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Anthem Extra Help (HMO)

Anthem Extra Help (HMO) H3447-028 Plan Details
4 out of 5 stars

Anthem Extra Help (HMO) is a HMO Medicare Advantage (Medicare Part C) plan offered by Anthem HealthKeepers
Plan ID: H3447-028

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$25.10
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Anthem Extra Help (HMO) is a HMO Medicare Advantage (Medicare Part C) plan offered by Anthem HealthKeepers
Plan ID: H3447-028

Have Medicare questions?

Talk to a licensed agent today to find a plan that fits your needs.

Get Medicare Help
Anthem Extra Help (HMO) H3447-028 Plan Details
4 out of 5 stars

Anthem Extra Help (HMO) is a HMO Medicare Advantage (Medicare Part C) plan offered by Anthem HealthKeepers
Plan ID: H3447-028

Have Medicare questions?

Talk to a licensed agent today to find a plan that fits your needs.

Get Medicare Help
$25.10
Monthly Premium

Virginia Counties Served

Henrico James City Newport News City Chesterfield Roanoke City Portsmouth City Chesapeake City Mecklenburg Richmond City Pittsylvania Campbell Middlesex Danville City Hopewell City Lynchburg City Franklin York Gloucester Halifax Prince Edward Goochland Augusta Hampton City Hanover Albemarle Norfolk City Suffolk City Stafford Roanoke Virginia Beach City Spotsylvania Petersburg City Colonial Heights City Powhatan Fredericksburg City Harrisonburg City Fauquier Botetourt Lunenburg Salem Emporia City Williamsburg City Montgomery Floyd Orange Amherst Waynesboro City Radford Prince George Shenandoah Culpeper Poquoson City Amelia Rockingham Rockbridge Charlottesville City Bedford Giles Northampton Isle of Wight Greensville Brunswick Lexington City Caroline Mathews Martinsville City Dinwiddie King William Henry Northumberland Pulaski Buena Vista City Staunton City Nottoway Wythe Bristol City Frederick Winchester City Washington Wise Tazewell

Basic Costs and Coverage

Coverage Cost
Monthly Deductible $545
Out of Pocket Max In-Network: $2900
Out-of-Network: N/A
Initial Coverage Limit $5030
Catastrophic Coverage Limit $8,000
Primary Care Doctor Visit
In-Network:
$0.00 copay
Specialty Doctor Visit
In-Network:
$20.00 copay
Inpatient Hospital Care
In-Network:
Days 1-5: $300.00 per day, per admission / Days 6-90: $0.00 per day, per admission
Additional Hospital Days: Unlimited additional days
Urgent Care
Urgent Care: $25.00 copay
Emergency Room Visit
Emergency Care: $90.00 copay
Worldwide Coverage: This plan covers urgent care and emergency services when traveling outside of the United States for less than six months. This benefit is limited to $100,000.00 per year.
Ambulance Transportation
Ground Ambulance: $300.00 copay Per Trip
Air Ambulance: 20% coinsurance

Health Care Services and Medical Supplies

Anthem Extra Help (HMO) covers additional benefits and services, some of which may not be covered by Original Medicare (Medicare Part A and Part B).

Coverage Cost
Chiropractic Services
In-Network:
Medicare Covered Chiropractic Services: $20.00 copay
Diabetes Supplies, Training, Nutrition Therapy and Monitoring
In-Network:
Diabetic Supplies: $0.00 copay
Durable Medical Eqipment (DME)
In-Network:
20% coinsurance
Diagnostic Tests, Lab and Radiology Services, and X-Rays
In-Network:
Lab Services: $0.00 copay
X-Rays: $20.00 copay - $90.00 copay
Therapeutic Radiological Services: 20% coinsurance
Outpatient Diagnostic Procedures/Tests: $0.00 copay - $100.00 copay
Diagnostic Radiological Services: $150.00 copay - $200.00 copay
Home Health Care
In-Network:
$0.00 copay
Mental Health Inpatient Care
In-Network:
Days 1-5: $300.00 per day, per admission / Days 6-90: $0.00 per day, per admission
Additional Hospital Days: Unlimited additional days
Mental Health Outpatient Care
In-Network:
Individual and Group Sessions: $40.00 copay
Outpatient Services / Surgery
In-Network:
Outpatient Hospital - Surgery: $300.00 copay
Observation Services: $300.00 copay
Ambulatory Surgical Center: $225.00 copay
Outpatient Substance Abuse Care
In-Network:
Individual and Group Sessions: $40.00 copay
Over-the-counter (OTC) Items
This plan covers certain approved, non-prescription, over-the-counter drugs and health-related items, up to $135 every quarter. Unused OTC amounts do roll over to the next quarter. Unused OTC amounts do not roll over to the next calendar year.
Podiatry Services
In-Network:
Medicare Covered Podiatry Services: $0.00 copay - $20.00 copay
Routine Foot Care: $0.00 copay
6 routine foot care visit(s) each year.
Skilled Nursing Facility Care
In-Network:
SNF Days 1 - 20: $0.00 per day / Days 21 - 100: $196.00 per day

Dental Benefits

The following dental services are covered from in-network providers.

Coverage Cost
Dental Care
In-Network:
Preventive and Comprehensive Dental Combined Allowance
This plan covers up to $3,500 for covered preventive and comprehensive dental services every year.

Medicare Covered Dental: $0.00 copay
Preventive Dental Services: $0.00 copay
Comprehensive Dental Services: $0.00 copay

Vision Benefits

The following vision services are covered from in-network providers.

Coverage Cost
Vision Benefits
In-Network:
Medicare Covered Eye Exam: $0.00 copay - $20.00 copay
Routine Eye Exam: $0.00 copay
This plan covers 1 routine eye exam(s) every year.
Medicare Covered Eye Wear: $0.00 copay
Routine Eye Wear: $0.00 copay
This plan covers up to $300.00 for eyeglasses or contact lenses every year.

Hearing Benefits

The following hearing services are covered from in-network providers.

Coverage Cost
Hearing Benefits
In-Network:
Medicare Covered Hearing Exam: $20.00 copay
Routine Hearing Exam: $0.00 copay for routine hearing exam(s). $0.00 copay for hearing aids up to the maximum plan benefit amount.
This plan covers 1 routine hearing exam every year. $300.00 maximum plan benefit for over-the-counter hearing aids OR 1 routine hearing aid fitting evaluation and a $3,000.00 maximum plan benefit for prescribed hearing aids every year.

Preventive Services and Health/Wellness Education Programs

The following services are covered from in-network providers.

Coverage Cost
Preventive Services and Health/Wellness Education Programs
In-Network:
$0.00 copay for Medicare Covered Preventive Services

Prescription Drug Costs and Coverage

The Anthem Extra Help (HMO) plan offers the following prescription drug coverage, with an annual drug deductible of $545 (excludes Tiers 1 and 6) per year.

Coverage
Cost
Coverage & Cost
Annual Drug Deductible $545 (excludes Tiers 1 and 6)
Preferred Generic
  • Preferred cost-share retail $0.00
  • Standard retail $0.00
  • Standard mail order $0.00
Select Care Drugs
  • Preferred cost-share retail $0.00
  • Standard retail $0.00
  • Standard mail order $0.00
Annual Drug Deductible $545 (excludes Tiers 1 and 6)
Preferred Generic
  • Preferred cost-share retail $0.00
  • Standard retail $0.00
  • Standard mail order $0.00
Select Care Drugs
  • Preferred cost-share retail $0.00
  • Standard retail $0.00
  • Standard mail order $0.00
Annual Drug Deductible $545 (excludes Tiers 1 and 6)
Preferred Generic
  • Preferred cost-share retail $0.00
  • Standard retail $0.00
  • Standard mail order $0.00
Select Care Drugs
  • Preferred cost-share retail $0.00
  • Standard retail $0.00
  • Standard mail order $0.00
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