Coverage & Benefits

Premera Medicare Advantage coverage

Medicare Advantage plan documents

If you’re a Premera Medicare Advantage member and need to find your plan name, check your Premera ID card.

Below you’ll find commonly used documents, such as the Annual Notice of Change (ANOC), Summary of Benefits and the Evidence of Coverage (EOC).

NEW VIDEO: USING YOUR MEDICARE ADVANTAGE BENEFITS

All plans include a free yearly checkup with a doctor to set a baseline for your overall health, discuss any changes, and develop a plan for keeping you healthy. Your doctor will do the following during your visit:

• Conduct a comprehensive health review
• Discuss your family history to tailor your care for potential risks
• Review medications you are currently taking
• Create an immunization schedule to make sure you stay up to date
• Complete a Health Risk Assessment that includes taking your weight, height, blood pressure, and more
• Create a personalized wellness schedule that includes a list of all screenings you should have in the coming years

How to use this benefit:

Call your primary care provider to schedule this visit. Make sure to tell them you are scheduling your Annual Wellness Visit (AWV). If you have chronic conditions that you’d like to address at the same time, make sure you let them know this as well. If you address chronic conditions during your AWV, you may have a copay for that portion of the visit.

Still need to find a primary care provider? Kinwell primary care clinics offer same- and next-day appointments for Annual Wellness Visits just for Premera members.

Schedule now!

Keep your mouth looking and feeling young! All plans have preventive and comprehensive dental embedded. You can expect the following and more:

• A $0 copay for routine preventive dental services such as oral exams, cleanings and X-rays
• A $25 annual deductible for covered comprehensive dental services such as fillings, crowns and dentures (as annual comprehensive deductible applies for in-network and out-of-network services)
• Routine oral exams and cleanings
• Periodontal maintenance

How to use this benefit:

1. Use our Find a Doctor tool
2. Browse by the Dental Care category
3. Find an In Network Dental Provider and schedule an appointment

USING YOUR DENTAL BENEFITS VIDEO

According to the Code of Federal Regulations and the Centers for Medicare & Medicaid Services guidelines, hearing aids or exams for the purpose of prescribing, fitting, or changing hearing aids are excluded from coverage under Original Medicare. Premera Medicare Advantage plans help you keep your retirement money safe by paying for costs not covered by Original Medicare alone, like hearing aids.

Hearing Care Solutions (HCS) delivers quality hearing care and hearing instruments at the greatest value to meet your lifestyle needs and includes an annual benefit of $1,000 per ear per year toward hearing aids.

Through Hearing Care Solutions, members receive:

• A hearing aid fitting at no cost
• A 60-day evaluation period to make sure everything feels right
• 1 year of follow-up care at no charge, with the original provider
• Choose from up to 9 major manufacturers

All instruments purchased through Hearing Care Solutions receive:

• 2-year supply of batteries for nonrechargeable devices (up to 64 cells per ear, per year)
• 3-year manufacturer’s warranty, including loss, damage, and repair
• 12-month interest-free financing, available to qualified applicants

How to use this benefit:

Call Hearing Care Solutions toll free at 866-344-7756. HCS will help you select a provider and schedule an appointment, or visit them online at hearingcaresolutions.com/pma/.

USING YOUR HEARING BENEFITS VIDEO

Through the CVS mail-order home delivery service, pay a $0 copay for a 90-day supply of preferred generic drugs or up to a 100-day supply of Select Care Drugs.

How to use this benefit:

1. Ask your doctor for a 90-day prescription or up to 100-day prescription for Select Care Drugs, then:
   1. Go to Caremark.com to create an account and fill out the New Prescription form, OR
   2. Fill out the CVS Order Form (.pdf) and mail it to:
      
      CVS Caremark
      PO Box 659541
      San Antonio, TX 78265-9541
2. Allow up to 10 business days from the day you submit your order for delivery.

OVER THE COUNTER (OTC)

Receive up to a $65 quarterly benefit for over-the-counter health and wellness products available through OTC Health Solutions. This benefit provides you with an easy way to get generic personal care items, bath and safety supplies, hearing aid batteries, and more. Catalog item prices include shipping, handling, and sales tax.

How to use this benefit:

1. Browse the OTC Health Solutions Catalog.
   2024 OTC Health Solutions Catalog (.pdf)
2. Place your order over the phone at 888-628-2770 or online at 
   2024 orders at cvs.com/benefits

For questions about OTC Health Solutions for 2024, view our FAQ (.pdf).

USING YOUR OVER THE COUNTER (OTC) BENEFITS VIDEO

Maintain your vision and eye health as you age with Premera vision benefits.

All plans include a routine eye exam and diabetic retinopathy screening once per calendar year. Up to a $250 hardware allowance to purchase lenses and frames or contacts.

How to use this benefit:

1. Use our Find a Doctor tool
2. Browse by all specialties (A-Z)
3. Find an in-network optometrist or ophthalmologist and schedule an appointment
4. Your doctor will submit your claim. You will be responsible for any out-of-pocket cost as outlined in your Summary of Benefits.
   2024 Summary of Benefits (.pdf)

USING YOUR VISION BENEFITS VIDEO

Help is only a call away.

All Premera Medicare members have access to free, confidential help from a nurse 24 hours a day, 7 days a week, 365 days a year. Nurses are available through this service to answer questions about medications, help you decide when and where to seek care, or simply provide reassurance when you need it.

How to use this benefit:

Call 855-339-8123 to speak with a nurse in the event of a non-emergency. 

Call 911 or go to the emergency room in the case of life-threatening emergencies, such as heart attacks or strokes.

All Premera Blue Cross Medicare Advantage members can enjoy their no-cost FitOn Health fitness membership.

You will have access to the best digital and in-person fitness experiences, with membership in the number one health and fitness platform.

• Unlimited premium digital fitness classes
• Nutrition programs with over 500 exclusive recipes
• Chronic disease courses and wellness content
• 13,000+ gyms, studios, and national fitness clubs like YMCA, LA Fitness and others. Click here to see if your gym is in FitOn Health’s preferred network.*

How to use this program:

First, you must register with an email and password at fitonhealth.com/register. If you have questions about using credits or other questions related to your fitness program, please email FitOn customer service at help@fitonhealth.com or call toll-free 855-378-6683 (TTY/TDD: 711), Monday through Friday, 5 a.m. to 8 p.m (PST).

Have questions or want to learn more? View frequently asked questions.

USING YOUR FITNESS PROGRAM VIDEO

*The FitOn Health program includes a distribution of monthly credits to plan participants for fitness experiences. Credits vary per gym and some gyms may require additional funds.

On behalf of Premera Blue Cross, FitOn Health is an independent company which provides the fitness program. Fitness Membership provided by FitOn Health.

On behalf of Premera Blue Cross, CVS Health, its subsidiaries and affiliates, including CVS Caremark Part D Services and OTC Health Solutions, LLC, is an independent provider of pharmacy benefit management services.

On behalf of Premera Blue Cross, Hearing Care Solutions is an independent company which provides the hearing aid benefit.