For 2017 Premera plans there has been dramatic changes (No PPO Network, Exchange Only Plans & Plan Redesigns). If you have a Premera plan it is extremely important to review what you have. The average price increase is 19.9%, however if you are receiving tax credits on the WA Exchange, then you are shielded from the vast majority of the increase (we can explain how).
NOTE: The Swedish and Providence Health facilities are NOT covered at all in 2017. So if your main doctor or hospital is Swedish, pick another carrier! No exceptions.
#1 Direct plans to Premera will end on 12/31/2016. If you want a Premera plan you MUST go through the WA Health Exchange (even if you make above the tax credit levels).
#2 Due to Premera losing $117 million in 2015, they are eliminating the BlueCard PPO out of state network and will not be covering doctors within the Swedish hospital and doctor network (just like what occurred in 2014). They will still cover true medical emergencies while traveling, but not basic or planned out of state procedures.
#3 Slimmer Networks in Washington State; you must choose a hospital network called a Personal Care Plan (PCP) for 2017 (in King, Snohomish and Pierce counties). IN all other counties where Premera is still offered there is an EPO (Exclusive Provider Organization) network which is still the full Heritage Signature Network as 2016, yet no out of WA coverage unless it’s an emergency. For the PCP networks you can change the 1st of any month to a different network (Regence does not allow you to change their EPO slimmer networks mid-year).
PCP Networks to Choose from (King, Snohomish & Pierce Counties)
NOTE: You can change Networks any day you want! So if you pick the Virginia Mason Network and want to see a Doctor in the UW Network you can, however you really should try to keep to one network, as you would need to go online and switch back to Virginia Mason before seeing a doctor there again. They WILL balance bill you for the cost if you forget and there is no way to appeal the additional cost of services.
Evergreen Health Partners
MutliCare Connected Care
Northwest Physicians Network
UW Medicine Accountable Care Network
Virginia Mason Medical Center
Everett Clinic
Changes to Premera Plans
The biggest change is needing to pick a hospital network. This keeps costs lower since they can coordinate care more efficiently. Due to this, the Deductibles have been lowered and Physical Therapy and Massage are covered BEFORE Deductible on Gold & Silver plans. One negative is that the Prescription Drug Formulary has been revised with 4 tiers (which can make some Rx more expensive). All plans cover an annual preventative exam at no cost (however they may charge you for additional services beyond the “preventative” level of services). You NEED to pick a Primary Care Doctor and can get them to give you referrals to another hospital network, yet might take some convincing since they have to give approval.
Quick Overview of Plans
Premera Gold $750 (Plan details here): The Personal Care Plan (PCP) Primary care visits are $15/visit and $40/specialist visit. The Prescription Drug coverage is $10 for Preferred Generics and $40 for Preferred Brand, $80 for Non-Preferred Brand and $100 for Specialty (which is an improvement since its covered before deductible). One huge advantage of Premera plans are they cover Minor Diagnostic (labs, imaging, x-rays, pathology tests) for $50 and Major Diagnostic (MRI, CT, PET scans) for $250. Chiropractic visits (10 max) and Acupuncture visits (12 max) are $15/visit before the deductible. The max out of pocket in the network is $4,500. Overall very solid plan for the price.
Premera Silver $2,500 (Plan details here): The Personal Care Plan (PCP) Primary care visits are $25/visit and $50/specialist visit. The Prescription Drug coverage is $15 for Preferred Generics and $50 for Preferred Brand, $100 for Non-Preferred Brand and for Specialty Drugs you pay Deductible of $2,500, then $150 copay. One huge advantage of Premera plans are they cover Minor Diagnostic (labs, imaging, x-rays, pathology tests) for $100 and Major Diagnostic (MRI, CT, PET scans) for $500 copay, then Deductible. Chiropractic visits (10 max) and Acupuncture visits (12 max) are $25/visit before the deductible. The max out of pocket in the network is $7,150. Overall very solid plan for the price.
Premera Bronze $4,500 (Plan details here): The Personal Care Plan (PCP) Primary care visits are $35/visit and $75/specialist visit. The Prescription Drug coverage is $25 for Preferred Generics. For all Brand drugs there is a Deductible of $1,500, then $75 for Preferred Brand, $175 for Non-Preferred Brand and $135 for Specialty Drugs. One huge advantage of Premera plans are they cover Minor Diagnostic (labs, imaging, x-rays, pathology tests) for $100 and Major Diagnostic (MRI, CT, PET scans) for $750 copay, then Deductible. Chiropractic visits (10 max) and Acupuncture visits (12 max) are $35/visit before the deductible. The max out of pocket in the network is $7,150. Overall very solid plan for the price.
LifeWise Health Insurance Plans
LifeWise is a subsidiary of Premera, so they share a similar network for 2017 plans for the first time. Previously Premera had a significantly better network. The core difference is that for 2017 the LifeWise plans do NOT cover many things up front before the deductible, so they are extremely different from the Premera plans.
The LifeWise plans are 16% cheaper than the Premera plans, however do not provide much value since they have the more narrow networks like Premera for 2017. If you are looking for a solid plan outline like LifeWise choose the Regence plan for a solid PPO network or choose a Molina plan that’s 20% cheaper than LifeWise for a more narrow network.
For those that choose a LifeWise plan there is an additional $100 fee per person, as LifeWise pays insurance brokers 0% just like the Group Health Access PPO plans. They are not bad plans, just better options for the cost.
Below are my areas of expertise:
- Health Insurance (Every company in Washington State)
- Life Insurance (33 companies)
- Paycheck Protection (8 companies)
- Tax Sheltered Accounts (Following IRS guidelines)
Gary Franke, Tamara Chandler & Justin Cross
Independent Broker
Achieve Alpha Insurance, LLC
12507 Bel-Red Rd, Ste 103
Bellevue, WA 98005
(425) 802-2783
gary@achieve-alpha.com
www.achieve-alpha.com