2020 Anthem | MaineHealth Advantage Extra (HMO) H9065-005 By AMH Health.

2020 Medicare Advantage Plan Services for
Anthem | MaineHealth Advantage Extra (HMO)


Anthem | MaineHealth Advantage Extra (HMO) H9065-005 is a 2020 Medicare Advantage Plan or Medicare Part-C plan by AMH Health available to residents in Maine. This plan includes additional Medicare prescription drug (Part-D) coverage. The Anthem | MaineHealth Advantage Extra (HMO) has a monthly premium of $16.60 and has an in-network Maximum Out-of-Pocket limit of $4,900 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $4,900 out of pocket. This can be a extremely nice safety net.

Anthem | MaineHealth Advantage Extra (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.

AMH Health works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Anthem | MaineHealth Advantage Extra (HMO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from AMH Health 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 AMH Health except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.





2020 AMH Health Medicare Advantage Plan Details

Name:
Anthem | MaineHealth Advantage Extra (HMO)
ID:
H9065-005
Provider:AMH Health
Year:2020
Type: Local HMO
Monthly Premium C+D: $16.60
Part C Premium:$0.00
MOOP: $4,900
Part D (Drug) Premium:$16.60
Part D Supplemental Premium$0.00
Total Part D Premium:$16.60
Drug Deductible:$275.00
Tiers with No Deductible:1
Gap Coverage:Yes
Benchmark:not below the regional benchmark
Type of Medicare Health:Enhanced Alternative
Drug Benefit Type:Enhanced




Part-C Premium

AMH Health plan charges a $0.00 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

Anthem | MaineHealth Advantage Extra (HMO) has a monthly drug premium of $16.60 and a $275.00 drug deductible. This AMH Health plan offers a $16.60 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 AMH Health 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 $16.60. 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 | MaineHealth Advantage Extra (HMO) medicare insurance offers a $0.00 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $4.10 for 75% low income subsidy $8.30 for 50% and $12.40 for 25%.



Full LIS Premium:$0.00
75% LIS Premium:$4.10
50% LIS Premium:$8.30
25% LIS Premium:$12.40


Gap Coverage

In 2020 once you and your plan provider have spent $4020 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 AMH Health plan does offer additional coverage through the gap.



AMH Health Drug Coverage and Formulary

A formulary is divided into tiers or levels of coverage based on the type or usage of your medication or benefit categories, according to drug costs. Each tier will have a defined out-of-pocket cost that you must pay before receiving the drug. You can see complete 2020 Anthem | MaineHealth Advantage Extra (HMO) H9065-005 Formulary here.

Drug Tier Copay
Preferred
Copay
Nonpreferred
1 $0 $0
2 $16 $16
3 $47 $47
4 $95 $100
5 28% 28%
6 $0 $0
*Initial Coverage Phase and 30 day supply

See the 2020 AMH Health Formulary





Coverage Area for Anthem | MaineHealth Advantage Extra (HMO)

(Click county to compare all available Advantage plans)

State: Maine
County:Cumberland, York,


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Source: CMS.
Data as of September 4, 2019.
Star Rating as of October 10, 2019.
Plan Services are 2019 information as reference. 2020 information will be added when released.
Notes: Data are subject to change as contracts are finalized. For 2020, 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 2020 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

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