Medicare plan premiums

Qualify for the Medicare rate

To qualify for the Medicare rate:

1. At least one covered family member must be enrolled in both Medicare Part A and Part B. (Medicare rates are not available to PEBB Continuation Coverage [Unpaid Leave] members.)
2. Medicare-enrolled subscribers in Kaiser Permanente NW's Senior Advantage, Kaiser Permanente WA's Medicare Advantage, or UnitedHealthcare PEBB Balance or PEBB Complete must sign and submit the Medicare Advantage Plan Election Form (Form C) to enroll in one of these plans.

Medical and dental plan premiums

• PEBB Continuation Coverage monthly premiums (2022)

Before you enroll

1. Make sure you live in the plan's service area.
2. Contact the plan or check the plan's provider directory to make sure your providers are in the plan's network.

Surcharges in addition to medical plan premiums

You will pay the following surcharges in addition to your medical plan premium if they apply to you.

• A $25-per-account premium surcharge will apply if you or any dependent (age 13 and older) enrolled in PEBB medical uses tobacco products.
• A $50 premium surcharge will apply if you enroll your spouse or state-registered domestic partner in PEBB medical and your spouse or state-registered domestic partner has chosen not to enroll in other employer-based group medical that is comparable to Uniform Medical Plan (UMP) Classic.

For more details, visit Surcharges.