Anthem MediBlue Dual Access (PPO D-SNP)

3 out of 5 stars* for plan year 2023
$0.00 Monthly Premium

Anthem MediBlue Dual Access (PPO D-SNP) is a PPO D-SNP Medicare Advantage (Medicare Part C) plan offered by Anthem Blue Cross and Blue Shield

Plan ID: H4909-028-000

$0.00 Monthly Premium

Missouri 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 Missouri 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$8,300.00
Initial drug coverage limit$0.00
Catastrophic drug coverage limit$7,400.00
Primary care doctor visitIn-Network:
$0.00 copay
Specialty doctor visit
Out-of-Network:
$0.00 copay
Inpatient hospital careIn-Network:
$0.00 copay per stay
Urgent careUrgent Care: $0.00 copay
Emergency room visitEmergency Care: $0.00 copay
Worldwide Coverage: This plan covers urgent care and emergency services when traveling outside of the United States for less than six months. This benefit is limited to $100,000.00 per year.
Ambulance transportationGround Ambulance: $0.00 copay Per Trip
Air Ambulance: $0.00 copay

Health Care Services and Medical Supplies

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

Coverage Details
Chiropractic services
Out-of-Network:
Medicare Covered Chiropractic Services: $0.00 copay
Diabetes supplies, training, nutrition therapy and monitoringIn-Network:
Diabetic Supplies: $0.00 copay
Durable medical equipment (DME)In-Network:
$0.00 copay
Diagnostic tests, lab and radiology services, and X-rays
Out-of-Network:
Lab Services: $0.00 copay
X-Rays: $0.00 copay
Therapeutic Radiological Services: $0.00 copay
Outpatient Diagnostic Procedures/Tests: $0.00 copay
Diagnostic Radiological Services: $0.00 copay
Home health care
Out-of-Network:
$0.00 copay
Mental health inpatient careIn-Network:
$0.00 copay per stay
Mental health outpatient care
Out-of-Network:
$0.00 copay
Outpatient services/surgeryIn-Network:
Outpatient Hospital - Surgery: $0.00 copay
Observation Services: $0.00 copay
Ambulatory Surgical Center: $0.00 copay
Outpatient substance abuse care
Out-of-Network:
$0.00 copay
Over-the-counter itemsYou can receive a $125.00 monthly spending allowance to buy eligible over-the-counter (OTC) products and healthy groceries at participating stores near you. OTC products and select healthy groceries are also available online.
Podiatry servicesIn-Network:
Medicare Covered Podiatry Services: $0.00 copay
Routine Foot Care: $0.00 copay
Unlimited routine foot care visits each year.
Skilled Nursing Facility (SNF) careIn-Network:
$0.00 copay per stay

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), 1 dental X-ray(s), 1 fluoride treatment(s) every year.

Medicare Covered Dental: $0.00 copay
Comprehensive Dental Services: $0.00 copay
This plan covers up to a $4,000.00 allowance for covered comprehensive dental services every year.

Vision Benefits

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

Coverage Details
Vision benefitsIn-Network:
Medicare Covered Eye Exam: $0.00 copay
Routine Eye Exam: $0.00 copay
This plan covers 1 routine eye exam(s) every year. $69.00 maximum eye exam coverage amount.
Medicare Covered Eye Wear: $0.00 copay
Routine Eye Wear: $0.00 copay
This plan covers up to $400.00 for eyeglasses or contact lenses every year.

Hearing Benefits

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

Coverage Details
Hearing benefits
Out-of-Network:
Medicare Covered Hearing Exam: $0.00 copay
Routine Hearing Exam: $0.00 copay for routine hearing exam(s).

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 Missouri 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 Missouri 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

Missouri Counties Served

Adair Audrain Bollinger Boone Butler Callaway Camden Cape Girardeau Carter Chariton Clark Cole Cooper Crawford Dent Douglas Dunklin Franklin Gasconade Hickory Howard Howell Iron Jefferson Knox Laclede Lewis Lincoln Linn Macon Madison Maries Marion Miller Mississippi Moniteau Monroe Montgomery Morgan New Madrid Oregon Osage Ozark Pemiscot Perry Phelps Pike Pulaski Putnam Ralls Randolph Reynolds Ripley Saint Charles Saint Francois Saint Louis Saint Louis City Sainte Genevieve Schuyler Scotland Scott Shannon Shelby Stoddard Sullivan Texas Warren Washington Wayne Wright
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