Insurance Accepted
Pacific Medical Centers is committed to making it simple for our valued patients to receive the care they need by offering a full range of primary and specialty services and accepting most major insurance plans.
We accept the following health insurance plans. If your plan name is not listed, we may be out of network with your plan, which will result in a higher cost share and rejected/denied referrals and/or prescriptions.
Please check with your insurance carrier for benefits and a listing of their participating network providers. This includes If you are calling for a Behavioral Health appointment.
Always check your coverage with your insurance carrier about specific care or procedures you might seek or be referred to. That way you can learn in advance what your out-of-pocket costs might be. Read more tips on getting the most out of your insurance.
Jump to:
- 2024 Medicare Options Accepted
- 2024 Group, Exchange and Other Plans Accepted
- HMO/Managed Care doctor selection
- Vision Care Coverage
- Getting the Most Out of Your Health Insurance
2024 Medicare Options Accepted
- Traditional Medicare (Part B)*
- Medicare Prescription Drug coverage (Part D) – at Maxor pharmacies located in PacMed clinics
- Medicare Advantage (Part C) – PacMed accepts a variety of these plans. Please see each insurer below for their specific Medicare Advantage plans where we are in network.
- Medicare Supplemental (“Medigap”) plans can also be used to pay for care at PacMed; these plans pay secondary to Medicare and may cover an additional percentage of Medicare Part B-eligible services. PacMed accepts all Medigap plans for those who also have Medicare as primary insurance.
* Note: Medicare Part A coverage is hospital insurance; PacMed does not have a hospital so this coverage does not apply. Please check with our affiliated hospital in your area about their Medicare Part A policy in case of hospital admissions.
2024 Group, Exchange and Other Plans Accepted
Start by looking for your insurance carrier’s name, then search for your plan under the category it falls within:
- Group / Employer Plan – available to you through an employer, union, trade association or other group you belong to
- Medicare Advantage Plans* – commercial plans that replace Original Medicare, also known as Medicare Part C
- Exchange and Individual Plans – available to purchase individually on the Washington State Health Insurance Exchange
- Medicaid Plans – for those who qualify for low-income health insurance through Washington State
*Medicare Advantage Plans may vary by clinic. You can contact Connexion Insurance Solutions at 1.877.315.3279 to find a plan that meets your needs. The plans listed below are not a complete listing of Medicare plans available in your service area. For a complete listing, please contact 1.800.MEDICARE (TTY users should call 1.877.486.2048), 24 hours a day/7 days a week or consult www.medicare.gov.
Click the “+” next to an insurer to view their plans we accept.
Some insurance plans may only be accepted for specialty care appointments. Please refer to the notes section under your insurer to confirm primary care visits are covered under your plan.
Group / Employer Plans
• Aetna Whole Health – Puget Sound
• Aetna Standard Plans Open Choice PPO
• Aetna Standard Plans Managed Choice POS
• Aetna Standard Plans Select
• Aetna Standard Plans Affordable Health Choices
• Aetna Standard Plans (Voluntary Plans)
• Aetna Open Access Plans Choice POS II
• Aetna Open Access Plans Select
• Aetna Open Access Plans Elect Choice EPO
• Aetna Open Access Plans Managed Choice POS
• Aetna HealthFund Plans Choice POS II
• Aetna HealthFund Plans Open Access Elect Choice EPO
• Aetna HealthFund Plans Open Access Managed Choice POS
• Aetna HealthFund Plans Open Access Aetna Select
• Aetna HealthFund Plans Open Choice PPO
Medicare Advantage Plans
• Aetna Medicare PPO Choice
• Aetna Medicare PPO Eagle
• Aetna Medicare PPO Preferred
• Aetna Medicare PPO Select
• Aetna Medicare PPO Smartfit
Aetna Medicare HMO-POS (A, B)
• Aetna Medicare HMO-POS Elite
• Aetna Medicare HMO-POS Extra Value Plus
• Aetna Medicare HMO-POS Platinum Plus
• Aetna Medicare HMO-POS Prime
• Aetna Medicare HMO-POS Smartfit Elite
• Aetna Medicare HMO-POS Value
• Aetna Medicare HMO-POS Value Plus
Not Accepted: Exchange and Individual Plans
Not Applicable: Medicaid Plans
NOTES
A Patients must update their assigned PCP to the PacMed provider they will see.
B Specialty referrals from outside Providence Swedish or PacMed PCPs require a pre-authorization or referral from your assigned PCP.
Group / Employer Plans
- Cigna Open Access Plus OAP
- Cigna Exclusive Provider Organization EPO
- Cigna Preferred Provider Organization PPO
- Cigna Medical Indemnity
- Cigna Medical Network Plan
- Cigna Medical Network Plan POS
- Cigna Medical Network Plan Open Access Point of Service
- Cigna HMO
- Cigna HMO POS
- Cigna HMO Open Access
- Cigna HMO Open Access POS
- Cigna SureFit
Medicare Advantage Plans
- Cigna True Choice Medicare PPO
- Cigna Preferred Medicare HMO (A, B)
Out of Network: Cigna Local Plus, Cigna Local Plus In-Network
Not Accepted: N/A
Not Applicable: Exchange and Individual Plans, Medicaid Plans
NOTES
A Patients must update their assigned PCP to the PacMed provider they will see.
B Specialty referrals from outside Providence Swedish or PacMed PCPs require a pre-authorization or referral from your assigned PCP.
Exchange and Individual Plans (A, B)
- Cascade Select Gold
- Cascade Select Silver
- Cascade Select Bronze
Medicare Advantage Plans (A, B)
- Community Health Plan of WA MA Freedom Plan HMO
- Community Health Plan of WA MA Plan 4 HMO
- Community Health Plan of WA MA Plan 2 HMO
- Community Health Plan of WA MA Plan 3 HMO
- Community Health Plan of WA MA Plan 1 HMO
- Community Health Plan of WA Dual Plan HMO D-SNP
- Community Health Plan of WA Dual Select HMO D-SNP
Medicaid Plans (A, B)
- Apple Health CHPW
Out of Network: N/A
Not Accepted: see notes
Not Applicable: Group/Employer Plans
NOTES
A Specialty Care only; Primary Care not accepted with this plan.
B Specialty referrals limited to Providence & Swedish as referring provider.
Exchange and Individual Plans
Ambetter Exchange:
- Ambetter Cascade Select Bronze (A, B)
- Ambetter Cascade Select Gold (A, B)
- Ambetter Cascade Select Silver (A, B)
- Ambetter Cascade Bronze
- Ambetter Cascade Gold
- Ambetter Cascade Silver
- Ambetter Balanced Care 4
- Ambetter Balanced Care Silver
- Ambetter Essential Care Bronze
- Ambetter Coordinated Care-Secure Care Gold
Medicaid Plans
Apple Health Coordinated Care ‘Core Connections” Foster Care
Apple Health Coordinated Care – Non-Foster (A, B)
Out of Network: N/A
Not Accepted: N/A
Not Applicable: Group/Employer Plans; Medicare Advantage
NOTES
A Specialty Care only; Primary Care not accepted with this plan.
B Specialty referrals limited to Providence & Swedish as referring provider.
Group / Employer Plans
- EverMed Direct Primary Care
Out of Network: N/A
Not Accepted: N/A
Not Applicable: Medicare Advantage Plans, Exchange and Individual Plans
Group / Employer Plans
- First Choice Health Network
Out of Network: N/A
Not Accepted: N/A
Not Applicable: Medicare Advantage Plans, Exchange and Individual Plans, Medicaid Plans
Group / Employer Plans
- All HMO and PPO Plans
Medicare Advantage Plans
- Humana USAA Honor PPO
- Humana Honor PPO
- Humana Choice PPO
- Humana Value Plus HMO (A, B)
- Humana Gold Plus HMO (A, B)
- Humana Gold Plus HMO D-SNP (A, B)
Out of Network: Any plans not listed
Not Accepted: N/A
Not Applicable: Exchange and Individual Plans
NOTES
A Patients must update their assigned PCP to the PacMed provider they will see.
B Specialty referrals from outside Providence Swedish or PacMed PCPs require a pre-authorization or referral from your assigned PCP.
Medicare Advantage Plans:
- PACE Program (A, B)
NOTES
A Specialty Care only; Primary Care not accepted with this plan.
B Specialty referrals limited to Providence & Swedish as referring provider.
Group / Employer Plans
- Kaiser Permanente Access PPO
- Kaiser Permanente WA PPO Plus First Choice Network
- Kaiser Permanente Options First Choice Network
- Kaiser Permanente Summit PPO First Choice Network
Medicare Advantage Plans (C, E, F)
- Kaiser Permanente Medicare Advantage Basic HMO
- Kaiser Permanente Medicare Advantage Optimal HMO
- Kaiser Permanente Medicare Advantage Essential HMO
- Kaiser Permanente Medicare Advantage Vital HMO
- Kaiser Permanente Medicare Advantage Key HMO
Exchange and Individual Plans (C, F)
- Kaiser Permanente Cascade Bronze
- Kaiser Permanente Cascade Gold
- Kaiser Permanente Cascade Silver
- Kaiser Permanente Basics Plus
- Kaiser Permanente Bronze HSA Silver
- Kaiser Permanente Bronze HSA X
- Kaiser Permanente Flex Bronze
- Kaiser Permanente Flex Gold
- Kaiser Permanente Flex Silver HD
- Kaiser Permanente Virtual Plus Bronze
- Kaiser Permanente Virtual Plus Silver
- Kaiser Permanente Virtual Plus Silver X
Out of Network: See notes.
Not Accepted: See notes.
Not Applicable: Medicaid Plans
NOTES
C Prior Authorization is required.
E Kaiser Medicare Advantage (MA) and Exchange/individual plans are contracted, but we are not preferred/designated as in-network. However, some specialists may be designated as in-network; please inquire with Kaiser before receiving care.
F On these plans, you cannot see a PacMed Primary Care provider.
Group / Employer Plans
- Lifewise Health Plan of WA Preferred
- LifeWise Assurance Co.
- LifeWise Primary
Exchange and Individual Plans
- LifeWise Cascade Bronze
- LifeWise Cascade Gold
- LifeWise Cascade Silver
- LifeWise Cascade Select Bronze
- LifeWise Cascade Select Gold
- LifeWise Cascade Select Silver
- LifeWise Essential Bronze
- LifeWise Essential Bronze HSA
- LifeWise Essential Gold
- LifeWise Essential Low Deductible
Out of Network: LifeWise Alpine Cascade Select
Not Accepted: N/A
Not Applicable: Medicare Advantage Plans, Medicaid Plans
Notes:
Primary Care not accepting new patients at this time; specialty referrals limited to Providence & Swedish as referring provider.
Exchange and Individual Plans
- Constant Care Silver 1
- Molina Cascade Bronze
- Molina Cascade Gold
- Molina Cascade Silver
Medicare Advantage Plans (A, B)
- Molina Medicare Choice Care HMO
- Molina Medicare Complete Care HMO D-SNP
- Molina Medicare Complete Care Select HMO D-SNP
Medicaid Plans (B)
- All Molina Managed Care Apple Health/Medicaid plans
Out of Network: Molina Medicare
Not Accepted: N/A
Not Applicable: Group / Employer Plans
NOTES
A Specialty Care only; Primary Care not accepted with this plan.
B Specialty referrals limited to Providence & Swedish as referring provider.
If you have Molina or other Medicaid eligibility-related questions, please call 206.621.4049.
Group / Employer Plans
- All PPO plans
Out of Network: N/A
Not Accepted: N/A
Not Applicable: Medicare Advantage Plans, Exchange and Individual Plans, Medicaid Plans
Group / Employer Plans
- Premera Blue Cross Foundation
- Premera Blue Cross Foundation Plus 1
- Premera Blue Cross Global
- Premera Blue Cross Heritage
- Premera Blue Cross Heritage Signature
- Premera Blue Cross Individual Signature
Medicare Advantage Plans (A, B)
- Premera Blue Cross Medicare Advantage HMO
- Premera Blue Cross Medicare Advantage Classic HMO
Exchange and Individual Plans
- Premera Blue Cross Cascade Bronze
- Premera Blue Cross Cascade Gold
- Premera Blue Cross Cascade Silver
- Premera Blue Cross Preferred Bronze EPO
- Premera Blue Cross Preferred Bronze HSA EPO
- Premera Blue Cross Preferred Gold EPO
- Premera Blue Cross Preferred Silver EPO
Out of Network: Premera Blue Cross Heritage Prime, Premera Blue Cross Heritage Prime HPN, Premera Blue Cross Peak Care (Multicare EPO/Tahoma Network)
Not Accepted: N/A
Not Applicable: Medicaid Plans
NOTES
A Patients must update their assigned PCP to the PacMed provider they will see.
B Specialty referrals from outside Providence Swedish or PacMed PCPs require a pre-authorization or referral from your assigned PCP.
Group / Employer Plans
- Providence Health Plan
Medicare Advantage Plans
- Providence Medicare Bridge 2 + Rx HMO-POS
- Providence Medicare Harbor + Rx HMO
- Providence Medicare Summit + Rx HMO-POS
- Providence Medicare Select Medical + Rx HMO
- Providence Medicare Choice + Rx HMO-POS
- Providence Medicare Cottonwood + Rx HMO-POS
- Providence Medicare Extra + Rx HMO
- Providence Medicare Focus Medical HMO
- Providence Medicare Pine + Rx HMO
- Providence Medicare Timber + Rx HMO
Out of Network: N/A
Not Accepted: N/A
Not Applicable: Exchange and Individual Plans, Medicaid Plans
Medicare Advantage Plans
- Regence BlueAdvantage HMO (A, B)
- Regence BlueAdvantage HMO Plus (A, B)
- Regence Valiance HMO (A, B)
- Regence MedAdvantage + Rx Classic PPO
- Regence MedAdvantage + Rx Core PPO
- Regence MedAdvantage + Rx Enhanced PPO
- Regence MedAdvantage + Rx Primary PPO
- Regence Valiance PPO
Out of Network: Regence KingCare Select
Not Accepted: N/A
Not Applicable: Medicaid Plans
NOTES
A Patients must update their assigned PCP to the PacMed provider they will see.
B Specialty referrals from outside Providence Swedish or PacMed PCPs require a pre-authorization or referral from your assigned PCP.
Group / Employer Plans
- USFHP (Uniformed Services Family Health Plan) – All Plans (A, B)
Out of Network: TRICARE Prime, TRICARE Select
Not Accepted: N/A
Not Applicable: Medicare Advantage Plans, Exchange and Individual Plans, Medicaid Plans
NOTES
A Patients must update their assigned PCP to the PacMed provider they will see.
B Specialty referrals from outside Providence Swedish or PacMed PCPs require a pre-authorization or referral from your assigned PCP.
All plans (A, B, C)
NOTES
A Specialty Care only; Primary Care not accepted with this plan.
B VA authorization needed for specialty referrals.
C Not accepting specialty referrals at this time.
Group / Employer Plans
- United Healthcare Core
- United Healthcare Choice Plus
- United Healthcare Navigate
- GEHA (Government Employees Health Association) – UHC Network
Medicare Advantage Plans
- AARP Medicare Advantage HMO-POS (C, D)
- UHC Dual Complete WA HMO-POS D-SNP (C, D)
- AARP Medicare Advantage PPO
- UHC Dual Complete PPO D-SNP
- UHC Care Advantage WA PPO I-SNP
- UHC Nursing Home Plan WA PPO I-SNP
- AARP Medicare Advantage Patriot No Rx PPO
Medicaid Plans
- United Healthcare Apple Health (A, B)
Out of Network: N/A
Not Accepted: N/A
Not Applicable: Exchange and Individual Plans
NOTES
A Specialty Care only; Primary Care not accepted with this plan.
B Specialty referrals limited to Providence & Swedish as referring provider.
C Patients must update their assigned PCP to the PacMed provider they will see.
D Specialty referrals from outside Providence Swedish or PacMed PCPs require a pre-authorization or referral from your assigned PCP.
Medicare Advantage Plans
- Wellcare Assist HMO (A, B)
- Wellcare Giveback HMO (A, B)
- Wellcare Mutal of Omaha Low Premium Open PPO
- Wellcare Mutal of Omaha No Premium Open PPO
- Wellcare No Premium HMO (A, B)
- Wellcare Patriot Giveback Open PPO
- Wellcare Dual Access HMO D-SNP (A, B)
- Wellcare Dual Liberty HMO D-SNP (A, B)
- Wellcare Dual Access Open PPO D-SNP
Out of Network: N/A
Not Accepted: N/A
Not Applicable: Exchange and Commercial plans
NOTES
A Patients must update their assigned PCP to the PacMed provider they will see.
B Specialty referrals from outside Providence Swedish or PacMed PCPs require a pre-authorization or referral from your assigned PCP.
HMO/Managed Care doctor selection
Some plans are considered HMO or Managed Care, which means they operate with a limited network of providers.
Assigning a PCP: Managed Medicare and Medicaid HMO plans require patients to receive primary care services from their assigned primary care physician (PCP), who is on file or “assigned” with your insurance plan. This assigned PCP acts as a care coordinator. Seeing specialists or other providers typically requires a referral from this assigned PCP, and those referrals are usually restricted to others within the same assigned HMO network.
Checking your assigned PCP: If you have one of these plans and would like to see a primary care physician with us, we recommend that you check with your insurance prior to your appointment to ensure the PCP you have assigned with your plan is the same one you are scheduled with. If your insurance has you assigned to a different PCP, they may not pay for your visits and any prescription or referral requests for specialized care may be denied.
Vision Care Coverage
- PacMed does not accept separate vision insurance products (such as VSP, Davis Vision, EyeMed, Humana Vision, etc.) for routine/preventative eye care from any outside insurance provider, with the exception of VSP plans for Providence Clinical Network caregivers. Vision care with PacMed is only typically covered if it is included in your medical plan’s “Summary of Benefits,” and/or associated with a medical issue (such as diabetes eye care). Even if a medical condition is present, some of your exam may not be covered if you have a separate vision plan.Before seeking vision treatment, we highly recommend that you CALL YOUR INSURANCE CARRIER and ask whether the services you are seeking are covered at PacMed. (If they confirm, ask for a call reference number for your records.)
Getting the Most Out of Your Health Insurance
We’ve put together some helpful tips to save you time and help you get the most out of your medical insurance. To maximize your health insurance benefits, please contact your insurance company’s Customer Service department for policy and benefit verification. The Customer Service phone number should be located on the back of your health insurance ID card.
- Please check with your insurance carrier for information on required referrals, authorizations and co-payments.
- Ask your insurance company about any upcoming procedures or visits to confirm coverage (see below)
- Please bring your insurance card to every appointment.
As with everything, good communication is the key to working well with insurance companies. Because policies vary, it’s important to contact your insurance company directly to confirm how your plan will pay charges for services and to keep records of the conversations.
1) Prior to your visit, ask your provider or care team:
- Is this a routine exam (i.e. an annual exam or physical)?
- Please note, if your visit is a routine annual exam or physical, your doctor will not be able to address questions about specific symptoms or health concerns, per insurance company contracts and rules. If you discuss medical issues outside the scope of a routine annual exam or physical, we are required to include that in our notes which will result in the visit being upgraded to a regular office exam, and may no longer be covered 100% by your insurance.
- What procedure (CPT) codes will likely apply to my visit/course of treatment?
2) Then, call your insurance company with your questions about their coverage of your upcoming visit. Some things you might ask:
- Do I have benefit coverage for (service name/CPT code)?
- Is a referral or preauthorization necessary to have this service? (If yes, your primary care provider must initiate the referral or preauthorization.)
- Do I have a deductible?
- Following my deductible, how much will I owe?
- How much will I be responsible for paying following the insurance coverage?
- What is the call reference number for this conversation? (use this in case you need to refer back to the call later if there are any disputes).
Do you need health insurance coverage?
If you need help finding insurance coverage for yourself or loved ones, please visit Washington Healthplanfinder.
Questions? Please call 206.621.4049.
Are you an external provider group of facility looking to refer your patient to PacMed?
Please fax in your request and all applicable chart notes to our centralized referral team at 206.505.1445.
Questions about the Affordable Healthcare Act? You can find more information here.
If you are unable to pay your full statement balance, please contact the Pacific Medical Centers Patient Accounts department at 206.621.4392 to discuss payment options.