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Anthem Chronic Care Advantage (PPO C-SNP) - H4909-029-000
$0.00
Monthly Premium
Anthem Chronic Care Advantage (PPO C-SNP) is a PPO C-SNP Medicare Advantage (Medicare Part C) plan offered by Anthem Inc.
Plan ID: H4909-029-000
* Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system.
$0.00
Monthly Premium
California Medicare beneficiaries may want to consider reviewing their Medicare Advantage (Medicare Part C) plan options. A Medicare Advantage plan combines your Original Medicare (Part A and Part B) benefits into a single plan.
Most Medicare Advantage plans cover prescription drugs, and many plans may offer other additional benefits Original Medicare doesn’t cover.
Learn more about California Medicare Advantage plans like the one below and find a plan that offers the benefits you want at an affordable price.
Basic Costs and Coverage
| Coverage | Details |
|---|---|
| Monthly plan premium | $0.00 |
| Vision coverage | |
| Dental coverage | |
| Hearing coverage | |
| Prescription drugs | |
| Medical deductible | $0.00 |
| Out-of-pocket maximum | $9,850.00 |
| Initial drug coverage limit | $0.00 |
| Catastrophic drug coverage limit | $2,100.00 |
| Primary care doctor visit | In-Network: 20% coinsurance |
| Specialty doctor visit | In-Network: 20% coinsurance |
| Inpatient hospital care | In-Network: $1,700.00 copay per stay |
| Urgent care | Urgent Care: $40.00 copay |
| Emergency room visit | Emergency Care: $115.00 copay Costshare waived if admitted to hospital within 24 hours Worldwide Coverage: This plan covers urgent care and emergency services, including emergency transportation, when traveling outside of the United States for less than six months. This benefit is limited to $100,000 per year. Worldwide Emergency/Urgent Care/Transportation: $0.00 copay |
| Ambulance transportation | Out-of-Network: Ambulance Services: Coinsurance for Medicare Covered Ambulance Services - Ground 20% Coinsurance for Medicare Covered Ambulance Services - Air 20% |
Health Care Services and Medical Supplies
Anthem Chronic Care Advantage (PPO C-SNP) covers a range of additional benefits. Learn more about Anthem Chronic Care Advantage (PPO C-SNP) benefits, some of which may not be covered by Original Medicare (Part A and Part B).
| Coverage | Details |
|---|---|
| Chiropractic services | In-Network: Medicare Covered Chiropractic Services: 20% coinsurance |
| Diabetes supplies, training, nutrition therapy and monitoring | Out-of-Network: $0.00 copay |
| Durable medical equipment (DME) | Out-of-Network: 20% coinsurance |
| Diagnostic tests, lab and radiology services, and X-rays | In-Network: Lab Services: 20% coinsurance X-Rays: 20% coinsurance Therapeutic Radiological Services: 20% coinsurance Outpatient Diagnostic Procedures/Tests: 20% coinsurance Diagnostic Radiological Services: 20% coinsurance |
| Home health care | In-Network: $0.00 copay |
| Mental health inpatient care | Out-of-Network: $1,700.00 copay per stay |
| Mental health outpatient care | In-Network: Individual and Group Sessions: 20% coinsurance |
| Outpatient services/surgery | In-Network: Outpatient Hospital - Surgery: 20% coinsurance Observation Services: 20% coinsurance Ambulatory Surgical Center: 20% coinsurance |
| Outpatient substance abuse care | Out-of-Network: 20% coinsurance |
| Podiatry services | Out-of-Network: Medicare Covered Podiatry Services: 20% coinsurance Routine Foot Care: $0.00 copay |
| Skilled Nursing Facility (SNF) care | Out-of-Network: Medicare-defined cost share |
Dental Benefits
The following dental services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.
| Coverage | Details |
|---|---|
| Dental care | This plan covers 2 oral exams, 2 cleanings, 2 fluoride treatments, and 2 dental X-rays every year. In-Network: Medicare Covered Dental: 20% coinsurance Preventive Dental Services: $0.00 copay Comprehensive Dental Services: $0.00 copay |
Vision Benefits
The following vision services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage
| Coverage | Details |
|---|---|
| Vision care | Out-of-Network: Medicare Covered Eye Exam: 20% coinsurance Routine Eye Exam: $0.00 copay Medicare Covered Eye Wear: 20% coinsurance Routine Eye Wear: $0.00 copay |
Hearing Benefits
The following hearing services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.
| Coverage | Details |
|---|---|
| Hearing care | Out-of-Network: Medicare Covered Hearing Exam: 20% coinsurance Routine Hearing Exam: $0.00 copay for routine hearing exam(s). 80% coinsurance for prescription or OTC hearing aids. |
Preventive Services and Health/Wellness Education Programs
The following services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.
| Coverage | Details |
|---|---|
| Preventive services and health/wellness education programs | Out-of-Network: $0.00 copay |
When reviewing California Medicare plans, be sure to find out if your doctors are part of the plan network. If a Medicare Advantage plan covers prescription drugs, make sure the plan formulary (list of drugs covered by the plan) includes your drugs.
You may be able to find plans in your part of California that offer similar benefits at similar or lower prices than the plan above. Call 1-800-557-6059 TTY 711, 24/7 to speak with a licensed insurance agent who can help you compare plans.
Plan Documents
| Links to plan documents |
California Counties Served
We offer plans from Humana, UnitedHealthcare®, Anthem Blue Cross and Blue Shield*, Aetna, HealthspringSM or Kaiser Permanente.