Frequently Asked Questions
General
How do I read the Summary of Benefits?
- On the top row, find the column with the plan that you enrolled into.
- Read down this column for all of the benefit coverage and information for that plan.
- Then, look to your left at the far-left column for the name of the benefit. Read across only to that one column where your plan information is stated.
General
Contact and communications
How do I contact Premera Blue Cross?
- Find the customer service number located on the back of your ID card or call 888-850-8526. TTY members can call 711. Our office hours are 8 a.m. – 8 p.m., seven days a week from October 1 through March 31; or 8 a.m. – 8 p.m., Monday through Friday from April 1 to September 30.
Contact and communications
Why am I not getting any information in the mail on programs like Healthy Rewards?
- To get access to Healthy Rewards, you’ll need to register for the program by going to Healthy Rewards, or by downloading the Premera Healthy Rewards app from Google Play (Android) or the App Store (iOS).
- If you made a request to be placed on the Do Not Contact list, Premera will no longer send you information on this program. Call customer service at the number on your ID card, and tell them to change your contact status so you can get information on Healthy Rewards and other programs.
Contact and communications
How can I sign up to receive text messaging from Premera?
- Secure text messaging from Premera allows you to receive immediate notification about account changes, benefit updates, and health updates.
- This is a free service exclusively for our members, but we need your permission to send text messages. To opt in for texts from Premera, visit www.premera.com/visitor/digital-health-messages.
- To stop receiving texts from Premera, simply reply STOP to one of Premera’s text messages, and you will be unsubscribed from this method of communication.
Contact and communications
Why am I occasionally being asked to complete a survey?
- We are always eager to know your thoughts about your health plan and the care you receive. We listen to you, so your opinion can have an impact on the way we improve our services.
- You may be randomly selected to fill out a survey that’s triggered after being offered a healthcare service, or after reaching out to someone in customer service or another department.
Contact and communications
How can I reduce the mass of communication from Premera?
- Call 1-888-850-8526 (TTY:711) and request to be placed on the Do Not Contact list. This will halt non-essential messages from being sent to you. Please allow a few weeks for this change to occur.
- To stop receiving emails from Premera, click on the Unsubscribe link at the bottom of the email message.
Contact and communications
How do I make a complaint or grievance?
- Call the customer service phone number located on the back of your ID card: 888-850-8526 (TTY:711).
- If you don’t want to call Premera, file a complaint about your Medicare health or drug plan by calling 888-868-7767 (TTY: 711), or complete the Medicare Complaint form.
- You can also call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048. 1-800-MEDICARE is available 24 hours a day, 7 days a week, except some federal holidays. If applicable, please provide your agent or broker’s name.
Contact and communications
Visits
What is the Welcome to Medicare visit? What is the difference between this visit, the Annual Wellness Visit, and an annual physical?
- The Welcome to Medicare visit is available to new Medicare Part B enrollees and is offered one time only. These visits are designed to allow time for you and your primary care provider (PCP) to create your personal health prevention plan and set a schedule for important preventive services to help you stay healthy throughout the year. Be sure to state that you would like a “Welcome to Medicare” preventive visit when booking your appointment.
- If you have Original Medicare, you qualify for the Welcome to Medicare physical. You must schedule your appointment within the first 12 months of enrolling in Medicare Part B.
- Medicare Advantage members can use the Annual Wellness Visit benefit once a year. This visit is the time for you and your PCP to discuss your overall health and make a plan for the year. Eligible Members with Part B:
- Are not within 12 months after the effective date of their first Medicare Part B coverage period.
- Have not had an initial preventive physical exam (IPPE) or annual wellness visit (AWV) within the past 12 months.
- The annual physical is a benefit provided to all Premera MA members. This routine visit includes a physical examination.
Visits
Why should I use Kinwell for my healthcare appointments?
- There are many Kinwell clinics conveniently located throughout the state. There’s probably a Kinwell clinic right in your neighborhood.
- This is a whole-person approach to patient care integrating primary care and behavioral health.
- Kinwell’s longer appointment times establish a more engaged one-to-one patient-provider relationship, and better health outcomes.
- Easy access to in-person and virtual care exclusively for Premera members.
- Timelier appointment availability.
Visits
Over-the-counter and prescription benefits
My prescription drug is not on Premera’s drug list? Why?
- The formulary, or drug list, is a listing of prescription drugs covered by a prescription drug plan. For certain prescriptions, special rules restrict how and when the plan covers them. A team of doctors and pharmacists developed these rules to encourage you and your provider to use drugs in the most effective ways.
- To find out if any of these restrictions apply to a drug you take or want to take, check the drug list.
Over-the-counter and prescription benefits
How do I use my quarterly over-the-counter (OTC) allowance? Can I use this OTC benefit to pay for prescription drugs?
- The OTC benefit can only be used for health products you buy on the shelf, like bandages, non-prescription pain relievers, and cold medicines.
- Refer to the OTC Catalog online at Premera.com/ma under Member Resources, OTC Catalog, for a list of covered items.
- Browse through the covered OTC items and either place the order online at cvs.com/benefits, or go to a CVS store to purchase items with your OTC allowance.
- Members receive a $50 or $65 quarterly benefit for over-the-counter health and wellness products available through OTC Health Solutions. Credit amounts will vary depending on which plan you are on.
- You can also call 888-628-2770 to place an order.
Over-the-counter and prescription benefits
Referrals, claims, and authorizations
Do I need a referral for an appointment with a specific healthcare service, or to see a specialist?
- Effective January 1, 2024, no referrals are needed when you see a provider in the Premera Medicare Advantage network, although some specialists may still require a referral directly from your primary care provider.
- If you see an out-of-network provider, a referral is required and must be reviewed by Premera.
- You can check on the status of a referral by calling a the customer service phone number located on the back of your ID card: 888-850-8526 (TTY:711).
Referrals, claims, and authorizations
How can I find out why my claim was denied?
- Call the customer service phone number located on the back of your ID card: 888-850-8526 (TTY:711).
Referrals, claims, and authorizations
Primary Care Providers
How can I find a provider?
- Visit medicareadvantage.premera.com/find-care/.
- Call the customer service number on the back of your member ID card.
Primary Care Providers
Why did Premera assign me a primary care provider (PCP)? How can I change my PCP?
- If you did not select an in-network PCP when you enrolled, or contacted Premera prior to receiving your ID Card, a PCP is automatically assigned to you.
- To change your PCP, call the customer service phone number listed on the back of your ID card.
Primary Care Providers
Costs
How can I get help with the rising cost of healthcare and prescription drugs?
- There are programs to assist you with your healthcare expenses.
- The federal government offers Extra Help on prescription drugs as well as premiums. Visit medicare.gov for more information and search for “Extra Help.” Get help with costs | Medicare
- The Statewide Health Insurance Benefits Advisors offers free, unbiased Medicare counseling at insurance.wa.gov. (Get help paying for prescription drugs | Washington State Office of the Insurance Commissioner) You can also call 800-662-6900.
- The Social Security Administration, 800-772-1213. TTY users should call 800-325-0778 between 7 a.m. and 7 p.m., Monday through Friday.
- You can also call Premera’s customer service number located on the back of your ID card: 888-850-8526 (TTY:711).
Costs
I paid into Medicare for many years. Why do I have out-of-pocket costs?
- Many people pay into the Medicare system through an automatic deduction from employment paychecks. This pays for your Medicare Part A and Part B services, otherwise known as Original Medicare. Original Medicare only pays for 80% of your healthcare costs.
- The Medicare Advantage plan that you are enrolled in provides healthcare coverage for Medicare Part C which helps pay for expenses that are not covered by Original Medicare.
- Costs for Medicare Advantage may include a monthly premium. Covered benefits can include a copay or coinsurance cost. Refer to your Summary of Benefits or Evidence of Coverage for more information. You can find this at medicareadvantage.premera.com/benefits/. Your share of costs is also found in the Explanation of Benefits.
Costs
Dental benefits
Are dental benefits included in my plan?
- Yes, all Premera Medicare Advantage plans have dental benefits.
- Refer to your Summary of Benefits or Evidence of Coverage for more information. You can find this at medicareadvantage.premera.com/benefits/. Your share of costs is also found in the Explanation of Benefits.
Dental benefits
How can I access my dental benefits?
- Visit medicareadvantage.premera.com/find-care/.
- Or, call the customer service number on the back of your member ID card.
- Once you have selected an in-network dental provider, call to book your appointment and take your member ID card with you.
Dental benefits
Fitness benefits
Where can I learn more about my fitness benefit, and the credits used for fitness experiences?
- To learn more about your fitness benefit, visit medicareadvantage.premera.com/benefits/. Scroll down to locate your benefit information. Or you can simply type “FitOn” in the search field to call up this information.
Fitness benefits
What is the FitOn program?
-
FitOn is a fitness program that is included with Premera Blue Cross Medicare Advantage and Medicare Supplement plans. The fitness program includes gym memberships, fitness classes (studio) and at-home FitKits.
- Premera Blue Cross Medicare Advantage members can use this program as of January 1, 2024.
- Premera Blue Cross Medicare Supplement members can use this program as of April 1, 2024.
Fitness benefits
Health questions
What is osteoporosis?
- Osteoporosis is a disease that affects our bones. It makes our bones weak and more likely to break due to low bone density. Bone density refers to how tightly packed the minerals and proteins are in our bones. Osteoporosis is called a “silent disease” because you may not even know you have it until you have broken a bone. Learn more.
Health questions
Why is bladder control important?
- One of the most common bladder problems that people experience is urinary incontinence, which is the involuntary leakage of urine. If left unmanaged or untreated, bladder control issues may cause discomfort, embarrassment, and restrict your regular social and physical activities. Learn more
- There are different types of urinary incontinence:
- Stress incontinence is when urine leaks as pressure is put on the bladder, such as during exercise or sneezing
- Urge incontinence is when there is a sudden need to urinate
- Overflow incontinence is when small amounts of urine leaks from a bladder that is always full
- Functional incontinence is when urine leaks because you have trouble getting to the bathroom
Health questions
Why is fall prevention important?
- According to the Centers for Disease Control and Prevention (CDC), more than one out of four adults aged 65 and older fall each year. Fall prevention is important because falls can lead to injuries that disrupt activities of daily living. Learn more
Health questions
Why is mental health important?
- Mental health is a part of your overall health and impacts the way you manage life changes, maintain brain function, and connect with others. Emotional, psychological, and social well-being are all part of mental health. Learn more
- With age, older adults are more likely to experience events that can increase the risk of developing mental health conditions like depression or anxiety. These events may include:
- Bereavement
- Drop in income
- Retirement
- Health problems
- Loneliness and social isolation
Health questions
Why is physical activity important?
- Physical activities are activities where you move and increase your heart rate above its resting rate, whether you do them for pleasure, work, or transportation. As an older adult, regular physical activity is one of the most important steps you can take to improve your health. It can prevent common health problems and strengthen your muscles so you can maintain an independent lifestyle. Learn more
Health questions
