Compare medical plans

Compare plan benefits and costs

All medical plans (except for Premera Blue Cross Medicare Supplement Plans) cover the same basic health care services but vary in other ways. These differences are provider networks, premiums, and drug formularies.

Use the tools below to compare plan benefits.

• Monthly premiums
• Benefits At-a-Glance for PEBB Medicare plans
• Medical Benefits Comparison Tool
• Medical plans available by county
• Medical Benefits At-a-Glance Comparison
• Behavioral health services by plan
• Health plans with health savings account (non-Medicare)
• Benefits and coverage by plan to view benefits booklets and Summaries of Benefits and Coverage.

Choosing a plan to go with Medicare Parts A and B?

Consider these questions:

• Are the services I need covered?
• How much are premiums, deductibles, and other costs?
• How much do I pay for services like hospital stays and doctor visits?
• Do my doctors and other providers accept the coverage? Are they part of the plan's network?
• Do I need to buy a Medicare Part D prescription drug plan? Does the plan cover medications I am currently taking?
• Am I satisfied with the quality of care and services provided?
• If I travel, am I covered in another state or outside the U.S.?

Medicare Advantage with Part D and Medicare Supplement plans

You must be enrolled in Medicare Part A and Part B to enroll in the Medicare Advantage with Part D plans or Medicare Supplement plans. See Medicare and turning age 65.

Medicare Advantage with Part D plans

These plans contract with Medicare to provide all Medicare-covered benefits; however, most also cover the deductibles, coinsurance, and additional benefits not covered by Medicare. Neither the health plans nor Medicare will pay for services received outside of the plan's network except for authorized referrals and emergency care.

Enrollment in Medicare Advantage with Part D plans may not be retroactive. Your enrollment is effective the first of the month after we receive your enrollment forms, or when you enroll in both Medicare Parts A and B, whichever is later. This date may be different from your retirement date. If we receive the forms after the date your enrollment in PEBB retiree insurance coverage is to begin, you may not select a Medicare Advantage with Part D plan until a special open enrollment or the next annual open enrollment.

Medicare Supplement Plan G, administered by Premera Blue Cross

Premera Blue Cross Medicare Supplement Plan G lets you use any Medicare contracted physician or hospital nationwide. This plan supplements your Original Medicare coverage by reducing most of your out-of-pocket expenses and providing extra benefits. It pays most deductibles, coinsurance, and copays covered by Medicare. If you choose Plan G, any enrolled members who are not eligible for Medicare will be enrolled in UMP Classic.

Medicare Supplement Plan G does not include prescription drug coverage. If you select this plan, you may need to enroll in Medicare Part D to get your prescriptions, unless you have other creditable prescription drug coverage. Visit Medicare Supplement Plan G for more information.

Plan differences to consider

When choosing a plan, here are some things to consider:

Premiums

Premiums vary by plan. A higher premium doesn’t necessarily mean higher quality of care or better benefits. Generally, the classic plans have higher premiums than the value plans. However, classic plans may have lower annual deductible, copays, or coinsurance costs.

View Retiree monthly premiums.

Deductibles

A deductible is a fixed dollar amount you must pay each year for covered health care expenses before the plan starts paying for covered services.

Medicare plans may also have a separate annual deductible for prescription drugs.

Your provider

If you want to see a particular provider, you should check whether they are in the plan’s network before you join. After you join a plan, you may change your provider, although the rules vary by plan. See Find a provider.

Type of plan

The PEBB Program offers three types of medical plans:

• Managed care plans: These plans may require you to choose an in-network primary care provider to meet or coordinate your health care needs. The plan may not pay benefits if you see an out-of-network provider.
• Preferred provider organization (PPO) plans: PPOs allow you to self-refer to any approved provider in most cases and usually provide a higher level of coverage if the provider is in-network.
• Consumer directed health plans (CDHP): A CDHP lets you use a health savings account (HSA) to help pay for out-of-pocket medical expenses tax-free. These plans have a lower monthly premium, a higher deductible and a higher out-of-pocket limit than most other plans. You cannot enroll in a CDHP if you are enrolled in Medicare.

Coinsurance or copays

A copay is a fixed fee you pay when you receive care.

Coinsurance is a percentage of the allowed amount charged by the provider that you pay.

Out-of-pocket limit

The annual out-of-pocket limit is the most you pay in a calendar year for covered benefits. Once you have reached the out-of-pocket limit, the plan pays 100 percent of allowed charges for most covered benefits for the rest of the calendar year. Certain charges (such as your annual deductible, copays, and coinsurance) may count toward your out-of-pocket limit. Others, such as your monthly premiums, do not. Read each plan’s certificate of coverage for details.

Referral procedures

Some plans allow you to self-refer to network providers for specialty care. Others require you to have a referral from your primary care provider.

Network adequacy

All health carriers in Washington are required to maintain provider networks that offer members reasonable access to covered services. Check the plans’ provider directories to see how many providers are accepting new patients and what the average wait time is for an appointment. For more information, see Behavioral health services by plan or Brennen’s Law (RCW 48.43.765).

Coordination with your other benefits

All PEBB medical plans coordinate benefit payments with other group plans, Apple Health (Medicaid), and Medicare. This is called coordination of benefits. It ensures the highest level of reimbursement for services when a person is covered by more than one plan. Payment will not exceed the benefit amount.

If you are also covered by another health plan, call the plan to ask how they coordinate benefits. This is especially important for those coordinating benefits between the PEBB and SEBB programs, and those enrolled in Apple Health (Medicaid).

One exception to coordination of benefits: PEBB medical plans that cover prescription drugs will not coordinate prescription-drug coverage with Medicare Part D. All PEBB medical plans, except Premera Blue Cross Medicare Supplement Plan G, provide either Medicare Part D coverage or creditable prescription drug coverage. If you enroll in a standalone Medicare Part D plan, you must enroll in Plan G or lose your PEBB retiree health plan coverage.