Anthem MediBlue Access (PPO)

3 out of 5 stars* for plan year 2023
$30.00 Monthly Premium

Anthem MediBlue Access (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Anthem Blue Cross Life and Health Insurance Company

Plan ID: H8552-029-000

$30.00 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 extra 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$30.00
Vision coverage
Dental coverage
Hearing coverage
Prescription drugs
Medical deductible$370.00
Out-of-pocket maximum$6,700.00
Initial drug coverage limit$0.00
Catastrophic drug coverage limit$7,400.00
Primary care doctor visitIn-Network:
$10.00 copay
Specialty doctor visit
Out-of-Network:
$50.00 copay
Inpatient hospital careIn-Network:
Days 1-7: $175.00 per day, per admission / Days 8-90: $0.00 per day, per admission
Additional Hospital Days: Unlimited additional days
Urgent careUrgent Care: $30.00 copay
Emergency room visitEmergency Care: $90.00 copay
Copay waived if admitted to hospital within 24 Hours
Ambulance transportationGround Ambulance: $325.00 copay Per Trip
Air Ambulance: 20% coinsurance

Health Care Services and Medical Supplies

Anthem MediBlue Access (PPO) covers a range of additional benefits. Learn more about Anthem MediBlue Access (PPO) benefits, some of which may not be covered by Original Medicare (Part A and Part B).

Coverage Details
Chiropractic servicesIn-Network:
Medicare Covered Chiropractic Services: $20.00 copay
Diabetes supplies, training, nutrition therapy and monitoringIn-Network:
Diabetic Supplies: $0.00 copay
Durable medical equipment (DME)In-Network:
20% coinsurance
Diagnostic tests, lab and radiology services, and X-raysIn-Network:
Lab Services: $0.00 - $5.00 copay
X-Rays: $25.00 copay
Therapeutic Radiological Services: 20% coinsurance
Outpatient Diagnostic Procedures/Tests: $0.00 - $75.00 copay
Diagnostic Radiological Services: $75.00 copay
Home health care
Out-of-Network:
40% coinsurance
Mental health inpatient care
Out-of-Network:
40% coinsurance per stay
Mental health outpatient care
Out-of-Network:
$50.00 copay
Outpatient services/surgeryIn-Network:
Outpatient Hospital - Surgery: $175.00 copay
Observation Services: $175.00 copay
Ambulatory Surgical Center: $100.00 copay
Outpatient substance abuse care
Out-of-Network:
40% coinsurance
Podiatry servicesIn-Network:
Medicare Covered Podiatry Services: $35.00 copay
Skilled Nursing Facility (SNF) careIn-Network:
SNF Days 1 - 20: $0.00 per day / Days 21 - 100: $140.00 per day

Dental Benefits

The following dental services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.

Coverage Details
Dental careIn-Network:
Preventive Dental Services: $0.00 copay
This plan covers: 2 oral exam(s), 2 cleaning(s) every year.

Medicare Covered Dental: $35.00 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 benefits
Out-of-Network:
Medicare Covered Eye Exam: 40% coinsurance
Routine Eye Exam: $0.00 copay
Medicare Covered Eye Wear: $0.00 copay
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 benefitsIn-Network:
Medicare Covered Hearing Exam: $35.00 copay
Routine Hearing Exam: $0.00 copay for routine hearing exam(s). $0.00 copay for hearing aids up to the maximum plan benefit amount.
This plan covers 1 routine hearing exam(s) and hearing aid fitting/evaluation(s) every year. $59.00 maximum plan benefit for routine hearing exam(s) every year. $3,000.00 maximum plan benefit coverage amount applies to prescribed hearing aids covered by the plan every year.

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:
40% coinsurance

Prescription Drug Costs and Coverage

The Anthem MediBlue Access (PPO) offers prescription drug coverage, with an annual drug deductible of $370.00 (excludes Tiers 1 and 6)

Coverage
Cost
Coverage & Cost
Annual drug deductible$370.00 (excludes Tiers 1 and 6)
Tier 1
  • Preferred retail $4.00
  • Standard retail $9.00
  • Standard mail order $0.00
  • Tier 6
  • Preferred retail $0.00
  • Standard retail $0.00
  • Standard mail order $0.00
  • Annual drug deductible$370.00 (excludes Tiers 1 and 6)
    Tier 1
  • Preferred retail $8.00
  • Standard retail $18.00
  • Standard mail order $0.00
  • Tier 6
  • Preferred retail $0.00
  • Standard retail $0.00
  • Standard mail order $0.00
  • Annual drug deductible$370.00 (excludes Tiers 1 and 6)
    Tier 1
  • Preferred retail $12.00
  • Standard retail $27.00
  • Standard mail order $0.00
  • Tier 6
  • Preferred retail $0.00
  • Standard retail $0.00
  • Standard mail order $0.00
  • 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

    Alpine Amador Butte Calaveras Colusa Contra Costa El Dorado Glenn Inyo Mariposa Mono Napa Placer Plumas San Francisco Shasta Sierra Solano Sonoma Sutter Tehama Tuolumne Yuba
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