Anthem MediBlue Plus (HMO)
Anthem MediBlue Plus (HMO) is a HMO Medicare Advantage (Medicare Part C) plan offered by Anthem Blue Cross and Blue Shield.
Plan ID: H9525-013.
$0.00
Monthly Premium
Anthem MediBlue Plus (HMO) is a HMO Medicare Advantage (Medicare Part C) plan offered by Anthem Blue Cross and Blue Shield.
Plan ID: H9525-013.
Kentucky Counties Served
Adair
Allen
Anderson
Barren
Boone
Boyd
Bullitt
Floyd
Henderson
Jefferson
Ballard
Bath
Bell
Bourbon
Boyle
Bracken
Breckinridge
Butler
Caldwell
Calloway
Campbell
Carlisle
Carroll
Carter
Casey
Christian
Claiborne
Clark
Clay
Clinton
Crittenden
Cumberland
Daviess
Edmonson
Elliott
Estill
Fayette
Fleming
Franklin
Fulton
Gallatin
Garrard
Grant
Graves
Grayson
Green
Greenup
Hancock
Hardin
Harlan
Harrison
Hart
Henry
Hickman
Hopkins
Jackson
Jessamine
Johnson
Kenton
Knott
Knox
Larue
Laurel
Lawrence
Lee
Leslie
Letcher
Lewis
Livingston
Logan
Lyon
Madison
Magoffin
Marion
Marshall
Martin
Mason
Mccracken
Mccreary
Mclean
Meade
Menifee
Mercer
Metcalfe
Monroe
Montgomery
Morgan
Muhlenberg
Nelson
Nicholas
Ohio
Oldham
Owen
Owsley
Pendleton
Perry
Pickett
Pike
Powell
Pulaski
Robertson
Rockcastle
Rowan
Russell
Scott
Shelby
Simpson
Spencer
Taylor
Todd
Trigg
Trimble
Union
Warren
Washington
Wayne
Webster
Whitley
Wolfe
Woodford
Basic Costs and Coverage
Coverage | Cost |
---|---|
Monthly Deductible | $0 |
Out of Pocket Max |
In-Network: $5300 Out-of-Network: N/A |
Initial Coverage Limit | $4660 |
Catastrophic Coverage Limit | $7,400 |
Primary Care Doctor Visit | In-Network: $0.00 copay |
Specialty Doctor Visit | In-Network: $35.00 copay |
Inpatient Hospital Care | In-Network: Days 1-7: $295.00 per day, per admission / Days 8-90: $0.00 per day, per admission Additional Hospital Days: Unlimited additional days |
Urgent Care | Urgent Care: $30.00 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: $260.00 copay Per Trip Air Ambulance: $260.00 copay |
Health Care Services and Medical Supplies
Anthem MediBlue Plus (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 - $25.00 copay X-Rays: $50.00 - $130.00 copay Therapeutic Radiological Services: 20% coinsurance Outpatient Diagnostic Procedures/Tests: $0.00 - $95.00 copay Diagnostic Radiological Services: $95.00 - $195.00 copay |
Home Health Care | In-Network: $0.00 copay |
Mental Health Inpatient Care | In-Network: Days 1-6: $275.00 per day, per admission / Days 7-90: $0.00 per day, per admission Additional Hospital Days: Unlimited additional days |
Mental Health Outpatient Care | In-Network: Individual and Group Sessions: $35.00 copay |
Outpatient Services / Surgery | In-Network: Outpatient Hospital - Surgery: $275.00 copay Observation Services: $275.00 copay Ambulatory Surgical Center: $225.00 copay |
Outpatient Substance Abuse Care | In-Network: Individual and Group Sessions: $35.00 copay |
Over-the-counter (OTC) Items | This plan covers certain approved, non-prescription, over-the-counter drugs and health-related items, up to $100 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 - $35.00 copay Routine Foot Care: $0.00 copay Unlimited routine foot care visits 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 Dental Services: $0.00 copay This plan covers: 2 oral exam(s), 2 cleaning(s), 1 dental X-ray(s), 1 fluoride treatment(s) every year. Medicare Covered Dental: $0.00 copay Comprehensive Dental Services: $0.00 copay This plan covers up to a $1,500.00 allowance for covered comprehensive dental services every year. |
Vision Benefits
The following vision services are covered from in-network providers.
Coverage | Cost |
---|---|
Vision Benefits | In-Network: Medicare Covered Eye Exam: $0.00 - $35.00 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 $200.00 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: $35.00 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(s) and hearing aid fitting/evaluation(s) every year. $3,000.00 maximum plan benefit coverage amount applies to prescribed hearing aids covered by the plan 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 |