From 2015 to 2016 there are not many changes to Premera plans. They condensed several plans into only five this year. They are all very attractive from pricing and coverage compared with other carriers. Below is a highlight of the main features of plans, click on the links to see the full detailed plans.
Changes to Premera Plans
The biggest change is that the Bronze $6,350 plan is now covering Specialists visits AFTER the Deductible (in 2015 this was just a flat $50/visit cost). However, this is still the best Bronze plan on the market. The Premera Gold $1,000 and Silver $3,000 now covers 2 primary care visits at no cost. Prescription Drugs are slightly more expensive on the Silver $3,000 plan. All plans cover an annual preventative exam at no cost (however they may charge you for additional services beyond the “preventative” level of services). Not many changes for 2016…other than the increase in price.
You will notice we will not be mentioning LifeWise (it’s best to switch to Premera like we did for most of our clients last year). In 2016 they are slimming down the network and having zero out of Washington and Oregon coverage…so if you want a better plan just pick Premera this year. Also Premera will be offering the “Narrow PPO” network as well. Since the plans are only about 5% lower cost it really doesn’t make sense to buy one of these plans. If you want a cheaper plan pick one of the “Narrow PPO” networks on the Exchange which are much cheaper.
Quick Overview of Plans
Premera Gold $1000 (Plan details here): This plan is not changing at all other than adding two primary care visits at no cost. Primary care visits are $10/visit and $30/specialist visit (in order to get the $10 for primary care you must designate that doctor as your primary care physician, you can switch anytime). The Prescription Drug coverage is $10 for Generics and $30 for Brand Name. One huge advantage of Premera plans are they cover Minor Diagnostic (labs, imaging, x-rays, pathology tests) at 80% BEFORE the Deductible. Chiropractic visits (10 max) and Acupuncture visits (12 max) are $20/visit before the deductible. Physical Therapy/Massage (25 visits) are covered after the deductible (choose Moda if this is very important to you). The max out of pocket in the network is $4,500. Overall very solid plan for the price and large nationwide coverage network.
Premera Silver $3,000 (Plan details here): This plan is has a few moderate changes other than adding two primary care visits at no cost. Primary care visits remain at $15/visit and a slight increase to $50/specialist visit (in order to get the $15 for primary care you must designate that doctor as your primary care physician, you can switch anytime). The Prescription Drug coverage is increasing moderately to $20 for Generics and $55 for Brand Name. One huge advantage of Premera plans are they cover Minor Diagnostic (labs, imaging, x-rays, pathology tests) at 80% BEFORE the Deductible. Chiropractic visits (10 max) and Acupuncture visits (12 max) are $20/visit before the deductible. Physical Therapy/Massage (25 visits) are covered after the deductible (choose Moda if this is very important to you). The max out of pocket in the network is $6,850. Overall very solid plan for the price and large nationwide coverage network.
Premera Bronze $6,350 (Plan details here): This plan is has one main change (specialist visits are now covered AFTER the $6,350 Deductible, before it was a flat $50/visit). The primary care remains at $20/visit (you must designate that doctor as your primary care physician, you can switch anytime). Chiropractic visits (10 max) and Acupuncture visits (12 max) are $20/visit before the deductible. Physical Therapy/Massage (25 visits) are covered after the deductible. The max out of pocket in the network is $6,850. Overall very solid plan for the price and large nationwide coverage network.
Premera Silver $3,000 HSA (Plan details here): This plan is has one change, with the deductible increasing from $2,500 to $3,000. Health Savings Accounts are a very unique type of coverage that ONLY cover medical expenses AFTER the $3,000 deductible (annual preventative exam is still no cost). The advantage is that they have a lower max out of pocket of $4,100 (better than the Premera Gold at $4,500) along with a lower cost since it is a Silver plan.
This is a great plan for those that intend on having a significant amount of medical expenses for the year (since the max out of pocket is $4,100) and you get a tax deduction for putting money in to a HSA checking account.
Premera Silver $5,250 HSA (Plan details here): This is a very similar plan to the Silver HSA, yet only makes sense if you want the cheapest plan with the strongest network. It operates in the same HSA manner with no up front doctor or Rx. The one change, with the max out of pocket increasing from $5,250 to $6,100.
Since the HSA plan is a high deductible health plan, this enables you to set up a checking account where you can deposit up to a max of $3,350 single or $6,750 family amount. This is tax deductible and the money can be used tax free for qualifying medical expenses (for anyone in the immediate family, even if they are not on the HSA plan). This is truly one of the only ways you can use money without the government taxing it.
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, MBA
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