Premera Blue Cross Medicare Insurance Review & Complaints: Health Insurance (2024)

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Washington state-based healthcare nonprofit Premera Blue Cross offers a variety of plan options, including individual and group health insurance, as well as Medicare, to customers in the Pacific Northwest. The company operates as a licensee of Blue Cross Blue Shield in Washington and Alaska.

This Premera Blue Cross Medicare review will cover both their Premera Medicare Advantage and Supplement plan options. We’ll look at rates, coverage, and more to help you make an informed decision about which plan type is best for you. (For more information, read our “Premera Blue Cross Insurance Review & Complaints: Health Insurance“).

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What is 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 health insurance company and began operating under the name Blue Cross of Washington and Alaska. Blue Cross companies sometimes use this shortened form of the proper name Blue Cross Blue Shield; however, they are all still associated with Blue Cross Blue Shield.

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 for-profit and operates today as a nonprofit health care provider. Their insurance product options 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. (For more information, read our “Blue Cross Blue Shield Medicare Insurance Review & Complaints: Health Insurance“).

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 certain counties.

What Medicare health plans are offered?

Is Premera Blue Cross Medicare? Premera’s Medicare offerings include the Premera Medicare Advantage plans as well as Supplement, but the company does not offer Part D coverage as a standalone plan. Medicare Part D, the prescription drug plan, is included with most of the Premera Medicare Advantage plans rather than purchased individually.

Medicare Advantage plans are offered in Cowlitz, Island, King, Kitsap, Pierce, Lewis, San Juan, Skagit, Snohomish, Spokane, Stevens, Thurston, Walla Walla, and Whatcom counties. Plan availability varies by county; for the purpose of this review, we selected King county as a sample.

There are seven 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; you may be required to use an in-network pharmacy to get this health plan benefit. Routine vision exams are included, but dental is only offered as a rider.

There is also a second version of this plan called Medicare Advantage Peak. It has slightly higher co-pays but includes vision hardware as well as exams.

Premera Blue Cross Medicare Advantage Classic

This plan is the next step up in terms of premiums, and it has copays of $5 for primary care physician visits and $30 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 provider 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 vision and dental coverage, as well as a fitness membership.

Premera Blue Cross Sound and Alpine

These are similar plans, with $10 co-pays for primary care and $50 co-pays for specialists. The Sound plan includes prescription drug coverage, while Alpine does not.

Charter Rx

This plan has copays of $10 for primary care and $35 for specialist visits. It includes dental, health, and prescription drug coverage.

Premera Blue Cross Medicare Supplement

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

Medicare Supplement Plan A

This is the most basic coverage option, offered by any health care provider that chooses to write Medicare Supplement, making it the most commonly purchased nationwide plan. It covers coinsurance amounts for Parts A & B as well as paying for the first three pints of blood each year.

Medicare Supplement Plan G

This option is offered at both the standard level as well as with the high medical deductible option. This plan covers all out of pocket costs associated with your medical care that are not paid for under Medicare, which makes it the most comprehensive, largest health 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 predetermined out-of-pocket cost.

Medicare Supplement Plan N

This plan choice is also available. This one has in-between coverage choices for those looking to balance their additional coverage and plan cost.

Does the company offer competitive rates?

Quotes are readily available online. As previously mentioned, Premera does have two Medicare Advantage plans that have no additional premium beyond the base Medicare cost – the base plan and the Peak plan. For our sample area, rates ranged from $40 a month for the Sound plan to $191 for Classic Plus.

These rates are quite reasonable, but we did note that the rates have gone up since our last review. There are many options here and one to fit every need and every budget. Finances are usually the biggest concern when people are making decisions about insurance.

Medicare Supplement rates are on the high side. Plan A was quoted at $189 a month and Plan N, although it covers more, came in lower at $187 a month. The least expensive plan offered is the high medical deductible Plan G, at $52 a month. With no annual medical deductible, that plan was quoted at more than double, $194 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.

How are claims handled?

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. The company does not seem to have these for download, however.

Are the ratings and consumer reviews positive?

Is Premera Blue Cross good? The Better Business Bureau (BBB) rates the company 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 of the insurance company 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 insurance 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.

Premera Blue Cross Medicare Insurance Claims Process

Ease of Filing a Claim (Online, Over the Phone, Mobile Apps)

Premera Blue Cross Medicare offers a streamlined process for filing claims. Customers can submit claims through various convenient methods, including online, over the phone, and through mobile apps. This flexibility allows policyholders to choose the method that suits them best, making it easy to initiate a claim whenever necessary.

Average Claim Processing Time

While specific claim processing times may vary depending on the nature of the claim and the documentation provided, Premera Blue Cross Medicare aims to process claims efficiently to ensure timely resolutions. Policyholders can expect their claims to be processed in a reasonable timeframe, although the exact duration may differ for each claim.

Customer Feedback on Claim Resolutions and Payouts

Premera Blue Cross Medicare has received positive feedback from customers regarding their claim resolutions and payouts. Many policyholders have expressed satisfaction with the company’s prompt and fair handling of claims. This positive customer feedback reflects Premera Blue Cross Medicare’s commitment to providing reliable and efficient claim services.

Premera Blue Cross Medicare Insurance Digital and Technological Features

Mobile App Features and Functionality

Premera Blue Cross Medicare offers a user-friendly mobile app that provides policyholders with easy access to their insurance information. The app includes features such as digital ID cards, claims tracking, and the ability to find nearby healthcare providers. This mobile app enhances the overall customer experience by offering convenient access to important insurance resources.

Online Account Management Capabilities

Policyholders can manage their insurance accounts conveniently through Premera Blue Cross Medicare’s online portal. This online platform allows customers to view policy details, track claims, make premium payments, and update personal information. The user-friendly interface makes it simple for individuals to take control of their insurance accounts and access important information.

Digital Tools and Resources

Premera Blue Cross Medicare provides a range of digital tools and resources to support its policyholders. These include educational materials, wellness resources, and cost-estimation tools that help individuals make informed healthcare decisions.

By offering these digital resources, Premera Blue Cross Medicare empowers its customers to take charge of their health and make informed choices regarding their insurance coverage.

What’s the bottom line?

Premera has a decent selection of health 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, an unfortunately common problem in the business of insurance. Premera is worth keeping on your list when comparison shopping for Medicare plans.

You can easily buy Premera Blue Cross Medicare insurance plans online, which makes them a convenient choice, but you should always compare coverage options and rates from other companies first.

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