How do I find a Premera Blue Cross Medicare Advantage Doctor?
Search for doctors, hospitals, and other specialists within the Premera Blue Cross Medicare Advantage Provider Network. Visit the Premera Blue Cross Medicare Advantage member site to find out more about Pharmacy Services, and Pharmacy Resources including our Medication Therapy Management Program.
What happens if the secondary payer does not pay Medicare?
The secondary payer (which may be Medicare) may not pay all the uncovered costs. If your employer insurance is the secondary payer, you may need to enroll in Medicare Part B before your insurance will pay. If the insurance company doesn't pay the Claim promptly (usually within 120 days), your doctor or other provider may bill Medicare.
Will Premera pay for a tumor or cyst?
Premera will review the claim submitted to determine if the service is payable under the medical or dental plan. If the tumor or cyst is tooth or gum related it is often payable under the dental plan.
What is Premera Medicare Advantage?
Premera serves over 2 million people and is the largest health plan provider in the Pacific Northwest. Medicare Advantage, or Medicare Part C, is an optional plan that can replace your original Medicare coverage (parts A and B).
Is Blue Cross Blue Shield the same as Premera?
Premera Blue Cross is an independent licensee of the Blue Cross Blue Shield Association. Premera Blue Cross is a member of a family of companies based in Mountlake Terrace, Washington, that provide health, life, vision, dental, stop-loss, disability, and other related products and services.
Is premera a Medicare insurance?
Premera is a regional health insurance provider that administers Medicare Advantage Plans in 14 counties in Washington and Alaska. It's the largest health plan in the Pacific Northwest and provides insurance coverage for more than two million people.
Is Premera Blue Cross Medicare?
Premera Blue Cross is an HMO plan with a Medicare contract. Enrollment in Premera Blue Cross depends on contract renewal.
How does a shared deductible plan work?
INTRODUCTION TO YOUR SHARED DEDUCTIBLE PLAN This plan is self-funded by Amazon and Subsidiaries (“the Group”), which means that the Group is financially responsible for the payment of plan benefits. The Group has the final discretionary authority to determine eligibility for benefits and construe the terms of the plan.
What's the Medicare approved amount?
The approved amount, also known as the Medicare-approved amount, is the fee that Medicare sets as how much a provider or supplier should be paid for a particular service or item. Original Medicare also calls this assignment. See also: Take Assignment, Participating Provider, and Non-Participating Provider.
What is a PPO plan?
A type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers. You pay less if you use providers that belong to the plan's network.
Is Premera nationwide?
Premera is headquartered in Washington State and provides health benefits to 2.5 million people nationwide.
What states does Premera cover?
Premera Blue Cross is headquartered in Mountlake Terrace, WA, with more than 3,250 employees working in operations in Seattle and Spokane, WA and Anchorage, AK. The company and its predecessors have operated in Washington since 1933 and in Alaska since 1952.
What type of insurance is Blue Cross Blue Shield?
Blue Cross Blue Shield Association (BCBSA) is a federation of 35 separate United States health insurance companies that provide health insurance in the United States to more than 106 million people.
What is the main purpose of cost sharing?
Cost-sharing reduces premiums (because it saves your health insurance company money) in two ways. First, you're paying part of the bill; since you're sharing the cost with your insurance company, they pay less.
What does cost sharing mean in insurance?
The share of costs covered by your insurance that you pay out of your own pocket. This term generally includes deductibles, coinsurance, and copayments, or similar charges, but it doesn't include premiums, balance billing amounts for non-network providers, or the cost of non-covered services.
How is cost sharing calculated?
To do this, divide the total cost share obligation by 1.52. (22,280 / 1.52 = 14,658 TDC)....Example:Cost CategoryAmount (example)Total Project Costs111,400X .20Cost share (20% Match on Total Project)22,280Request from Sponsor (80% of Total Project)89,1207 more rows
How to order a premera?
If it’s your first time placing your order online, you’ll need to create an account by visiting cvs.com/otchs/premera. Then, select Create account and follow the instructions.
Is Premera Blue Cross Medicare Advantage over the counter?
Medicare News. Published April 13, 2020. Many Premera Blue Cross Medicare Advantage (MA) plans have an over-the-counter (OTC) benefit of $50 per quarter for OTC health and wellness products. It’s included with our Total Health, Classic, and Core Plus plans and our Alpine, Peak+Rx, Sound+Rx, and Charter+Rx plans.
When submitting a dental claim that includes other insurance, do you submit the claim first?
When submitting a dental claim that includes other insurance, we recommend you submit the claim first to the primary insurance plan. Then send a copy of the other insurance plan's explanation of benefits along with your claim to us. This allows us to make sure that we coordinate benefits promptly and accurately.
Is Premera insurance covered by accident?
The following is general Premera payment policy that states that dental services that are rendered, as a result of an accident are not a covered benefit except when the services are: Necessitated as a direct result of the accidental injury. Are performed within the scope of the provider's license.
Medicare Advantage Plans (HMO)
Medicare Advantage is another way to get your Medicare Part A and Part B benefits. Medicare Advantage plans are required to cover everything that Medicare Part A and Part B covers except for hospice care, which Part A still covers.
Premera Blue Cross Medicare Supplement plans
Another option you may have is to apply for a Medicare Supplement (Medigap) plan to help pay for Medicare’s out-of-pocket costs. Different Medigap plans may pay for different amounts of those costs, such as copayments, coinsurance, and deductibles. Premera Blue Cross is a private insurance company in Washington.
How does Medicare work with other insurance?
When there's more than one payer, "coordination of benefits" rules decide which one pays first. The "primary payer" pays what it owes on your bills first, and then sends the rest to the "secondary payer" (supplemental payer) ...
What is the difference between primary and secondary insurance?
The insurance that pays first (primary payer) pays up to the limits of its coverage. The one that pays second (secondary payer) only pays if there are costs the primary insurer didn't cover. The secondary payer (which may be Medicare) may not pay all the uncovered costs.
How long does it take for Medicare to pay a claim?
If the insurance company doesn't pay the claim promptly (usually within 120 days), your doctor or other provider may bill Medicare. Medicare may make a conditional payment to pay the bill, and then later recover any payments the primary payer should have made. If Medicare makes a. conditional payment.
How many employees does a spouse have to have to be on Medicare?
Your spouse’s employer must have 20 or more employees, unless the employer has less than 20 employees, but is part of a multi-employer plan or multiple employer plan. If the group health plan didn’t pay all of your bill, the doctor or health care provider should send the bill to Medicare for secondary payment.
When does Medicare pay for COBRA?
When you’re eligible for or entitled to Medicare due to End-Stage Renal Disease (ESRD), during a coordination period of up to 30 months, COBRA pays first. Medicare pays second, to the extent COBRA coverage overlaps the first 30 months of Medicare eligibility or entitlement based on ESRD.
What is the phone number for Medicare?
It may include the rules about who pays first. You can also call the Benefits Coordination & Recovery Center (BCRC) at 1-855-798-2627 (TTY: 1-855-797-2627).
What happens when there is more than one payer?
When there's more than one payer, "coordination of benefits" rules decide which one pays first. The "primary payer" pays what it owes on your bills first, and then sends the rest to the "secondary payer" (supplemental payer) to pay. In some rare cases, there may also be a third payer.
What is the difference between Medicare and Medicaid?
Eligible for Medicare. Medicare. Medicaid ( payer of last resort) 1 Liability insurance only pays on liability-related medical claims. 2 VA benefits and Medicare do not work together. Medicare does not pay for any care provided at a VA facility, and VA benefits typically do not work outside VA facilities.
Is Medicare a secondary insurance?
When you have Medicare and another type of insurance, Medicare is either your primary or secondary insurer. Use the table below to learn how Medicare coordinates with other insurances. Go Back. Type of Insurance. Conditions.
What is a premera blue cross?
What's Part C? Premera Blue Cross offers Medicare Advantage plans to residents of Washington state. Most of Premera’s plans include prescription drug coverage. Premera serves over 2 million people and is the largest health plan provider in the Pacific Northwest. Medicare Advantage, or Medicare Part C, is an optional plan ...
Does Medicare Advantage include dental insurance?
These may include prescription medications and dental coverage, among others. of people with Medicare choose to enroll in a Medicare Advantage plan for their coverage. Medicare Advantage plans are sold through private insurance companies. These plans must provide at least the same coverage as original Medicare.
Does Premera offer Medicare in Washington?
And even in Washington, plan availability varies by county. Premera offers Medicare Advantage plans in the following Washington counties in 2021: If you’re a Washington resident, you can enter your ZIP code here to see which Premera Medicare Advantage plans are offered in your area.
Does Premera cover emergency services?
If you need to see someone outside your provider’s network, coverage will not apply and you’ll have to pay all costs. Emergency services are the exception. All of Premera’s plans include prescription drug coverage. With original Medicare (Part A and Part B), you have to choose a separate Medicare Part D prescription drug plan.
Does Premera HMO have a primary care doctor?
With the Premera HMO Medicare Advantage plans, you’ll be asked to choose a primary care doctor who will oversee your care. You’ll have the option of seeing specialists, when needed, within the plan’s network of providers.
Does Premera have HMO?
The types of Medicare Advantage plans include: However, Premera offers only HMO plans through its Medicare Advantage program.
Can you tailor Medicare Advantage plans to fit your needs?
Plan availability and prices vary based on your location and the services you want included. You can tailor Medicare Advantage plans to fit your specific healthcare needs and budget. Additional coverage and services will cost more. Plus, your plan might limit which providers, services, and products you can choose from.