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Medicare Matters: A Premera primer

My self-imposed sabbatical from writing this column has ended and I am back with a vengeance. My batteries are fully charged and I am raring to go on all things insurance related. So, sit back, read on and enjoy and hopefully learn something that will be of benefit to yourself or a friend.

It seems appropriate that the subject for today’s column is the Affordable Care Act, as the open enrollment finished three weeks ago on March 31.

I will be giving some pointers and primers on how to get the best use from your new insurance plans if you are on the Premera or Lifewise plans. From here on I shall just refer to Premera as both companies’ benefits and premiums are identical, so when I say Premera I am also including Lifewise.

I will be primarily discussing the Premera plans as they were the only offerings we had here in Clallam County that were available on the Exchange. The other major company is Regence and they did not offer any of their plans on the Exchange and were therefore unable to offer any tax credits or premium subsidies.

If you have a new metallic (Bronze, Silver or Gold) plan from Premera, it is important that you choose a Primary Care Provider (PCP). For example, if you are on a Bronze plan and went to see your regular doctor, if you had designated that doctor as your PCP your co-pay would be a maximum of $20; if not designated, it would be $50. That is quite a significant saving. If you have not done so already, call Premera at the number on the back of your ID card and ensure you choose a doctor, or you can do this yourself at the Premera website.

You can even choose a naturopath as a primary care provider, which is fantastic news for many folks.

The new plans have an expanded list of preventative services and for the first time a list of preventative prescription medications.

The lists are available on the Premera website at www.premera.com or stop by my office and we will gladly provide you with a list.

If you have a condition such as hypertension, high cholesterol or diabetes, all the new plans will provide you with many generic prescription drugs for a $0 co-pay and no deductible.

That is right, you walk into the pharmacy and walk out without dipping into your pocket other than to show your Premera card.

The list of medications is a decent size list; however, I will tell you that if you are on expensive brand-name medications they are not on the $0 co-pay list.

It is always worth showing your Premera ID card as you will get a discount at the pharmacy and more importantly the costs of your medications do count toward both deductibles as well as your “out of pocket maximums.”

The list of preventative services also is quite extensive and has grown both for men and women in the past year.

Take heed ...

Here is an important word of warning. I went to my dermatologist for my annual preventative screening and I asked the billing clerk to code my visit as a preventative visit. She replied that was not the code they generally used. She did bill it as preventative and it was covered at 100 percent. Otherwise I am on an HSA plan where it would not have been covered at all and the Premera negotiated discounted rate was $167. Quite a savings just for asking.

A couple of pointers on the Premera provider network:

You can either call a provider or look on the Premera website to find a preferred provider; however, a word of warning — the website is not current, so be careful.

For example, Dr. James Hult, who works at Pacific Family and Internal Medicine with Dr. George Mathew, is listed as a preferred provider on the website, but closer checking shows that accreditation was based upon his former employment at Pacific Primary Care.

Pacific Family and Internal Medicine are offering quite a significant discount to Premera patients until they get their contracting sorted out with Premera. Many thanks for Dr. Mathew for doing so.

With many more folks having insurance coverage than ever before, this is highlighting a growing problem both locally and nationwide and that is the shortage of primary care providers. Most providers are not accepting new patients and have a wait list of patients.

Olympic Medical Practitioners, a division of Olympic Medical Center, will shortly be opening a clinic at 800 N. Fifth Ave., as well as providing a walk-in clinic at their main building at 844 N. Fifth Ave. Last time I checked they were not yet taking appointments as they were not 100 percent sure who would be staffing the clinic.

Please take the time now to learn more about your policies as that way you can avoid frustration when it comes time to use the benefits. As always, feel free to contact my office or Premera directly if you have any questions or concerns.

 

Phil Castell is the owner of Castell Insurance and can be reached at phil@castellinsurance.com or 683-9284.

 

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