2019 Anthem MediBlue ESRD (PPO SNP) EA-H8552

Anthem MediBlue ESRD (PPO SNP) By Anthem Blue Cross Life and Health Insurance Co.



Anthem MediBlue ESRD (PPO SNP) is a 2019 Medicare Advantage Special Needs Plan plan by Anthem Blue Cross Life and Health Insurance Co.. This plan from Anthem Blue Cross Life and Health Insurance Co. works with Medicare to give you significant coverage beyond original Medicare. If you decide to sign up you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Anthem Blue Cross Life and Health Insurance Co. and not Original Medicare. All Medicare SNPs also provide Medicare additional Part-D drug coverage. Anthem MediBlue ESRD (PPO SNP) EA-H8552 is a Chronic Condition SNP (C-SNP). A Chronic Condition SNP is for beneficiaries with the following severe or disabling chronic conditions: Chronic Lung Disorders. If you have Medicare and you develop certain severe or disabling conditions you can join a Medicare SNP designed to serve people with those conditions at any time.



2019 Medicare Special Needs Plan Details

Plan Name:
Anthem MediBlue ESRD (PPO SNP)
Plan ID:
EA-H8552
Special Needs Type: Chronic or Disabling Condition
Provider: Anthem Blue Cross Life and Health Insurance Co.
Plan Year:2019
Plan Type: Local PPO
Monthly Premium C+D: $34.80
Chronic Condition:Chronic Lung Disorders


COMPARE AND SAVE ON MEDICARE INSURANCE




The Anthem MediBlue ESRD (PPO SNP) EA-H8552 is available to residents in California, and all Medicare SNPs must provide Medicare additional prescription drug (Part-D) coverage. Anthem MediBlue ESRD (PPO SNP) is a Local PPO. A preferred provider organization (PPO) is a medicare plan that has created contracts with a network of "preferred" providers for you to choose from at reduced rates. You do not need to select a primary care physician and you do not need referrals to see other providers in the network. Offering you a little more flexibility overall. You can get medical attention from a provider outside of the network but you will have to pay the difference between the out-of-network bill and the PPOs discounted rate.

Part-C Premium

Anthem Blue Cross Life and Health Insurance Co. plan charges a 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 MediBlue ESRD (PPO SNP) plan has a monthly drug premium of $34.80 and a $130.00 drug deductible. This Anthem Blue Cross Life and Health Insurance Co. plan offers a $34.80 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 Life and Health Insurance Co. 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 $34.80. 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 MediBlue ESRD (PPO SNP) medicare insurance plan offers a $0.00 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $8.70 for 75% low income subsidy $17.40 for 50% and $26.10 for 25%.



Part C Premium:
Part D (Drug) Premium: $34.80
Part D Supplemental Premium $0.00
Total Part D Premium: $34.80
Drug Deductible: $130.00
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: $8.70
50% LIS Premium: $17.40
25% LIS Premium: $26.10
Initial Coverage Limit:$3820
Gap Coverage: Yes


Gap Coverage

In 2019 once you and your plan provider have spent $3,820 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 brand-name drugs and 37% on generic drugs unless your plan offers additional coverage. This Anthem Blue Cross Life and Health Insurance Co. plan does offer additional coverage through the gap.





Plan Services




Health plan deductible


Coming soon



Emergency care/Urgent care


Emergency $90 per visit (always covered)
Urgent care $25 per visit (always covered)



Diagnostic procedures/lab services/imaging


Diagnostic tests and procedures In-Network 20%
Diagnostic tests and procedures Out-of-Network 20%
Lab services In-Network 20%
Lab services Out-of-Network 20%
Diagnostic radiology services (e.g., MRI) In-Network 20%
Diagnostic radiology services (e.g., MRI) Out-of-Network 20%
Outpatient x-rays In-Network 20%
Outpatient x-rays Out-of-Network 20%



Hearing


Hearing exam In-Network 20%
Hearing exam Out-of-Network 20%
Fitting/evaluation Not covered
Hearing aids - inner ear Not covered
Hearing aids - outer ear Not covered
Hearing aids - over the ear Not covered



Preventive dental


Oral exam In-Network $0 copay
Oral exam Out-of-Network 20%
Cleaning In-Network $0 copay
Cleaning Out-of-Network 20%
Fluoride treatment Not covered
Dental x-ray(s) In-Network $0 copay
Dental x-ray(s) Out-of-Network 20%



Comprehensive dental


Non-routine services In-Network $0
Non-routine services Out-of-Network 20%
Diagnostic services In-Network $0
Diagnostic services Out-of-Network 20%
Restorative services In-Network $0
Restorative services Out-of-Network 20%
Endodontics In-Network $0
Endodontics Out-of-Network 20%
Periodontics In-Network $0
Periodontics Out-of-Network 20%
Extractions In-Network $0
Extractions Out-of-Network 20%
Prosthodontics, other oral/maxillofacial surgery, other services In-Network $0
Prosthodontics, other oral/maxillofacial surgery, other services Out-of-Network 20%



Vision


Routine eye exam In-Network $0
Routine eye exam Out-of-Network $0 copay
Other Not covered
Contact lenses In-Network $0
Contact lenses Out-of-Network $0 copay
Eyeglasses (frames and lenses) In-Network $0
Eyeglasses (frames and lenses) Out-of-Network $0 copay
Eyeglass frames In-Network $0
Eyeglass frames Out-of-Network $0 copay
Eyeglass lenses In-Network $0
Eyeglass lenses Out-of-Network $0 copay
Upgrades Not covered



Mental health services


Inpatient hospital - psychiatric In-Network Coming soon
Inpatient hospital - psychiatric Out-of-Network Coming soon
Outpatient group therapy visit with a psychiatrist In-Network 20%
Outpatient group therapy visit with a psychiatrist Out-of-Network 20%
Outpatient individual therapy visit with a psychiatrist In-Network 20%
Outpatient individual therapy visit with a psychiatrist Out-of-Network 20%
Outpatient group therapy visit In-Network $0 copay
Outpatient group therapy visit Out-of-Network 20%
Outpatient individual therapy visit In-Network $0 copay
Outpatient individual therapy visit Out-of-Network 20%



Skilled Nursing Facility


In-Network Coming soon
Out-of-Network Coming soon



Rehabilitation services


Occupational therapy visit In-Network 20%
Occupational therapy visit Out-of-Network 20%
Physical therapy and speech and language therapy visit In-Network 20%
Physical therapy and speech and language therapy visit Out-of-Network 20%



Ground ambulance


In-Network 20%
Out-of-Network 20%



Other health plan deductibles?


In-Network No



Transportation


In-Network $0 copay
Out-of-Network 50%



Foot care (podiatry services)


Foot exams and treatment In-Network $0 or 20%
Foot exams and treatment Out-of-Network 20%
Routine foot care In-Network $0
Routine foot care Out-of-Network 20%



Medical equipment/supplies


Durable medical equipment (e.g., wheelchairs, oxygen) In-Network 20% per item
Durable medical equipment (e.g., wheelchairs, oxygen) Out-of-Network 20% per item
Prosthetics (e.g., braces, artificial limbs) In-Network 20% per item
Prosthetics (e.g., braces, artificial limbs) Out-of-Network 20% per item
Diabetes supplies In-Network $0 copay
Diabetes supplies Out-of-Network 20% per item



Wellness programs (e.g., fitness, nursing hotline)


Covered



Medicare Part B drugs


Chemotherapy In-Network 20%
Chemotherapy Out-of-Network 20%
Other Part B drugs In-Network 20%
Other Part B drugs Out-of-Network 20%



Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)


$10,000 In and Out-of-network
$6,700 In-network



Optional supplemental benefits


No



Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?


In-Network No



Inpatient hospital coverage


In-Network Coming soon
Out-of-Network Coming soon



Outpatient hospital coverage


In-Network 20% per visit
Out-of-Network 20% per visit



Doctor visits


Primary In-Network $0 copay
Primary Out-of-Network $0 copay
Specialist In-Network $0 or 20% per visit
Specialist Out-of-Network $0 or 20% per visit



Preventive care


In-Network $0 copay
Out-of-Network 20%



Ratings for Anthem MediBlue ESRD (PPO SNP) EA

2018 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
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
Monitoring Physical Activity
Adult BMI Assessment


Managing Chronic And Long Term Care for Older Adults

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


Member Experience with Health Plan

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


Member Complaints and Changes in Anthem MediBlue ESRD (PPO SNP) Plans Performance

Total Rating
Complaints about Health Plan
Members Leaving the Plan
Health Plan Quality Improvement


Health Plan Customer Service Rating for Anthem MediBlue ESRD (PPO SNP)

Total Customer Service Rating
Timely Decisions About Appeals
Reviewing Appeals Decisions
Call Center, TTY, Foreign Language


Anthem MediBlue ESRD (PPO SNP) 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


Drug Safety and Accuracy of Drug Pricing

Total Rating
MPF Price Accuracy
Drug Adherence for Diabetes Medications
Drug Adherence for Hypertension (RAS antagonists)
Drug Adherence for Cholesterol (Statins)
MTM Program Completion Rate for CMR
Statin with Diabetes


Coverage Area for Anthem MediBlue ESRD (PPO SNP)



Source: CMS.

Plans as of September 2, 2018.

Star Rating as of October 10, 2018.

Notes: Data are subject to change. All contracts for 2019 have not been finalized. For 2019, enhanced alternative plans may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part Part D benefit.

Includes 2019 approved contracts/plans. Employer sponsored 800 series plans and plans under sanction are excluded.

Call For A licensed Sales Agent

1-855-492-4169

  • Mon-Fri 8:30am-8:00pm


Call to Enroll!