• Benefits & Coverage

  • You can enroll over the phone by contacting Premera Medicare Advantage Plans at 888-868-77678 a.m. to 8 p.m., seven days a week, Pacific Time. TTY/TDD users should call 711.

    Enrollment Form eDocument - Fill out the form online, print it and fax it to 855-332-4053.

    You may also mail it to the following address:
    Premera Blue Cross Medicare Advantage
    PO Box 4198
    Portland OR 97208-4198

    You will receive a notice in the mail acknowledging receipt of your enrollment request. Individuals must have both Part A and Part B to enroll. Medicare beneficiaries may also enroll in Premera Blue Cross Medicare Advantage Plans through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov.

    Summary of Benefits 

    Multi-Language Insert - We have free interpreter services to answer any questions you may have about our health or drug plan. To get an interpreter, just call us at 888-850-8526.

    Star Ratings Information - Each year CMS evaluates Medicare Advantage plans on various criteria, and assigns star ratings based on plan performance. Note: Premera Blue Cross is too new to be rated.

    Extra Help

    You may qualify for Extra Help.

    The government subsidizes prescription drug costs for members with limited incomes. People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If eligible, Medicare could pay for up to one-hundred (100) percent of drug costs including monthly prescription drug premiums, annual deductibles, and co-insurance. Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty. Many people are eligible for these savings and don’t know it. For more information about this Extra Help see the LIS Premium Summary Table, contact your local Social Security office, or call 800-MEDICARE (800-633-4227), 24 hours per day, 7 days per week. TTY users should call 877-486-2048.

    For more detailed information about our plans:

    Premera Blue Cross Medicare Advantage (HMO)

    Premera Blue Cross Medicare Advantage Plus (HMO)

    Premera Blue Cross Medicare Advantage (HMO-POS)

    Premera Blue Cross Medicare Advantage Plus (HMO-POS)

    We know that before you trust your health care coverage to Premera Blue Cross you want to know that we'll be here for you when you need us. These questions and answers explain Premera Blue Cross Medicare Advantage Plans and should help give you peace of mind.

    When does Medicare coverage start?
    What are Medicare Parts A and B?
    How do I enroll in Medicare Parts A and B?
    Who is eligible?
    How do I find the right plan?
    When do I apply?
    Do I get to pick my own doctor?
    If I have insurance through my employer or my spouse’s employer, do I need to enroll in Medicare Part B?
    What is Medicare Part D?
    What is the Income-Related Monthly Adjusted Amount (Part D- IRMAA)?
    If I have prescription drug insurance through my employer or my spouse’s employer, do I need to enroll in Medicare Part D?
    What is the difference between a Medigap or supplement plan and a Medicare Advantage plan?
    What happens after I join?
    Are there prior authorization requirements? 
    Help is here  

    When does Medicare coverage start?

    Medicare coverage starts on your Medicare effective date. Your effective date is the first of the month in which you turn 65, unless your birthday is on the first of the month. If your 65th birthday is on the first of the month, Medicare will start on the first of the month that precedes your 65th birthday. For example: If you turn 65 on August 15, your Medicare effective date will be August 1. If you turn 65 on August 1, your Medicare effective date will be July 1.

    What are Medicare Parts A and B?

    Medicare Part A provides coverage for inpatient services, such as a hospitalization or a stay in a skilled nursing facility. Medicare Part B provides coverage for outpatient services, such as a visit to the doctor, lab work or emergency room care.

    How do I enroll in Medicare Parts A and B?

    If you collect Social Security at or before age 65, the Social Security Department will automatically enroll you in Medicare Parts A and B. You should receive your Medicare card from the Social Security Administration about three months before your 65th birthday. If you are celebrating your 65th birthday and are not collecting Social Security, or if you are losing group coverage, then you need to contact the Social Security office, www.ssa.gov or 800-772-1213, to enroll in Medicare Parts A and B.

    Who is eligible?

    You can enroll in a Premera Blue Cross Medicare Advantage plan if:

    • You are entitled to Medicare Part A (hospital coverage) and enrolled in Medicare Part B (medical coverage)
    • You live in a county where Premera Blue Cross Medicare Advantage Plans are offered. See the service area map
    • You do not have end-stage renal (kidney) disease (Some exceptions may apply)

    If you obtain routine care from out-of-plan providers neither Medicare nor Premera Blue Cross Medicare Advantage Plans will be responsible for the costs except in emergency or urgent care situations or for out-of-area renal dialysis. Some exceptions apply to members of Premera Blue Cross Medicare Advantage (HMO-POS) who choose to use their point of service benefit. Please contact plan for details or refer to the Summary of Benefits for your plan.

    Members may enroll in a plan only during specific times of the year. Contact customer service for more information.

    Premera Blue Cross’s contract with CMS is renewed annually and that the availability of coverage beyond the end of the current contract year is not guaranteed.

    How do I find the right plan?

    Learn more about Premera Blue Cross Medicare Advantage Plans by:

    • Asking your physicians which Medicare Advantage plans they accept. This is a good way to start because it narrows down the list of possibilities for you to research. If your physician doesn’t accept Medicare, we can help you find one who does
    • If you take prescription drugs, reviewing Medicare plan drug lists to see if your prescriptions are covered
    • Going to the Web sites of the health insurance companies on your list, and review information about premiums and coverage
    • Asking questions. You’ll want answers that help you to do the following: understand how you’ll use the plan; decide what is important to you; and evaluate premium and coverage options
    • Going to a community meeting, calling and talking to a sales representative, or make an appointment to see a sales representative in person. Have a conversation, and keep asking questions until you have all the answers you need

    When do I apply?

    Call the health plan or go to its website to complete and submit an application during one of the following time frames:

    • 65th birthday – You can submit an application up to three months before your Medicare effective date, during the month of your effective date or up to three months after your effective date
    • Annual enrollment – You can enroll in and/or change plans from October 15 to December 7, for an effective date of January 1
    • Loss of group coverage – If you are losing your group coverage, we suggest that you submit an application at least one month before losing your coverage, or contact your new plan of choice
    • Disability - If you get Medicare due to a disability, you can join three months before and three months after your 25th month of disability

    There are other situations that allow you to enroll outside these time frames. Contact the health plan for more information.

    Do I get to pick my own doctor?

    Absolutely. To help you get the health care you need, we ask that you build a relationship with one doctor who you feel comfortable with, a doctor you trust, a doctor who can get to know you and your health history. We call this doctor your "primary care provider." With a Premera Blue Cross Medicare Advantage plan you must select a primary care provider in our network. Please view our Provider and Pharmacy Directory, or call 888-868-7767. TTY 711.

    If I have insurance through my employer or my spouse’s employer, do I need to enroll in Medicare Part B?

    It depends. If you are covered on a retirement group plan, you probably need to enroll in Medicare Parts A and B. However, if you or your spouse is actively employed or are covered under group coverage, consider the size of the employer in determining whether or not to waive your Medicare Part B. If the employer is small (fewer than 20 employees), it’s in your best interest to enroll in Medicare Part B. Your employer assumes that you have enrolled; and if you don’t have Part B, you will pay for the services that Part B would have covered. For example, if you see a physician and are charged $100, and your employer group’s plan covers $20, you will owe $80 if you haven’t signed up for Part B. If the employer is large (20 or more employees), ask questions to understand whether and how your employer’s plan covers Part B services, and whether the plan is considered creditable coverage. “Creditable” means that the plan pays as much as or more than Part B would pay. If you don’t have creditable coverage and you sign up for Part B after your initial election period, you will owe a penalty.

    What is Medicare Part D?

    Medicare Part D is prescription drug insurance available to you when you turn 65. It is a voluntary program, which means you aren’t required to enroll and you have the option to enroll in the future. However, it is important to note that if you are eligible for Medicare and are not enrolled in a Part D plan, or a plan that is considered creditable coverage, you could be subject to a penalty.

    What is the Income-Related Monthly Adjusted Amount (Part D- IRMAA)?

    If you have a higher income, you will pay a higher premium for your Medicare prescription drug coverage (Part D). The extra premium amount is called the Income-Related Monthly Adjustment Amount (Part D- IRMAA). You must pay both the extra amount, as well as your plan's premium each month in order to keep Medicare prescription drug coverage. Social Security will send you a letter if you have to pay an extra amount for your Medicare prescription drug coverage. Social Security's letter explains how they determined the amount you must pay and the actual amount. If you disagree with the amount you must contact the Social Security Administration. You can visit them at www.socialsecurity.gov/mediinfo.htm, call 1-800-772-1213, or visit your local Social Security Office. TTY users should call 800-325-0778.

    If I have prescription drug insurance through my employer or my spouse’s employer, do I need to enroll in Medicare Part D?

    It depends. If the employer prescription drug plan is considered creditable coverage, you don’t need to enroll in a Part D prescription drug plan. If the employer prescription drug plan is not considered creditable coverage, you will be subject to the monthly penalty if you do not enroll in a Part D prescription drug plan. You and/or your Medicare-eligible spouse should receive a letter from the employer about whether the employer’s prescription drug plan meets the Medicare definition of creditable coverage.

    What is the difference between a Medigap or supplement plan and a Medicare Advantage plan?

    A Medigap or supplement plan helps fill the gap between Medicare coverage and the total cost you are charged for a service. You pay a separate premium for this type of plan. Medicare is the primary payer, while the supplement plan is the secondary payer. A Medicare Advantage plan adds benefits not covered by Medicare and charges a premium for the additional coverage. Medicare Advantage pays primary and virtually handles all of the paperwork for you.

    What happens after I join?

    We will send you a packet containing your Evidence of Coverage and other materials that explain how to use your coverage. Please read these materials when you get them. We'll also send you a member identification card.

    Note: This information is only an overview of benefits from Premera Blue Cross Medicare Advantage Plans. A complete explanation of benefits, limitations and exclusions can be found in the Evidence of Coverage and Summary of Benefits.

    Are there prior authorization requirements?

    Some in-network medical services are covered only if your doctor or other network provider gets “prior authorization” from our plan. You may need to fill out a prior authorization form before receiving services.

    Please contact Customer Service for more information.

    If you have other questions, please contact the Premera Blue Cross Medicare Advantage Plans sales team locally at
    888-868-7767.We are open seven days a week, between 8 a.m. and 8 p.m. (Pacific Time).

    Help is here

    If you need enrollment help or want more information about a Premera Blue Cross Medicare Advantage Plan, please call the phone numbers listed on this page.

  • Contact Us

    Sales

    888-868-7767
    8 am to 8 pm Pacific Time
    7 Days a week

    TTY/TDD 711

    More contact info 

    Customer Service

    888-850-8526
    8 am to 8 pm Pacific Time
    7 Days a week

    TTY/TDD 711