2022 Anthem l MaineHealth Advantage Access (PPO)


Anthem l MaineHealth Advantage Access (PPO) H9219-002 is a 2022 Medicare Advantage Plan or Part-C by AMH Health available to residents in Maine. This plan includes additional prescription drug (Part-D) coverage. The Anthem l MaineHealth Advantage Access (PPO) has a monthly premium of $24.00 and has an in-network maximum out-of-pocket limit of $5,800 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $5,800 out-of-pocket. This can be a extremely nice safety net.

Anthem l MaineHealth Advantage Access (PPO) 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.

AMH Health works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Anthem l MaineHealth Advantage Access (PPO) 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 you are always covered for urgently needed and emergency care. Plus you receive all 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 Medicare Advantage.




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2022 AMH Health Medicare Advantage Plan Costs

Name:
Anthem l MaineHealth Advantage Access (PPO)
Plan ID:
H9219-002
Provider:AMH Health
Year:2022
Type: Local PPO
Monthly Premium C+D: $24.00
Part C Premium:$0.00
MOOP: $5,800
Part D (Drug) Premium:$24.00
Part D Supplemental Premium$0.00
Total Part D Premium:$24.00
Drug Deductible:$400.00
Tiers with No Deductible:1
Gap Coverage:Yes
Benchmark:not below the regional benchmark
Type of Medicare Health:Enhanced Alternative
Drug Benefit Type:Enhanced
Similar Plan: H9219-001
New Plan: 2023 H9219-001




Anthem l MaineHealth Advantage Access (PPO) Part-C Premium

AMH Health 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.



H9219-002 Part-D Deductible and Premium

Anthem l MaineHealth Advantage Access (PPO) has a monthly drug premium of $24.00 and a $400.00 drug deductible. This AMH Health plan offers a $24.00 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 $24.00 . The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lowered due to negative basic or supplemental premiums.



AMH Health Gap Coverage

In 2022 once you and your plan provider have spent $4430 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.



Premium Assistance

The Low Income Subsidy (LIS) helps people with Medicare pay for prescription drugs, and lowers the costs of Medicare prescription drug coverage. Depending on your income level you may be eligible for full 75%, 50%, 25% premium assistance. The Anthem l MaineHealth Advantage Access (PPO) medicare insurance offers a $0.00 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $6.00 for 75% low income subsidy $12.00 for 50% and $18.00 for 25%.



Full LIS Premium:$0.00
75% LIS Premium:$6.00
50% LIS Premium:$12.00
25% LIS Premium:$18.00


H9219-002 Formulary or Drug Coverage

Anthem l MaineHealth Advantage Access (PPO) formulary is divided into Tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers. By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price. You can see complete 2022 Anthem l MaineHealth Advantage Access (PPO) H9219-002 Formulary here.

Drug Tier Copay
Preferred
Pharmacy
Copay
Nonpreferred
Pharmacy
Tier 1 $3 $8
Tier 2 $10 $15
Tier 3 $42 $47
Tier 4 $95 $100
Tier 5 26% 26%
Tier 6 $0 $0
*Initial Coverage Phase and 30 day supply





2021 Anthem l MaineHealth Advantage Access (PPO) Summary of Benefits

*This will be updated with 2022 data when available.



Additional Benefits


No



Comprehensive Dental


Diagnostic services Not covered
Endodontics Not covered
Extractions Not covered
Non-routine services Not covered
Periodontics Not covered
Prosthodontics, other oral/maxillofacial surgery, other services Not covered
Restorative services Not covered



Deductible


$1,000 annual deductible



Diagnostic Tests and Procedures


Diagnostic radiology services (e.g., MRI) $100-200 copay
Diagnostic radiology services (e.g., MRI) 40% coinsurance (Out-of-Network)
Diagnostic tests and procedures $0-80 copay
Diagnostic tests and procedures 40% coinsurance (Out-of-Network)
Lab services 40% coinsurance (Out-of-Network)
Lab services $0-10 copay
Outpatient x-rays $20-40 copay
Outpatient x-rays 40% coinsurance (Out-of-Network)



Doctor Visits


Primary $0 copay
Primary 40% coinsurance per visit (Out-of-Network)
Specialist $35 copay per visit
Specialist 40% coinsurance per visit (Out-of-Network)



Emergency care/Urgent Care


Emergency $90 copay per visit (always covered)
Urgent care $35 copay per visit (always covered)



Foot Care (podiatry services)


Foot exams and treatment $35 copay
Foot exams and treatment 40% coinsurance (Out-of-Network)
Routine foot care Not covered



Ground Ambulance


$295 copay (Out-of-Network)
$295 copay



Hearing


Fitting/evaluation 20% coinsurance (Out-of-Network)
Fitting/evaluation $0 copay
Hearing aids $0 copay
Hearing aids $0 copay (Out-of-Network)
Hearing exam 40% coinsurance (Out-of-Network)
Hearing exam $35 copay



Inpatient Hospital Coverage


$300 per day for days 1 through 6
$0 per day for days 7 through 90
40% per stay (Out-of-Network)



Medical Equipment/Supplies


Diabetes supplies 40% coinsurance per item (Out-of-Network)
Diabetes supplies $0 copay
Durable medical equipment (e.g., wheelchairs, oxygen) 40% coinsurance per item (Out-of-Network)
Durable medical equipment (e.g., wheelchairs, oxygen) 0-20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs) 20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs) 40% coinsurance per item (Out-of-Network)



Medicare Part B Drugs


Chemotherapy 40% coinsurance (Out-of-Network)
Chemotherapy 20% coinsurance
Other Part B drugs 40% coinsurance (Out-of-Network)
Other Part B drugs 20% coinsurance



Mental Health Services


Inpatient hospital - psychiatric $290 per day for days 1 through 6
$0 per day for days 7 through 90
Inpatient hospital - psychiatric 40% per stay (Out-of-Network)
Outpatient group therapy visit $40 copay
Outpatient group therapy visit 40% coinsurance (Out-of-Network)
Outpatient group therapy visit with a psychiatrist 40% coinsurance (Out-of-Network)
Outpatient group therapy visit with a psychiatrist $40 copay
Outpatient individual therapy visit 40% coinsurance (Out-of-Network)
Outpatient individual therapy visit $40 copay
Outpatient individual therapy visit with a psychiatrist $40 copay
Outpatient individual therapy visit with a psychiatrist 40% coinsurance (Out-of-Network)



MOOP


$10,000 In and Out-of-network
$5,800 In-network



Option


No



Optional supplemental benefits


Yes



Outpatient Hospital Coverage


$0-250 copay per visit
40% coinsurance per visit (Out-of-Network)



Package #1


Deductible
Monthly Premium $24.00



Package #2


Deductible
Monthly Premium $34.00



Package #3


Deductible
Monthly Premium $55.00



Preventive Care


$0 copay
40% coinsurance (Out-of-Network)



Preventive Dental


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



Rehabilitation Services


Occupational therapy visit 40% coinsurance (Out-of-Network)
Occupational therapy visit $40 copay
Physical therapy and speech and language therapy visit $40 copay
Physical therapy and speech and language therapy visit 40% coinsurance (Out-of-Network)



Skilled Nursing Facility


$0 per day for days 1 through 20
$184 per day for days 21 through 100
40% per stay (Out-of-Network)



Transportation


Not covered



Vision


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



Wellness Programs (e.g. fitness nursing hotline)


Covered





Ready to Enroll?

Click Here

Or Call
1-855-778-4180
Mon-Fri 8am-8pm EST
Sat 8am-8pm EST




Coverage Area for Anthem l MaineHealth Advantage Access (PPO)

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Source: CMS.
Data as of September 1, 2021.
Notes: Data are subject to change as contracts are finalized. For 2022, 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 2022 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

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