Anthem Medicare Preferred Standard (PPO) By Anthem Blue Cross Life and Health Insurance Co.
Anthem Medicare Preferred Standard (PPO) is a 2014 Medicare Advantage ("Part C" or "MA 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 Part A and Part B benefits. If you decide to sign up for Anthem Medicare Preferred Standard (PPO) 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 Life and Health Insurance Co. 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 Medicare Preferred Standard (PPO) |
|---|---|
| Plan ID: | H8552-006 |
| Provider: | Anthem Blue Cross Life and Health Insurance Co. |
| Plan Year: | 2014 |
| Plan Type: | Local PPO |
| Monthly Premium C+D: | $106.00 |
| MOOP: | $4,500 |
Coverage Area for Anthem Medicare Preferred Standard (PPO)
(Click county to compare all available plans)
| State: |
California| County: | San Diego, | |
|---|
The Anthem Medicare Preferred Standard (PPO) H8552-006 is available to residents in California, and has a in-network Maximum Out-of-Pocket limit of $4,500 MOOP. This means that if you get sick or need a high cost procedure your co-pays are capped. If you enroll in Anthem Medicare Preferred Standard (PPO) plan you will stop paying co-pays for the rest of the year once you pay out of pocket $4,500 This is a very nice safety net. This plan includes additional Medicare prescription drug (Part-D) coverage.
Anthem Medicare Preferred Standard (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.
Ratings for Anthem Medicare Preferred Standard (PPO) H8552
| 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 Medicare Preferred Standard (PPO)
| 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 Medicare Preferred Standard (PPO)
| 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 Life and Health Insurance Co. plan charges a $50.80 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 Medicare Preferred Standard (PPO) plan has a monthly drug premium of $55.20 and a $173.00 drug deductible. This Anthem Blue Cross Life and Health Insurance Co. plan offers a $55.20 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 $55.20. 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 Medicare Preferred Standard (PPO) medicare insurance plan offers a $27.10 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $34.10 for 75% low income subsidy $41.10 for 50% and $48.20 for 25%.
| Part C Premium: | $50.80 |
|---|---|
| Part D (Drug) Premium: | $55.20 |
| Part D Supplemental Premium | $0.00 |
| Total Part D Premium: | $55.20 |
| Drug Deductible: | $173.00 |
| Tiers with No Deductible: | 1 |
| Benchmark: | not below the regional benchmark |
| Type of Medicare Health Plan: | Basic Alternative |
| Drug Benefit Type: | Basic |
| Full LIS Premium: | $27.10 |
| 75% LIS Premium: | $34.10 |
| 50% LIS Premium: | $41.10 |
| 25% LIS Premium: | $48.20 |
| 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 Life and Health Insurance Co. 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.