The PEBB Program’s annual open enrollment is November 1 through 30. Learn more.

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?

You must enroll in Medicare Supplement Plan F by December 1, 2019. You cannot enroll in Plan F during this year’s annual open enrollment (November 1 through 30, 2019).

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

Plan F will not accept new members as of January 1, 2020

As of January 1, 2020, Premera Blue Cross Medicare Supplement Plan F will not accept new members.

If you are enrolled in Plan F as of December 31, 2019, you can stay in Plan F unless an enrolled dependent becomes eligible for Medicare on or after January 1, 2020, or you defer or terminate your PEBB coverage. If you defer or terminate, you cannot reenroll in Plan F in the future.

If you choose to stay in Plan F, you do not need to call or submit any forms to stay enrolled. Your Plan F coverage will continue automatically.

Change your coverage

You must make a change to your account if you are enrolled in Plan F and an enrolled dependent becomes eligible for Medicare on or after January 1, 2020. You must either change your medical plan or remove your dependent from coverage to stay in Plan F. If you remove your dependent for this reason, they will not be eligible for PEBB Continuation Coverage.

If your dependent is enrolled in Plan F and you become eligible for Medicare on or after January 1, 2020, you will have to change to another PEBB medical plan for you and your dependent.

Premera Blue Cross Medicare Supplement Plan G will be offered as a new PEBB medical plan for 2020. Plan G is the only PEBB Medicare Supplement plan available for members enrolling on or after January 1, 2020. The only benefit difference between Plan F and Plan G is that Plan G does not cover the Medicare Part B deductible.

For more benefit information, see Premera’s Outline of Medicare Supplement Coverage. If you have questions about Plan G, please call Premera Blue Cross at 1-800-817-3049. If you have questions about making a plan change, please call the PEBB Program at 1-800-200-1004 (TRS: 711).

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.

Is there a quick way to see benefits and costs?

Outline of coverage

2019

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 monthly plan costs?

2020

 

Note: Medicare rates shown below have been reduced by the state-funded contribution up to the lesser of $183 or 50 percent of plan premium per retiree per month.

 

Plan F (age 65 or older, eligible by age)

Plan F (Under age 65, eligible by disability)

Subscriber only

$112.84

$188.47

Subscriber and spouse1 (1 Medicare eligible)2

$787.50

$863.13

Subscriber and spouse1 (2 Medicare eligible - 1 retired, 1 disabled)

$296.25

$296.25

Subscriber and spouse1 (2 Medicare eligible)

$220.61

$371.88

Subscriber and child(ren) (1 Medicare eligible)2

$618.83

$694.46

Subscriber, spouse,and child(ren) - (1 Medicare eligible)2

$1,293.49

$1,369.12

Subscriber, spouse,and child(ren) - (2 Medicare eligible - 1 retired, 1 disabled)2

$802.99

$802.99

Subscriber, spouse,and child(ren) - (2 Medicare eligible)2

$726.60

$877.87

1 or state-registered domestic partner

2 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.

 

Plan F (age 65 or older, eligible by age)

Plan F (Under age 65, eligible by disability)

Subscriber only

$215.55

$366.41

Subscriber and spouse1 (1 Medicare eligible)2

$895.27

$1,046.13

Subscriber and spouse1 (2 Medicare eligible - 1 retired, 1 disabled)

$581.96

$581.96

Subscriber and spouse1 (2 Medicare eligible)

$431.10

$732.82

Subscriber and child(ren) (1 Medicare eligible)2

$726.60

$877.46

Subscriber, spouse1, and child(ren) (1 Medicare eligible)2

$1,401.26

$1,552.12

Subscriber, spouse1, and child(ren) (2 Medicare eligible - 1 retired, 1 disabled)2

$1,093.01

$1,093.01

Subscriber, spouse1, and child(ren) (2 Medicare eligible)2

$942.15

$1,243.87

1 or state-registered domestic partner

2 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.

2019

Note: Medicare rates shown below have been reduced by the state-funded contribution up to the lesser of $168 or 50 percent of plan premium per retiree per month.

 

Plan F (age 65 or older, eligible by age)

Plan F (Under age 65, eligible by disability)

Subscriber only

$112.16

$199.00

Subscriber and spouse1 (1 Medicare eligible)2

$781.04

$867.88

Subscriber and spouse1 (2 Medicare eligible - 1 retired, 1 disabled)

$305.19

$305.19

Subscriber and spouse1 (2 Medicare eligible) $218.35 $392.03

Subscriber and child(ren) (1 Medicare eligible)2

$613.82

$700.66

Subscriber, spouse,1 and child(ren) - (1 Medicare eligible)2

$1,282.69

$1,369.53

Subscriber, spouse,1 and child(ren) - (2 Medicare eligible - 1 retired, 1 disabled)2

$807.60

$807.60

Subscriber, spouse,1 and child(ren) - (2 Medicare eligible)2 $720.01 $893.69

1 or state-registered domestic partner

2 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.

 

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 spouse1 (1 Medicare eligible)2

$887.23

$1,035.88

Subscriber and spouse1 (2 Medicare eligible - 1 retired, 1 disabled)

$573.41

$573.41

Subscriber and spouse1 (2 Medicare eligible)

$424.76

$722.06

Subscriber and child(ren) (1 Medicare eligible)2

$720.01

$868.66

Subscriber, spouse,1 and child(ren) - (1 Medicare eligible)2 $1,388.88 $1,537.53
Subscriber, spouse,1 and child(ren) - (2 Medicare eligible - 1 retired, 1 disabled)2 $1,081.04 $1,081.04
Subscriber, spouse,1 and child(ren) - (2 Medicare eligible)2 $932.39 $1,229.69

1 or state-registered domestic partner

2 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.

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