Compare medical plans

Information and tools to help you choose the medical plan that's right for you.

Get a side-by-side comparison of common medical benefits and costs for services.

Medical benefits comparison tool

Things to think about when choosing a medical plan

Choosing a medical plan is an important decision. Many people think first about cost and which doctors and hospitals are in the network. All PEBB medical plans, except for Premera Blue Cross Medicare Supplement Plan F, cover the same basic health care services but vary in other ways, such as provider networks, monthly plan costs, and prescription drug coverage.

When selecting a PEBB medical plan, your options are limited based on eligibility and where you live. You must consider which plans are available in your county and whether you and any eligible dependents you wish to enroll are enrolled in Medicare Part A and Part B. Remember, if you cover eligible dependents, everyone must enroll in the same medical and dental plans (with some exceptions, based on eligibility for Medicare Part A and Part B).

As you research your plan options, consider these questions:

Am I eligible to enroll in the plan?

Not everyone qualifies to enroll in a CDHP with a health savings account (HSA) or a UMP Plus plan. See Health plans with health savings account (non-Medicare) (for CDHP eligibility information) and UMP Plus Who can enroll? (for UMP Plus eligibility information).

Do I live in the plan's service area?

In most cases, you must live in a medical plan’s service area to join the plan. See Medical plans available by county. If you move out of your plan's service area, you may need to change your plan. You must report your new address to your personnel, payroll, or benefits office no later than 60 days after your move.

How do I compare the plans?

All medical plans, except for Premera Blue Cross Medicare Supplement Plan F, cover the same basic health care services but vary in other ways, such as provider networks, premiums, and drug formularies. Get a side-by-side comparison of common medical benefits and costs for services.

Medical plan benefits comparison

Medicare plan benefits comparison

Plan differences to consider

When choosing a plan to best meet your needs, here are some things to consider:

Premiums

Your previous plan can charge up to 102 percent of total plan premiums for COBRA coverage. The PEBB Program charges 100 percent of the total plan premiums for COBRA coverage and PEBB continuation coverage, as well as applicable tobacco use and spouse or state-registered domestic partner coverage premium surcharges. Other options, like coverage under a spouse’s plan or through the Health Benefit Exchange, may be less expensive. See Plan costs.

Deductibles

Most medical plans, except Premera Blue Cross Medicare Supplement Plan F, and Kaiser Permanente NW’s (formerly Group Health) and Kaiser Permanente WA’s Medicare Advantage plans, require you to pay an annual deductible before the plan pays for covered services. UMP Classic, and Kaiser Permanente WA Classic, Value, and SoundChoice plans also have a separate annual deductible for some prescription drugs. Preventive care and certain other services are exempt from the medical plans’ deductibles. This means you do not have to pay your deductible before the plan covers the service.

Plan benefits

Look at the plans' benefits booklets and Summaries of Benefits and Coverage to find out what is covered and your costs for care. See Benefits and coverage by plan.

Coinsurance or copays

Some plans require you to pay a fixed amount, called a copay. Other plans require you to pay a percentage of an allowed fee when you receive care, called a coinsurance.

Out-of-pocket limit

The annual out-of-pocket limit is the most you pay in a calendar year for covered benefits. UMP Classic, and Kaiser Permanente WA Classic, Value, and SoundChoice plans have a separate out-of-pocket limit for prescription drugs. Once you have paid this amount, the plans pay 100 percent of allowed charges for most covered benefits for the rest of the calendar year. Certain charges incurred during the year (such as your annual deductible, copays, and coinsurance) count toward your out-of-pocket limit. There are a few costs that do not apply toward your annual out-of-pocket limit:

  • Monthly premiums and applicable surcharges.
  • Charges above what the plan pays for a benefit.
  • Charges above the plan’s allowed amount paid to a provider.
  • Charges for services or treatments the plan doesn’t cover.
  • Coinsurance for non-network providers.
  • Prescription drug deductible and prescription-drug coinsurance (UMP Classic and Kaiser Permanente WA non-Medicare plans only).

Prescription drug coverage

If you’re currently taking medication, a change in your health coverage may affect your medication costs—and in some cases, your medication may not be covered by another plan. You may want to check if your current medications are listed in drug formularies for other health coverage. A drug formulary is a list of prescription drugs (both generic and brand name) that are preferred by your health plan.

Referral procedures

Some plans allow you to self-refer to any network provider; others require you to have a referral from your primary care provider. All plans allow self-referral to a participating provider for women’s health care services.

Your provider

Use the health plans' provider directories to find a provider near you and make sure the provider is in your plan's network. See Find a provider.

Paperwork

In general, PEBB plans don’t require you to file claims. However, UMP Classic members may need to file a claim if they receive services from a non-network provider. CDHP members should also keep paperwork received from their provider or from qualified health care expenses to verify eligible payments or reimbursements from their health savings account.

Coordination with your other benefits

If you are also covered through your spouse’s or registered domestic partner’s comprehensive group health coverage, call the medical and/or dental plan(s) directly to ask how they will coordinate benefits. All PEBB plans (except Premera Blue Cross Medicare Supplement Plan F) coordinate benefit payments with other group plans, Medicaid, and Medicare. This is called coordination of benefits (COB). This coordination ensures benefit costs are more fairly distributed when a person is covered by more than one plan. However, the amount your PEBB plan pays for benefits will not change for a particular service or treatment, even if you or a dependent have an individual medical or dental policy covering that service or treatment.

Exception to coordination: PEBB plans that cover prescription drugs will not coordinate prescription drug coverage with Medicare Part D. All PEBB plans cover prescription drugs except Premera Blue Cross Medicare Supplement Plan F. If you enroll in Medicare Part D, you must enroll in Premera Blue Cross Medicare Supplement Plan F or lose your PEBB retiree coverage.

How do the PEBB Program plans work with Medicare?

You must be enrolled in Medicare Part A and Part B to enroll in the Medicare Advantage or Medicare Supplement plans. Also, not everyone qualifies to enroll in a consumer-directed health plan (CDHP) with a health savings account (HSA). See Medicare and PEBB benefits (COBRA only).

Visit the plan websites: Kaiser Permanente WA (formerly Group Health) plans, Kaiser Permanente NW* plans, Medicare Supplement Plan F, or Uniform Medical Plan (UMP) plans.

*Kaiser Foundation Health Plan of the Northwest, with plans offered in Clark and Cowlitz counties in WA, and the Portland, OR area.

What is a value-based plan and why should i choose one if available in my county of residence?

Value-based plans aim to provide high quality care at a lower cost. Providers have committed to follow evidence-based treatment practices, coordinate care with other providers in your network, and meet certain measures about the quality of care they provide.

What type of plan should I select?

Your options are limited to plans that are available in your county and whether you or your covered dependents are enrolled in Medicare Part A and Part B.  The PEBB Program offers three types of medical plans.

Consumer-directed health plans (CDHPs)

CDHPs let you use a health savings account (HSA) to help pay for out-of-pocket medical expenses tax free, have a lower monthly premium than most plans, and a higher deductible and a higher out-of-pocket limit. Remember, if you cover eligible dependents, everyone must enroll in the same medical and dental plans (with some exceptions, based on eligibility for Medicare Part A and Part B). See Health plans with health savings account (HSAs)

Managed care plans

Managed-care plans may require you to select a primary care provider within its network to fulfill or coordinate all of your health care needs. You can change providers at any time, for any reason within the contracted network. The plan may not pay benefits if you see a noncontracted provider.

Preferred provider organization (PPO) health plans

PPOs allow you to self-refer to any approved provider type in most cases, but usually provide a higher level of coverage if the provider contracts with the plan.

Medical plan options

In general, PEBB retirees may choose from the plans listed below. Your options are limited to the plans available in your county and whether you are enrolled in Medicare Part A and Part B. Remember, if you cover eligible dependents, everyone must enroll in the same medical plan (with some exceptions, based on eligibility for Medicare Part A and Part B). Continuation coverage (LWOP) subscribers are not eligible for Medicare plans.

Medicare options

For members enrolled in Medicare Part A and B. Value-based plans noted in bold.

  • Kaiser Permanente NW Senior Advantage
  • Kaiser Permanente WA (formerly Group Health) Medicare Plan (Medicare Advantage or Original Medicare coordination plan)
  • Medicare Supplement Plan F, administered by Premera Blue Cross
  • UMP Classic (Medicare), administered by Regence BlueShield

Non-Medicare options

For members not eligible for Medicare or enrolled in Part A only. Value-based plans noted in bold.

Consumer-directed health plans (CDHPs)

  • Kaiser Permanente NW CDHP*
  • Kaiser Permanente WA (formerly Group Health) CDHP
  • UMP CDHP, administered by Regence BlueShield

*Kaiser Foundation Health Plan of the Northwest, with plans offered in Clark and Cowlitz counties in WA, and the Portland, OR area.

Managed care plans

  • Kaiser Permanente NW Classic*
  • Kaiser Permanente WA Classic (formerly Group Health Classic)
  • Kaiser Permanente WA SoundChoice (formerly Group Health SoundChoice) (Note: At least one family member must not be enrolled in Medicare Part A and Part B.)
  • Kaiser Permanente WA Value (formerly Group Health Value)

*Kaiser Foundation Health Plan of the Northwest, with plans offered in Clark and Cowlitz counties in WA, and the Portland, OR area.

Preferred-provider (PPO) plans

  • UMP Classic, administered by Regence BlueShield
  • UMP Plus—Puget Sound High Value Network, administered by Regence BlueShield (Note: Not available to retirees enrolled in Medicare Part A and Part B.)
  • UMP Plus—UW Medicine Accountable Care Network, administered by Regence BlueShield (Note: Not available to retirees enrolled in Medicare Part A and Part B.)