Care
Receive care from a broad network of providers you know and trust.
Our Medical Network
With thousands of local doctors in our Medicare Advantage network, you'll be sure to find a doctor who's right for you. Our plan service area includes these Washington state counties.
Western Washington
Whatcom, Skagit, Snohomish, King, Pierce, Thurston, Lewis, Island, San Juan, Kitsap and Cowlitz
Eastern Washington
Spokane, Stevens and Walla Walla
Primary Care
Your primary care provider (PCP) is the main point of contact for your healthcare needs. Your PCP tracks your overall health, including:
- Coordinating care
- Monitoring your medications
- Referring you to the right specialist
Referrals
Your PCP will provide most of your health care and when medically appropriate, refer you to a Premera Blue Cross Medicare Advantage (HMO) specialist.
However, for in-network services, a referral from Premera Blue Cross is not required for most specialists, hospitals, skilled nursing facilities and home care agencies. Although Premera does not require a referral, some of the above mentioned services may require it.
Prior authorizations
In some cases, your PCP will also need to request prior authorization (prior approval) for inpatient or outpatient procedures, which is common practice for most carriers. You can find a list of services that require prior authorization in your EOC.
Introducing Kinwell primary care
Kinwell clinics are opening across Washington state and are exclusive to Premera members. The Kinwell experience includes:
- A whole-person approach to patient care integrating primary care and behavioral health.
- Longer appointment times to establish a better 1:1 patient-provider relationship.
- Convenient access to in-person and virtual care just for Premera members.
- Health coaching support for established patients at no additional cost.
Find out more at kinwellhealth.com. If you’re interested in switching to a Kinwell primary care provider, call customer service at 888-850-8526.
Looking for a Primary Care Provider?
If you do not have a PCP or would like to change your PCP, call customer service and they can update it for you.
888-850-8526 (TTY: 711)
October 1 through March 31: 8 a.m. to 8 p.m., 7 days a week
April 1 through September 30: 8 a.m. to 8 p.m., Monday through Friday
Wellness Visits
Checkups are important. Getting an annual checkup or going in for a preventive visit is useful for everyone. Routine exams can help spot health issues before they begin. They can also identify problems early, before they become serious and difficult to treat. That's why Premera offers an annual physical exam and annual wellness visit at no cost, as part of your plan benefits.
An annual wellness visit is available at no additional cost and includes:
- Review of your medical history, current medications, and treatment plans
- Discussion of age-related concerns, such as memory loss, balance, and fall protection
- Discussion about vaccinations and boosters
- Lifesaving screenings for high blood pressure, colon cancer, and other cancers
In addition to your annual wellness visit, an annual physical exam is also available at no additional cost and includes a more comprehensive hands-on age and gender-appropriate examination than an annual wellness visit. It may also include lab work as needed (you may pay for part of the cost of some lab tests).
To make the most of these visits, download our preventive services checklist, medicine and supplement tracker, family history tracker, and be prepared with visit topics and questions.
Preventive Services
Many preventive services are covered at no cost. Examples include:
- You pay a $0 copay for each Medicare-covered preventive glaucoma and diabetic retinopathy screening once per year
- Falls risk assessment
- Bone density screening
- Cancer screenings for breast, colon, prostate, and other cancers
- Vaccinations for Hepatitis B, flu, COVID, and pneumonia
Talk to your PCP about any additional services they recommend. Review your Evidence of Coverage to see a full list of covered preventive services.