2014 Anthem Senior Advantage Plus (HMO) H3655-030 By Anthem Blue Cross and Blue Shield

Anthem Senior Advantage Plus (HMO) By Anthem Blue Cross and Blue Shield



Anthem Senior Advantage Plus (HMO) is a 2014 Medicare Advantage ("Part C" or "MA Plan") plan by Anthem Blue Cross and Blue Shield. This plan from Anthem Blue Cross and Blue Shield works with Medicare to give you significant coverage beyond Part A and Part B benefits. If you decide to sign up for Anthem Senior Advantage Plus (HMO) you still retain Original Medicare. But you will get additional Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from Anthem Blue Cross and Blue Shield and not Original Medicare. With Medicare Advantage plans your always covered for urgently needed and emergency care and you receive all of the benefits of Original Medicare from this plan except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.



2014 Medicare Advantage Plan Details

Plan Name:
Anthem Senior Advantage Plus (HMO)
Plan ID:
H3655-030
Provider: Anthem Blue Cross and Blue Shield
Plan Year:2014
Plan Type: Local HMO
Monthly Premium C+D: $53.00
MOOP: $4,100


Coverage Area for Anthem Senior Advantage Plus (HMO)

(Click county to compare all available plans)





The Anthem Senior Advantage Plus (HMO) H3655-030 is available to residents in Ohio, and has a in-network Maximum Out-of-Pocket limit of $4,100 MOOP. This means that if you get sick or need a high cost procedure your co-pays are capped. If you enroll in Anthem Senior Advantage Plus (HMO) plan you will stop paying co-pays for the rest of the year once you pay out of pocket $4,100 This is a very nice safety net. This plan includes additional Medicare prescription drug (Part-D) coverage.

Anthem Senior Advantage 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 need special care for a physician specialist, your primary care physician will make the arrangements and tell you where you can go in the network. You will need your PCPs okay, called a referral. Without getting a referral or services received from out-of-network providers are not typically covered by the plan.



Ratings for Anthem Senior Advantage Plus (HMO) H3655

2014 Overall Rating
Part C Summary Rating
Total Experience Rating
Complaints, Improvements
Total Customer Service Rating
Total Preventative Rating
Chronic And Long Term Care


Member Experience Rating for Anthem Senior Advantage Plus (HMO)

Total Experience Rating
Getting Needed Care
Timely Care and Appointments
Customer Service
Health Care Quality
Rating of Health Plan
Care Coordination


Member Complaints, Problems Getting Service and Improvements in Health Plans

Total Rating
Members Leaving the Plan
Complaints about Health Plan
Access to Service
Performance Problems
Health Plan Quality Improvement


Customer Service Rating for Anthem Senior Advantage Plus (HMO)

Total Customer Service Rating
Timely Decisions About Appeals
Reviewing Appeals Decisions
Call Center


Staying Healthy, Screening, Testing, & Vaccines

Total Preventative Rating
Breast Cancer Screening
Colorectal Cancel Screening
Cardiovascular Screening
Diabetes Care
Glaucoma Testing
Annual Flu Vaccine
Improving Physical
Improving Mental Health
Monitoring Physical Activity
Adult BMI Assessment


Ratings For Managing Chronic And Long Term Care

Total Rating
Medication Review
Functional Status Assessment
Pain Screening
Osteoporosis Management
Diabetes Care - Eye Exam
Diabetes Care - Kidney Disease
Diabetes Care - Blood Sugar
Diabetes Care - Cholesterol
Controlling Blood Pressure
Rheumatoid Arthritis
Improving Bladder Control
Reducing Risk of Falling
Plan - Cause Readmissions


Part-C Premium

Anthem Blue Cross and Blue Shield plan charges a $41.20 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.



Part-D Deductible and Premium

The Anthem Senior Advantage Plus (HMO) plan has a monthly drug premium of $11.80 and a $60.00 drug deductible. This Anthem Blue Cross and Blue Shield plan offers a $11.80 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 $0.00 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 $11.80. 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.



Premium Assistance

Depending on your income level you may be eligible for full 75%, 50%, 25% premium assistance. The Anthem Senior Advantage Plus (HMO) medicare insurance plan offers a $0.00 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $2.90 for 75% low income subsidy $5.90 for 50% and $8.80 for 25%.



Part C Premium: $41.20
Part D (Drug) Premium: $11.80
Part D Supplemental Premium $0.00
Total Part D Premium: $11.80
Drug Deductible: $60.00
Tiers with No Deductible: 1
Benchmark: not below the regional benchmark
Type of Medicare Health Plan: Enhanced Alternative
Drug Benefit Type: Enhanced
Full LIS Premium: $0.00
75% LIS Premium: $2.90
50% LIS Premium: $5.90
25% LIS Premium: $8.80
Inital Coverage Limit:$2850
Gap Coverage: No Gap Coverage


Gap Coverage

In 2014 once you and your plan provider have spent $2,850 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be require to pay 47.5% of the plan's cost for covered brand-name prescription drugs and 72% of the cost for generic drugs unless your plan offers additional coverage. This Anthem Blue Cross and Blue Shield plan offers No Gap Coverage through the gap. No Gap Coverage means 0% of formulary drugs are covered through the gap or 15 or less brand name products are covered through the gap.



Source: CMS.

Plans as of September 3, 2013.

Star Rating as of September 27, 2013.

For More Information on Ratings Please See the CMS Tech Notes Here.

Plans are subject to change as contracts are finalized.

Includes 2014 approved contracts/plans. Employer sponsored 800 series plans and plans under sanction are excluded.

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