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Medicare Supplement Plan F

What is Medicare Supplement Plan F?

Medicare Supplement Plan F, administered by Premera Blue Cross, allows the use of any Medicare contracted physician or hospital nationwide. The plan is designed to supplement your Medicare coverage by reducing your out-of-pocket expenses and providing additional benefits. It pays some Medicare deductibles and coinsurances, but primarily supplements only those services covered by Medicare.

You may choose to purchase a Medicare supplement plan from a private insurance company or enroll in the Premera Blue Cross Medicare Supplement Plan F that the PEBB Program offers, if eligible for PEBB retiree coverage. There is no prescription drug coverage with this plan so a Part D prescription drug plan is also needed unless you have other creditable drug coverage (e.g., VA benefits).

In Medicare Supplement Plan F, benefits such as vision, hearing exams, and routine physical exams may have limited coverage or may not be covered at all.

If you select Medicare Supplement Plan F, any eligible family members who are not entitled to Medicare will be enrolled in UMP Classic.

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

Note: The PEBB Program does not offer the high-deductible Plan F shown in the Outline of Medicare Supplement Coverage.

How do I enroll?

To enroll in Premera's Medicare Supplement Plan F, you need to complete the following forms:

Do you need help completing the Retiree Coverage Election/Change form (form A)? Download instructions.

How do I find a provider?

Visit Premera's online provider directory. Medicare Supplement Plan F allows the use of any Medicare contracted physician or hospital nationwide.

What are the full benefits of the plan?

Certificate of coverage

2018

Summaries of benefits and coverage are not available for Medicare supplement plans. For PEBB Program Medicare plan summaries, see the medical benefits comparison tool.

Is there a quick way to see benefits and costs?

Outline of coverage

2018

Summaries of benefits and coverage are not available for Medicare supplement plans. For PEBB Program Medicare plan summaries, see the medical benefits comparison tool.

What are the 2018 monthly plan costs?

For retirees

  Plan F (age 65 or older, eligible by age) Plan F (Under age 65, eligible by disability)
Subscriber only $111.21 $216.05
Subscriber and spouse* (1 Medicare eligible)3 $764.05 $868.89
Subscriber and spouse* (2 Medicare eligible - 1 retired, 1 disabled) $322.24 $322.24
Subscriber and spouse* (2 Medicare eligible) $217.40 $427.08
Subscriber and child(ren) (1 Medicare eligible)** $600.84 $705.68
Full family (1 Medicare eligible)** $1,253.68 $1,358.52
Full family (2 Medicare eligible - 1 retired, 1 disabled)** $813.37 $813.37
Full family (2 Medicare eligible)** $707.03 $916.71

For COBRA/Continuation Coverage (formerly LWOP)

  Plan F (age 65 or older, eligible by age) Plan F (Under age 65, eligible by disability)
Subscriber only $212.38 $361.03
Subscriber and spouse* (1 Medicare eligible)3 $870.24 $1,018.89
Subscriber and spouse* (2 Medicare eligible - 1 retired, 1 disabled) $573.41 $573.41
Subscriber and spouse* (2 Medicare eligible) $424.76 $722.06
Subscriber and child(ren) (1 Medicare eligible)3 $707.03 $855.68
Full family (1 Medicare eligible)3 $1,359.87 $1,508.52
Full family (2 Medicare eligible - 1 retired, 1 disabled)3 $1,068.06 1,068.06
Full family (2 Medicare eligible)3 $919.41 $1,216.71

* or state-registered domestic partner

** If a Medicare supplement plan is selected, non-Medicare eligible dependents are enrolled in Uniform Medical Plan (UMP) Classic. The rates shown reflect the total due, including premiums for both plans.

Note: Medicare rates shown above have been reduced by the state-funded contribution up to the lesser of $150 or 50 percent of plan premium per retiree per month.

Do I live in the medical plan's service area?

Medicare Supplement Plan F is available in all Washington, Oregon, and Idaho counties, and nationwide.

Contact

Premera Blue Cross
Online:
Premera website (general information, not PEBB specific)
Phone: 1-800-817-3049
TTY: 1-800-842-5357