washington and Alaska, taking on the BCBS banner. It was in 1998 that Medical Service Corporation merged with Blue Cross Blue Shield of Washington and Alaska, resulting in the formation of Premera Blue Cross.

Premera Blue Cross continues to serve most of Washington and Alaska, while subsidiary company Lifewise operates in Oregon and parts of Washington. In 2002, the company made a move towards becoming a for-profit corporation, which it abandoned five years later. Premera today still operates as a not-for-profit corporation.

Premera offers individual and family health plans, group plans, and Medicare plans. We have reviewed the Medicare branch of Premera separately here.

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Premera Health Plans

Premera has a long list of individual plans at several levels, although many of the plans listed apply only to those who meet specific requirements, including income-based cost-sharing plans and American Indian plans. There are three plan categories: EPO, High Deductible, and PersonalCare.

EPO Plans

Premera offers EPO plans at the Bronze, Silver, and Gold levels. There are three main plans, with various cost-sharing options for each plan.

The Gold EPO 1500 has a $1,500 individual deductible, doubled for a family. Primary care visits are covered at 100% for the first two visits, and then there is a $15 copay. Specialist visits and urgent care both have a $45 copay. Prescription drugs start with a $10 copay for preferred generics. Most services have a 30% coinsurance after the deductible is met. There are two American Indian cost-sharing options for this plan.

The Silver EPO 4500 has a $4,500 individual deductible and $9,000 for a family. This plan also offers the first two office visits with no charge, and then the copay is $30. Both specialist visits and urgent care have a $60 copay. Preferred generic drugs start at $30. This plan is available at 5 cost-sharing levels, including two American Indian plans.

The Bronze EPO 6350 has a $6,350 individual deductible, which is doubled for a family. There is a $50 copay for office visits, and specialist visits have a 40% coinsurance cost. Urgent care has a $60 copay. This plan is offered with two American Indian cost-sharing options as well.

High Deductible Plans

The Premera High Deductible plans utilize an HSA to help prepare for medical costs. This plan is only available at the Bronze level, with one standard plan and two American Indian cost-sharing choices.

The Bronze HSA EPO 5250 has a $5,250 individual deductible; with the family deductible double that amount. After the deductible is met, primary care and specialist visits are covered with a 30% coinsurance cost. That same coinsurance amount applies to most other services, including urgent care and prescription drugs.

PersonalCare Plans

PersonalCare plans are available in Gold, Silver, and Bronze levels, each with a variety of cost-sharing options.

The Gold plan has a $1,500 individual deductible, which is doubled for the family deductible. Like the EPO Gold, primary care visits are covered with a $15 copay, and the first two visits are covered 100%. Specialist visits have a $45 copay and urgent care a 30% coinsurance. Prescriptions start at $10 for preferred generics.

The Silver plan has a $4,500 individual deductible, and $9,000 family. Again, it mirrors the EPO plan for primary care visits, with the first two covered in full and subsequent visits carrying a $15 copay. Specialist visits have a $60 copay and urgent care a 30% coinsurance. Prescriptions start at $30 for Tier 1 preferred generics.

The Bronze plan has an individual deductible of $6,350, and a family deductible that is double that amount. Primary care visits have a $50 copay, and specialist visits a 40% coinsurance; this amount also applies to urgent care. Prescription drugs have a coinsurance charge starting at 40% for preferred generics.

Dental Plans

Premera has a range of dental plans available in specific counties. Both adult and pediatric plans are offered to cover preventative services as well as minor and major dental care.

Rates

We ran a search for a 30-year-old male non-smoker in the county where Premera’s headquarters is located. The plans returned were all the PersonalCare level, and the least expensive monthly rate was $374.49 for the Bronze level plan. The Gold plan was the most expensive at $551.73.

While we are unable to fairly compare these rates on a national level, they do rank on the higher side compared to what we have seen elsewhere for similar coverage. With high deductibles and high coinsurance costs, the Bronze plan at nearly $400 a month is expensive compared to other options, although again the location has to be taken into consideration.

Claims

Claims are handled completely internally, as with most health insurance companies. It’s rare that an insured is involved in the claims process unless there is an issue that needs to be resolved. This is common to most insurers.

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Ratings and Consumer Reviews

Premera Blue Cross has a B rating with the Better Business Bureau (BBB), and this ranking is due to one complaint to which the company did not respond and three that were not resolved. Overall, there have 29 complaints on file in the past three years, and ten of those were closed in the past year.

A total of 51 reviews on Yelp have resulted in an overall 1.5-star ranking. The majority of these reviews are negative, with a few positives sprinkled in. Many focus on poor customer service, long hold times, and difficulty with services being covered. While none of these complaints is unusual for a health insurance company, this is a fairly high complaint volume for any insurance company on Yelp.

The National Committee for Quality Assurance gives Premera an overall 3.0 ranking. Rankings are low across the board in Consumer Satisfaction and generally unimpressive in most other categories.

The Bottom Line

Given the limited plan selections, high monthly premiums, and overall questionable reputation, consumers may want to do their homework and be sure to compare Premera’s plans with others for their individual insurance needs. A general impression of Premera is that it is on the expensive side with reviews that aren’t as pleasant as many other health insurance providers.

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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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