Premera Blue Cross Medicare Review

Premera Blue Cross Medicare
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Serving the Pacific Northwest both directly and through subsidiaries, Premera Blue Cross provides a range of health care plan options under the Blue Cross Blue Shield (BCBS) banner. The company has a long history in health care and provides coverage to about 2 million people across their coverage area, including Medicare customers.

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About Premera Blue Cross

Premera’s roots are planted back in Washington state, where it was founded as the Washington Hospital Service. The company expanded its health care services to Alaska in 1959, and in 1969 took on the Blue Cross Blue Shield license and changed the name to Blue Cross of Washington and Alaska. Blue Cross and Blue Shield companies license the name and provide health plans as part of a network of independent companies.

The 1998 merger with Medical Services Corporation (MSC) led to the use of the new name, Premera Blue Cross, while the Alaska plan eventually took on the name Premera Blue Shield of Alaska. Today the company also provides services in Oregon under one of its subsidiaries, LifeWise.

Although, at one point the company intended to convert to a for-profit health insurance provider, Premera currently remains a non-profit. They offer a range of individual health plans, dental plans, and offer both Medicare Advantage and Medicare Supplement plans. The company’s headquarters are located in Mountlake Terrace, WA.

Medicare Plans

Premera offers Medicare Advantage plans that include Part D Prescription Drug coverage, but doesn’t offer any stand alone Part D plans. They do also offer Medicare Supplement plans to fill in the gaps left by Original Medicare.

Medicare Advantage

There are three HMO plans available from Premera, each with an increasing premium and differing coverage. All of the plans include Part D coverage for prescriptions, and all are zero deductible plans. Plans are available in a limited coverage area, meaning coverage is not automatically available in all of the states and counties where their other health plans can be purchased. Specifically, plans are only offered in King, Pierce, Snohomish, Spokane, and Thurston counties within Washington state.

The basic HMO plan is the lowest level of coverage and has no additional premium on top of the regular Medicare premium, which is paid on the government plan. This plan has a $15 co pay for office visits, a $50 co pay for specialist visits, and a $65 Urgent Care co pay. This plan also includes a $75 co pay for emergency care that is waived if the patient is admitted. Inpatient hospital care is subject to a $450 co pay for the first four days, after which there is no charge. Outpatient care is a coinsurance of 15% for an ambulatory surgical center, and 20% for an outpatient hospital. The plan does not include vision coverage and has an option to add dental for an additional cost. Prescription drugs have a $320 deductible for Tiers 3-5 (there is no deductible applied to Tiers 1 and 2) and drug costs start at $5 for preferred generics.

The next level up is the Classic HMO. Much of the coverage is the same as the basic plan, but there are a few differences. This plan includes vision coverage, with a $50 co pay for exams and an allowance of $150 for eye wear. Dental coverage is included. The plan has a lower $275 drug deductible (with the same Tier rules), with slightly lower costs for drugs starting at $4.

The highest level available is the Classic Plus HMO. This plan has lower co pays than the first two, at $10 for office visits and $40 for specialist visits. Inpatient hospital care is covered with a $350 co pay for the first four days and no charge thereafter. Outpatient coinsurance comes with a $250 co pay. Vision is included with a $40 co pay for exams and the same eye wear allowance, and dental is also included. The prescription drug coverage has a $200 deductible with the same Tier rules, and starts at a $4 co pay.

Medicare Supplement

Premera has four Medicare Supplement plans available. They offer plans A, F, F with high deductible, and N.

Plan A is the most basic level of coverage that any health insurance provider can offer, and pays for hospital and medical coinsurance, hospice coinsurance, and the first three pints of blood annually.

After this basic plan, providers can select which other options they will offer. In this case, Premera offers F and N, which are both popular choices and are commonly offered by other insurance companies.

Additionally, they also have a high deductible option for Plan F. Choosing the high deductible option means a much lower monthly premium, but in return your paying some expenses out of pocket before coverage kicks in. The deductible for this plan is $2180, while the regular Plan F has no deductible. Both plans cover Medicare covered costs at 100%, but with the high deductible plan that coverage only applies after the deductible is met.

The Plan N option also has a deductible, but it is much lower at $166. It also has an office visit co pay of $20, and covers emergency medical outside of the U.S.

Medicare Rates at Premera

Premera does not offer coverage in the areas where we obtain our nationwide comparison rate samples, however, they do offer very clear pricing on their website in order to make shopping for a plan a bit easier.

Medicare Supplement plans are priced at $166 per month for Plan A, $207 per month for the no deductible Plan F, and $88 for the high deductible Plan F. Plan N is priced at $164 per month. Considering the increase in coverage provided by Plan F, it’s worth taking a look at this higher-priced plan, as it provides more value for your money.

The high deductible Plan F option is a good choice if you’d prefer to pay a smaller monthly bill, but can handle paying the deductible out of pocket if needed.

The Medicare Advantage plans are also clearly priced, with the basic HMO plan requiring no premium above and beyond what you already pay for Medicare Parts A & B. The Classic HMO has a $75 monthly premium, and the Classic Plus has a premium of $128 a month. While we can’t compare to the rates we have seen in other areas and our sample states, these do appear to be in line with or below what we have seen elsewhere for similar plans.

Ratings and Reviews of Premera

Premera Blue Cross holds an A- rating with the Better Business Bureau, although they are not accredited. There have been 36 complaints filed in the past three years, with 17 of those in the past 12 months. Overall, that is not a large number for a company serving around 2 million people.

There are some Yelp reviews for Premera as well, most of them negative. The 35 reviews on Yelp leave the company with a 1.5 approximate star rating. Many of the complaints are in regards to inordinately long hold times with customer service – one customer reports being on hold for 2 hours before giving up. Poor customer service response, difficulty finding providers, and denial of claims are also cited repeatedly in the complaints.

The number of complaints is low considering the size of this company, however, it does appear that Premera needs to increase the size of their customer service staff answering incoming calls, as the cited wait times are very long.

The Bottom Line

Premera has a good selection of Medicare Advantage and Supplement plans with reasonable premium options. Although the reviews leave some questions regarding how well staffed the customer service all center is, overall there aren’t enough complaints to raise red flags. Premera has been around a long time and is well established; they are certainly worth a look when comparison shopping for Medicare plans.

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

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