Benefits & Coverage

  • If you live in King, Pierce, Snohomish, Spokane, or Thurston county, you can enroll over the phone by contacting Premera Blue Cross Medicare Advantage Plans at 888-868-7767 (TTY: 711), 8 a.m. to 8 p.m., 7 days a week.

    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 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. Star ratings are calculated each year and may change from one year to the next. In 2017, Premera's Medicare Advantage plans earned a 3.5 out of 5 star quality rating.

    Changing your plan is easy (for existing Medicare Advantage members only)

    If you are an existing Premera Medicare Advantage member, changing to a different Premera Medicare Advantage plan is as easy as 1-2-3.

    Here's what existing members need to do to change their plan:

    1. Print the Plan Change Form.
    2. Fill it out.
    3. Mail it to Premera Blue Cross Medicare Advantage Plans at:
    4. Premera Blue Cross Medicare Advantage Plans
      PO Box 4198
      Portland, OR 97228-4198
      or fax it to 1-855-332-4053

    You will receive a notice in the mail acknowledging receipt of the completed plan change or a request for additional information if the form is not complete.

    If you would like assistance changing your plan over the phone, please call 855-339-4205 (TTY: 711).

    Adding optional dental coverage is easy (existing Medicare Advantage members only)

    You may add the optional dental plan within 60 days of enrolling in your Premera Blue Cross Medicare Advantage (HMO) plan. The optional dental plan is $26 a month. Coverage is effective the first of the month following the date we receive your completed enrollment form.

    Here's what existing members need to do to enroll in the optional dental plan:

    1. Print the Optional Dental Plan Enrollment Form
    2. Fill it out.
    3. Mail it to Premera Blue Cross Medicare Advantage Plans at:
    4. Premera Blue Cross Medicare Advantage Plans
      PO Box 4198
      Portland, OR 97228-4198
      or fax it to 1-855-332-4053

    You will receive a notice in the mail acknowledging the receipt of the completed enrollment into the optional dental plan.

    If you would like assistance enrolling in the optional dental plan over the phone, please call 855-339-5205 (TTY: 711).

    Members may enroll in a plan only during specific times of the year

    From October 15 through December 7 of each year, beneficiaries have the option to change plans, or add or drop Part D Coverage. Contact Customer Service for details.

    Premera Blue Cross Medicare Advantage Plans contract with CMS is renewed annually and the availability of coverage beyond the end of the current contract year is not guaranteed.

    For more detailed information about our plans:

    Premera Blue Cross Medicare Advantage (HMO)

    Premera Blue Cross Medicare Advantage Classic (HMO)

    Premera Blue Cross Medicare Advantage Classic Plus (HMO)

    Download a printable version of the provider directory or dental directory.

    Premera Blue Cross Medicare Advantage (HMO), Premera Blue Cross Medicare Advantage Classic (HMO) and Premera Blue Cross Medicare Advantage Classic Plus (HMO) has a network of doctors, hospitals, pharmacies, and other providers. If you use the providers that are not in our network, the plan may not pay for these services.

    Emergency and Disaster Preparedness

    Emergency and Disaster Declarations

    If you live in an area that's been declared an emergency or disaster, the usual rules for your medical care may change for a short time. If you find yourself in this situation, contact us at 888-850-8526 (TTY: 711) for more information.

    Seeing your doctors or other providers in a disaster or emergency

    • You may be able to see certain doctors or go to certain hospitals that accept Medicare patients, even if the doctor or hospital isn't in the Premera Blue Cross Medicare Advantage provider network and your health care need isn't an emergency.
    • You may not have to meet Premera Blue Cross Medicare Advantage prior authorization rules for out-of-network services.
    • If you usually pay more for out-of-network or out-of-area care, Premera Blue Cross Medicare Advantage may apply the in-network rate during the emergency or disaster period.

    Filling prescriptions in a disaster or emergency

    If you're not able to go to your usual network pharmacy to replace your prescription drugs or if you had to leave your home without your drugs, or your drugs have been damaged or lost because of the emergency or disaster, then contact us at 888-850-8526 (TTY: 711) for help.

    If you can't reasonably get to a network pharmacy, you may be able to use an out-of-network pharmacy to fill your prescriptions. For more information on out-of-network pharmacies please see “About out-of-network pharmacies.” You may pay more for drugs you get at an out-of-network pharmacy.

    Where can I find more information on emergency or disaster declarations?

    • If the President has declared it an emergency or disaster, please visit the Federal Emergency Management Agency (FEMA) webpage, or call 1-800-621-FEMA (800-621-3362) to see if your area is affected. TTY users should call 800-462-7585.
    • If a Governor has declared it an emergency or disaster, please visit your state government's official website to find out if your area is affected.
    • If the Secretary of the Department of Health and Human Services (HHS) has declared a public health emergency, please visit the HHS Public Health Emergency website, or call 1-800-MEDICARE to find out if your area is affected.
  • Fraud and Abuse

    Healthcare fraud

  • Healthcare fraud occurs when a false claim is deliberately submitted to a health plan. It affects virtually everyone, taking critical dollars out of our already financially overwhelmed healthcare system.

    The National Healthcare Anti-Fraud Association estimates that as much as $50 billion is lost annually in the United States to healthcare fraud. The U.S. General Accounting Office reports that this figure might even be as high as $120 billion. It’s easy to see why losses of that magnitude affect costs for consumers, providers, and insurers.

    Those who commit healthcare fraud can face fines and/or jail terms. For example, making false or misleading statements on a health plan application carry a penalty of up to five years in prison.

    It's critical that we do all we can to prevent, detect, and investigate healthcare fraud and abuse by providers, producers, employer groups or members. Premera has a Special Investigations Unit to look into suspected instances of fraud. We also have a Fraud Hotline you can call anytime, 888-844-8985 to report fraud.
    • Sign only one claim form per visit
    • Guard your health insurance ID number as you would credit card information
    • Check your Explanation of Benefits (EOB) for inflated charges, incorrect billed services or dates of service, and any false statements
    • Call our Fraud Hotline, 24/7 at 888-844-8985 to report possible fraudulent activity
    • Learn more with The Rising Cost of Healthcare Fraud
  • Medicare National Coverage Determinations

    A National Coverage Determination (NCD) is a nationwide determination of whether Medicare will pay for an item or service.

    Medicare coverage is limited to clinically proven items and services that are reasonable and necessary for the diagnosis or treatment of an illness or injury (and within the scope of a Medicare benefit category). National Coverage Determinations are made through an evidence-based process, with opportunities for public participation. In some cases, the Centers for Medicare and Medicaid Services own research is supplemented by an outside technology assessment and/or consultation with the Medicare Evidence Development & Coverage Advisory Committee.

    In the absence of a national coverage policy, an item or service may be covered at the discretion of the Medicare contractors based on a Local Coverage Determination.

    Once an NCD is finalized and published, its coverage guidelines are binding nationwide. It is important to discuss the medical necessity of your medical care with your doctor. Items and services that are not determined by Medicare to be medically necessary will not be covered by Medicare or our plan.

    Updates to National Coverage Determinations

    When the Centers for Medicare and Medicaid Services updates the NCDs, the changes can be found here: