Premera Blue Cross Ending Medicare Advantage in 2025

If you are currently enrolled in a Premera Blue Cross Blue Shield Medicare Advantage plan, there’s some crucial information that you’ll need to learn about for this upcoming Medicare Annual Election Period.

Unfortunately, Premera Blue Cross is ending its Medicare Advantage plans across the state of Washington. This will affect roughly 32,000 people in the state.

Now, I need to emphasize that this only affects their Medicare Advantage portfolio. This does not affect their Medicare Supplement (also known as Medigap) members. 

So, if you have a Medicare Supplement (Medigap) plan with Premera, then those plans will be the same going into 2025.

Those of you who have a Premera Blue Cross Medicare Advantage plan will be forced to go back to the marketplace to try to find a new plan that will take effect on January 1st, 2025. Your current Premera Medicare Advantage plan will still serve you through the remainder of 2024. 

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• Check your mail!

  Every year, all Medicare Advantage insurance companies are required to send a statement to all members letting them know of plan changes and/or plan termination.

  Historically, people receive those notifications, and they simply disregard these letters or throw them away.

  So, I highly recommend that you keep an eye on your mailbox to receive this information—to confirm what I’m about to share with you.

The Medicare Annual Election Period runs every year from October 15th through December 7th. During this time, people can shop and compare plans. I highly suggest that you utilize this Annual Election Period to find a replacement for your Premera Medicare Advantage plan.

Update: If you have received notice that your plan is changing or ending, please call us to find an alternate option: 888-414-4547

Hi. I’m Mark Prip with Policy Guide, and I have been teaching people about Medicare for the last 15+ years. At the bottom of this page, I will provide you with all of the resource links from which I’m gathering information so you can review it for yourself – as evidence of these changes that are to come.

Let’s start with the announcement of these changes from Premara.

The Premara Announcement

This statement is directly from the Premara Blue Cross CEO, taken from an article that I reviewed on PR Newswire:

“This was an incredibly difficult decision, particularly given our position as the only local commercial health plan in Washington and our commitment to serving our community.

Despite our best efforts, the challenging market and financial constraints have made the long-term success of our Medicare Advantage program unsustainable.

Through the remainder of 2024, our commitment to our Medicare Advantage members is unwavering. We’ll continue to ensure that they receive excellent service they have come to expect from Premera Blue Cross.”

I also went to the Premera Blue Cross website and took the below screenshot. Basically (right there on the Medicare Advantage page) is a bold statement letting current policyholders know that:

“Premera Blue Cross has publicly announced the company will exit the Medicare Advantage market as of January 1, 2025. Premera will no longer offer Medicare Advantage plans.

All existing Medicare Advantage members’ coverage will end December 31st of 2024.”

And again, as I said at the beginning of this article, the Premera Medicare Supplement plan members will not be affected.

So the next question is: why is this happening?

Why Is This Happening?

Obviously, I read you the statement from the CEO, but that was kind of vague and generalized.

I recently covered Aetna, which is dropping upwards of 400,000 people across the United States. I also covered the changes with Humana, which is doing the exact same thing. These providers are not leaving the market, but they’re making major reductions in many, many states.

Let’s look a little further at what Premera is saying.

“Premera Blue Cross, a leading health plan in the Pacific Northwest, announced today that it will no longer offer Medicare Advantage plans starting January 1, 2025. This strategic decision is influenced by changing market conditions and financial pressures.

By exiting the Medicare Advantage market, Premera plans to redirect its resources towards other growing business lines, such as employer-sponsored health plans, Medicare Supplement plans, and plans offered under the Affordable Care Act.

This shift will enable Premera to invest in innovative solutions and programs to increase access to affordable healthcare.”

The bottom line is this. Medical loss ratios (the amount that these insurance companies are receiving as reimbursement from the federal government) are not sustainable, or at least that’s what these companies are claiming.

So, we’re seeing many of these smaller, localized companies unable to weather the storm when it comes to the medical loss ratio.

Next, I want to give you some ideas on how to prepare and find a replacement plan during this year’s Medicare Annual Election Period.

Option #1: Find Another Medicare Advantage Plan

If you want to find another Medicare Advantage plan, the good news is that finding a replacement company will not be that hard.

I recommend that you make a list of your current:

• Doctors
• Hospitals
• Medical providers
• Prescription medications (including the proper spelling and dosage)

This is important because when you go to the marketplace to find a new plan, you want one that covers all your medical providers and prescription medications.

You also want to find a plan that’s affordable and has benefit structures similar to those of your Premera Blue Cross Medicare Advantage plan.

Option #2: Switch to a Medigap Plan

Unfortunately, losing your Medicare Advantage plan is, quite frankly, a nightmare. But because this loss of coverage is out of your control, it triggers a guaranteed issue right.

This means if you’ve always wanted a Medigap (or Medicare Supplement) plan but have been unable to qualify due to current medical conditions, those medical conditions are waived.

So, if you leave your Premera Medicare Advantage plan and pick up a Medigap or Medicare Supplement plan, those health questions will not be asked to determine your eligibility.

If you want that Medicare Supplement plan, now is the time when you can switch over to that.

Benefits of Medigap

A Medigap (or Medicare Supplement) plan will cost more per month, but it will provide far superior coverage.

With a Medigap plan:

You will not deal with networks.

You will not deal with provider disputes between the provider and the Medicare Advantage company.

You will not deal with prior authorizations.

You will not deal with referrals.

You will not deal with copays and deductibles.

Your Original Medicare will generally cover 80% of all Medicare costs. The Medigap plan is going to come in and pay that 20% balance.

My Final Thoughts

You’re not the only one experiencing this.  Just about every major Medicare Advantage company in the marketplace is making some kind of shift and change.

Generally, that is increasing cost shares on Medicare Advantage plans, or for you folks on the Premera Blue Cross, they’re actually terminating the plan.

I highly recommend you keep an eye out for the mail. That will solidify all of the information I’m providing you. Have all of your information ready to shop for another plan.

Obviously, the goal is to avoid gaps in coverage. Once you find proof from Premera, jump on the marketplace and try to find a replacement plan.

Now, if you need help with this, we can come in and do a needs analysis for you. We will help you with those lists of prescriptions, get your doctor’s list together, and then look at what’s available with other companies for the 2025 year. We can help you transition to another plan.

If you have questions, give us a call. We would be happy to do everything we can to help you understand more in-depth what these changes mean for you. Thanks!

Sources:  Premara  |  PR Newswire

FAQs

• What is causing Premera Blue Cross to exit the Medicare Advantage market?

  Premera Blue Cross has decided to leave the Medicare Advantage market due to changing market conditions and financial pressures. By reallocating their resources, Premera aims to focus on expanding other business lines such as employer-sponsored health plans and Medicare Supplement plans.

• How will the closure of Premera’s Medicare Advantage plans affect members?

  Although the Medicare Advantage plans are being phased out, members are protected by guaranteed issue rights. This ensures that members can transition to a new plan without being denied due to pre-existing conditions, allowing them to maintain continuous coverage.

• What should members do to prepare for finding a new Medicare plan?

  Members should compile a list of current healthcare providers and prescription medications. This information is crucial when evaluating new plans to ensure that all medical needs and preferred providers are covered by the new plan chosen.

• Are Medicare Supplement plans a good alternative to Medicare Advantage plans?

  Medicare Supplement plans can be a beneficial alternative due to their broader coverage and absence of network restrictions. Although they may have higher monthly premiums, they typically result in fewer out-of-pocket expenses for members.

• Is it possible for members to have gaps in coverage during this transition?

  To avoid coverage interruptions, members must act quickly and find a replacement plan before their current Premera Blue Cross Medicare Advantage plan expires. This may involve reaching out to alternative insurance providers or utilizing the assistance of an insurance broker.