Anthem Blue Cross and Blue Shield Name of Carrier BluePreferred for Group Name of Plan F-20-500/6350-90% 15/40/60/30% PART A: TYPE OF COVERAGE 1. TYPE OF PLAN Preferred Provider plan 2. OUT-OF-NETWORK CARE COVERED?1 Yes, but the patient pays more for Out-of-Network care 3. AREAS OF COLORADO WHERE PLAN IS AVAILABLE Plan is available throughout.
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Anthem MediBlue Plus (HMO) H9525-008 is a 2021 Medicare Advantage Plan or Medicare Part-C plan by Anthem Blue Cross and Blue Shield available to residents in Kentucky. This plan includes additional Medicare prescription drug (Part-D) coverage. The Anthem MediBlue Plus (HMO) has a monthly premium of $0 and has an in-network Maximum Out-of-Pocket limit of $5,300 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $5,300 out of pocket. This can be a extremely nice safety net.
- The Affordable Care Act (ACA, or health care reform law) requires Anthem Blue Cross and Blue Shield (Anthem) to cover certain preventive care services with no member cost-sharing (copayments, deductibles, or coinsurance).1 Cost-sharing requirements may still apply to preventive care services received from out-of-network providers.
- In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. Trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123.
Anthem MediBlue Plus (HMO) is a Local HMO. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your PCP will serve as your personal doctor to provide all of your basic healthcare services. If you require specialized care or a physician specialist, your primary care physician will make the arrangements and inform you where you can go in the network. You will need your PCPs okay, called a referral. Services received from an out-of-network provider are not typically covered by the plan.
Anthem Blue Cross and Blue Shield works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Anthem MediBlue Plus (HMO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Anthem Blue Cross and Blue Shield and not Original Medicare. With Medicare Advantage Plans you are always covered for urgently needed and emergency care. Plus you receive all of the benefits of Original Medicare from Anthem Blue Cross and Blue Shield except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.
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2021 Anthem Blue Cross and Blue Shield Medicare Advantage Plan Costs
| Name: |
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| Plan ID: | H9525-008 |
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| Provider: | Anthem Blue Cross and Blue Shield |
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| Year: | 2021 |
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| Type: | Local HMO |
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| Monthly Premium C+D: | $0 |
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| Part C Premium: | $0 |
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| MOOP: | $5,300 |
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| Part D (Drug) Premium: | $0 |
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| Part D Supplemental Premium | $0 |
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| Total Part D Premium: | $0 |
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| Drug Deductible: | $0 |
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| Tiers with No Deductible: | 0 |
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| Gap Coverage: | Yes |
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| Benchmark: | not below the regional benchmark |
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| Type of Medicare Health: | Enhanced Alternative |
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| Drug Benefit Type: | Enhanced |
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| Similar Plan: | H9525-004 |
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Anthem MediBlue Plus (HMO) Part-C Premium
Anthem Blue Cross and Blue Shield plan charges a $0 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.
H9525-008 Part-D Deductible and Premium
Anthem MediBlue Plus (HMO) has a monthly drug premium of $0 and a $0 drug deductible. This Anthem Blue Cross and Blue Shield plan offers a $0 Part D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0 this Premium covers any enhanced plan benefits offered by Anthem Blue Cross and Blue Shield above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $0 . The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lower due to negative basic or supplemental premiums.
Anthem Blue Cross and Blue Shield Gap Coverage
In 2021 once you and your plan provider have spent $4130 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA 'donut hole') You will be required to pay 25% for prescription drugs unless your plan offers additional coverage. This Anthem Blue Cross and Blue Shield plan does offer additional coverage through the gap.
H9525-008 Formulary or Drug Coverage
Anthem MediBlue Plus (HMO) formulary is divided into tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers.By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price.
2021 Anthem MediBlue Plus (HMO) Summary of Benefits
Additional Benefits
Comprehensive Dental
| Diagnostic services | $0 copay |
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| Endodontics | 70% coinsurance |
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| Extractions | 50% coinsurance |
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| Non-routine services | $0 copay |
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| Periodontics | 70% coinsurance |
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| Prosthodontics, other oral/maxillofacial surgery, other services | 70% coinsurance |
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| Restorative services | 50% coinsurance |
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Deductible
Diagnostic Tests and Procedures
| Diagnostic radiology services (e.g., MRI) | $180-225 copay |
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| Diagnostic tests and procedures | $0-225 copay |
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| Lab services | $0-25 copay |
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| Outpatient x-rays | $50-130 copay |
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Doctor Visits
| Primary | $5 copay per visit |
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| Specialist | $35 copay per visit |
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Emergency care/Urgent Care
| Emergency | $90 copay per visit (always covered) |
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| Urgent care | $40 copay per visit (always covered) |
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Foot Care (podiatry services)
| Foot exams and treatment | $0-35 copay |
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| Routine foot care | $0 copay |
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Ground Ambulance
Hearing
| Fitting/evaluation | $0 copay |
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| Hearing aids | $0 copay |
|---|
| Hearing exam | $35 copay |
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Inpatient Hospital Coverage
$300 per day for days 1 through 7
$0 per day for days 8 through 90 |
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Medical Equipment/Supplies
| Diabetes supplies | $0 copay |
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| Durable medical equipment (e.g., wheelchairs, oxygen) | 0-20% coinsurance per item |
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| Prosthetics (e.g., braces, artificial limbs) | 20% coinsurance per item |
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Medicare Part B Drugs
| Chemotherapy | 20% coinsurance |
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| Other Part B drugs | 20% coinsurance |
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Mental Health Services
| Inpatient hospital - psychiatric | $275 per day for days 1 through 6
$0 per day for days 7 through 90 |
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| Outpatient group therapy visit | $40 copay |
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| Outpatient group therapy visit with a psychiatrist | $40 copay |
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| Outpatient individual therapy visit | $40 copay |
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| Outpatient individual therapy visit with a psychiatrist | $40 copay |
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MOOP
Option
Optional supplemental benefits
Outpatient Hospital Coverage
Package #1
| Deductible |
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| Monthly Premium | $17.00 |
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Package #2
| Deductible |
|---|
| Monthly Premium | $23.00 |
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Package #3
| Deductible |
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| Monthly Premium | $51.00 |
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Preventive Care
Preventive Dental
| Cleaning | $0 copay |
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| Dental x-ray(s) | $0 copay |
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| Fluoride treatment | $0 copay |
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| Oral exam | $0 copay |
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Rehabilitation Services
| Occupational therapy visit | $40 copay |
|---|
| Physical therapy and speech and language therapy visit | $40 copay |
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Skilled Nursing Facility
$0 per day for days 1 through 20
$184 per day for days 21 through 100 |
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Transportation
Vision
| Contact lenses | $0 copay |
|---|
| Eyeglass frames | $0 copay |
|---|
| Eyeglass lenses | $0 copay |
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| Eyeglasses (frames and lenses) | $0 copay |
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| Other | Not covered |
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| Routine eye exam | $0 copay |
|---|
| Upgrades | Not covered |
|---|
Wellness Programs (e.g. fitness nursing hotline)
Reviews for Anthem MediBlue Plus (HMO) H9525
| 2019 Overall Rating |
|---|
| Part C Summary Rating |
|---|
| Part D Summary Rating |
|---|
| Staying Healthy: Screenings, Tests, Vaccines |
|---|
| Managing Chronic (Long Term) Conditions |
|---|
| Member Experience with Health Plan |
|---|
| Complaints and Changes in Plans Performance |
|---|
| Health Plan Customer Service |
|---|
| Drug Plan Customer Service |
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| Complaints and Changes in the Drug Plan |
|---|
| Member Experience with the Drug Plan |
|---|
| Drug Safety and Accuracy of Drug Pricing |
|---|
Staying Healthy, Screening, Testing, & Vaccines
| Total Preventative Rating |
|---|
| Breast Cancer Screening |
|---|
| Colorectal Cancer Screening |
|---|
| Annual Flu Vaccine |
|---|
| Improving Physical |
|---|
| Improving Mental Health |
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| Monitoring Physical Activity |
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| Adult BMI Assessment |
|---|
Managing Chronic And Long Term Care for Older Adults
| Total Rating |
|---|
| SNP Care Management |
|---|
| Medication Review |
|---|
| Functional Status Assessment |
|---|
| Pain Screening |
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| Osteoporosis Management |
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| Diabetes Care - Eye Exam |
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| Diabetes Care - Kidney Disease |
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| Diabetes Care - Blood Sugar |
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| Rheumatoid Arthritis |
|---|
| Reducing Risk of Falling |
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| Improving Bladder Control |
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| Medication Reconciliation |
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| Statin Therapy |
|---|
Member Experience with Health Plan
| Total Experience Rating |
|---|
| Getting Needed Care |
|---|
| Customer Service |
|---|
| Health Care Quality |
|---|
| Rating of Health Plan |
|---|
| Care Coordination |
|---|
Anthem Blue Cross Blue Shield Ppo Deductible
Member Complaints and Changes in Anthem MediBlue Plus (HMO) Plans Performance
| Total Rating |
|---|
| Complaints about Health Plan |
|---|
| Members Leaving the Plan |
|---|
| Health Plan Quality Improvement |
|---|
| Timely Decisions About Appeals |
|---|
Health Plan Customer Service Rating for Anthem MediBlue Plus (HMO)
| Total Customer Service Rating |
|---|
| Reviewing Appeals Decisions |
|---|
| Call Center, TTY, Foreign Language |
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Anthem MediBlue Plus (HMO) Drug Plan Customer Service Ratings
| Total Rating |
|---|
| Call Center, TTY, Foreign Language |
|---|
| Appeals Auto |
|---|
| Appeals Upheld |
|---|
Ratings For Member Complaints and Changes in the Drug Plans Performance
| Total Rating |
|---|
| Complaints about the Drug Plan |
|---|
| Members Choosing to Leave the Plan |
|---|
| Drug Plan Quality Improvement |
|---|
Member Experience with the Drug Plan
| Total Rating |
|---|
| Rating of Drug Plan |
|---|
| Getting Needed Prescription Drugs |
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Drug Safety and Accuracy of Drug Pricing
| Total Rating |
|---|
| MPF Price Accuracy |
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| Drug Adherence for Diabetes Medications |
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| Drug Adherence for Hypertension (RAS antagonists) |
|---|
| Drug Adherence for Cholesterol (Statins) |
|---|
| MTM Program Completion Rate for CMR |
|---|
| Statin with Diabetes |
|---|
Ready to Enroll?
Or Call
1-855-778-4180
Mon-Sat 8am-11pm EST
Sun 9am-6pm EST
Coverage Area for Anthem MediBlue Plus (HMO)
(Click county to compare all available Advantage plans)
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Source: CMS.
Data as of September 9, 2020.
Notes: Data are subject to change as contracts are finalized. For 2021, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit.Includes 2021 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.
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Benefit Details
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- Covered Drug List
Medical Deductible
- Individual:
- N/A
- Family:
- N/A
- Per Person:
- N/A
Drug Deductible
- Individual:
- N/A
- Family:
- N/A
- Per Person:
- N/A
Medical & Drug Deductible
- Individual:
- $6,350
- Family:
- $12700
- Per Person:
- $6350
Medical Max Out-of-Pocket
- Individual:
- N/A
- Family:
- N/A
- Per Person:
- N/A
Drug Max Out-of-Pocket
- Individual:
- N/A
- Family:
- N/A
- Per Person:
- N/A
Medical & Drug Max Out-of-Pocket
- Individual:
- $8,150
- Family:
- $16300
- Per Person:
- $8150
Eligible Locations
County
Adair; Audrain; Barry; Bollinger; Boone; Butler; Callaway; Camden; Cape Girardeau; Carter; Cedar; Chariton; Christian; Clark; Cole; Cooper; Crawford; Dade; Dallas; Dent; Douglas; Dunklin; Gasconade; Greene; Hickory; Howard; Howell; Iron; Knox; Laclede; Lawrence; Lewis; Linn; Macon; Madison; Maries; Marion; Miller; Mississippi; Moniteau; Monroe; Montgomery; Morgan; New Madrid; Oregon; Osage; Ozark; Pemiscot; Perry; Phelps; Pike; Polk; Pulaski; Putnam; Ralls; Randolph; Reynolds; Ripley; Schuyler; Scotland; Scott; Shannon; Shelby; Stoddard; Stone; Sullivan; Taney; Texas; Wayne; Webster; Wright
Valid in these Zip Codes
N/A
Primary Care Physician
- Copay:
- $30.00 Copay with deductible
- Coinsurance:
- 20.00% Coinsurance after deductible
- Exclusions:
- N/A
- Benefit Explanation:
- First 2 visits subject to copay. Visits 3+ subject to deductible and coinsurance.
Specialist
- Copay:
- $60.00 Copay with deductible
- Coinsurance:
- 20.00% Coinsurance after deductible
- Exclusions:
- N/A
- Benefit Explanation:
- First 2 visits subject to copay. Visits 3+ subject to deductible and coinsurance.
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Prescription Drugs
Preferred Brand Drugs
- Copay:
- $50.00
- Coinsurance:
- Not Applicable
- Exclusions:
- N/A
- Benefit Explanation:
- Cost share shown is for a 30 day supply.
Generic Drugs
- Copay:
- $20.00
- Coinsurance:
- Not Applicable
- Exclusions:
- N/A
- Benefit Explanation:
- Cost share shown is for a 30 day supply.
Specialty Brand Drugs
- Copay:
- Not Applicable
- Coinsurance:
- 40.00% Coinsurance after deductible
- Exclusions:
- N/A
- Benefit Explanation:
- Cost share shown is for a 30 day supply.
Non-Preferred Brand Drugs
- Copay:
- Not Applicable
- Coinsurance:
- 40.00% Coinsurance after deductible
- Exclusions:
- N/A
- Benefit Explanation:
- Cost share shown is for a 30 day supply.
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Hospital Services
- Copay:
- Not Applicable
- Coinsurance:
- 20.00% Coinsurance after deductible
- Exclusions:
- N/A
- Benefit Explanation:
- N/A
Inpatient Services
- Copay:
- Not Applicable
- Coinsurance:
- 20.00% Coinsurance after deductible
- Exclusions:
- N/A
- Benefit Explanation:
- N/A
Emergency Room
- Copay:
- $500.00 Copay after deductible
- Coinsurance:
- 20.00% Coinsurance after deductible
- Exclusions:
- N/A
- Benefit Explanation:
- Emergency Room copay is waived if directly admitted to the hospital.
Urgent Care
- Copay:
- $75.00
- Coinsurance:
- Not Applicable
- Exclusions:
- N/A
- Benefit Explanation:
- N/A
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Anthem Blue Cross Blue Shield Copay For Mri
Maternity
Bcbs Anthem Insurance
Labor and Delivery Hospital Stay
- Copay:
- Not Applicable
- Coinsurance:
- 20.00% Coinsurance after deductible
- Exclusions:
- N/A
- Benefit Explanation:
- N/A
Anthem Blue Cross Blue Shield Deductible
Pre and Postnatal Office Visit
- Copay:
- Not Applicable
- Coinsurance:
- 20.00% Coinsurance after deductible
- Exclusions:
- N/A
- Benefit Explanation:
- N/A
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Routine Eye Exams for Children
1 Visit(s) per Year
- Copay:
- No Charge
- Coinsurance:
- Not Applicable
- Exclusions:
- N/A
- Benefit Explanation:
- N/A
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Dental
Routine Dental Checkups for Children
Copays For Blue Cross Coverage
2 Visit(s) per Year
- Copay:
- No Charge after deductible
- Coinsurance:
- Not Applicable
- Exclusions:
- N/A
- Benefit Explanation:
- N/A
Routine Dental Checkups for Adults
- Copay:
- N/A
- Coinsurance:
- N/A
- Exclusions:
- N/A
- Benefit Explanation:
- N/A
Basic Dental Care - Child
- Copay:
- Not Applicable
- Coinsurance:
- 50.00% Coinsurance after deductible
- Exclusions:
- N/A
- Benefit Explanation:
- N/A
Anthem Blue Cross Blue Shield Copay
Basic Dental Care - Adult
- Copay:
- N/A
- Coinsurance:
- N/A
- Exclusions:
- N/A
- Benefit Explanation:
- N/A
Major Dental Care - Child
- Copay:
- Not Applicable
- Coinsurance:
- 50.00% Coinsurance after deductible
- Exclusions:
- N/A
- Benefit Explanation:
- N/A
Major Dental Care - Adult
- Copay:
- N/A
- Coinsurance:
- N/A
- Exclusions:
- N/A
- Benefit Explanation:
- N/A
Bcbs Copay Amount
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Spouse, Yes; Adopted Child, No; Foster Child, No; Ward, No; Stepson or Stepdaughter, No; Self, Yes; Child, No; Court Appointed Guardian, No; Life Partner, Yes
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