Anthem MediBlue Dual Access (PPO D-SNP)

3.5 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 Life and Health Insurance Company

Plan ID: H8552-030-000

$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 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$0.00
Vision coverage
Dental coverage
Hearing coverage
Prescription drugs
Medical deductible$0.00
Out-of-pocket maximum$7,550.00
Initial drug coverage limit$0.00
Catastrophic drug coverage limit$7,400.00
Primary care doctor visit
Out-of-Network:
$0.00 copay
Specialty doctor visitIn-Network:
$0.00 copay
Inpatient hospital careIn-Network:
$0.00 copay - Medicare-defined cost share
Additional Hospital Days: Unlimited additional days
Urgent careUrgent Care: $0.00 copay - $60.00 copay
Emergency room visitEmergency Care: $0.00 copay - $90.00 copay
Copay waived if admitted to hospital within 24 Hours
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 - 20% coinsurance Per Trip
Air Ambulance: $0.00 copay - 20% coinsurance

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 - 20% coinsurance
Diabetes supplies, training, nutrition therapy and monitoring
Out-of-Network:
$0.00 copay
Durable medical equipment (DME)In-Network:
$0.00 copay - 20% coinsurance
Diagnostic tests, lab and radiology services, and X-rays
Out-of-Network:
Lab Services: $0.00 copay - 20% coinsurance
X-Rays: $0.00 copay - 20% coinsurance
Therapeutic Radiological Services: $0.00 copay - 20% coinsurance
Outpatient Diagnostic Procedures/Tests: $0.00 copay - 20% coinsurance
Diagnostic Radiological Services: $0.00 copay - 20% coinsurance
Home health careIn-Network:
$0.00 copay
Mental health inpatient careIn-Network:
Days: 1-5: $275.00 per day, per admission / Days: 6-90: $0.00 per day, per admission
Additional Hospital Days: Unlimited additional days
Mental health outpatient care
Out-of-Network:
$0.00 copay - 20% coinsurance
Outpatient services/surgery
Out-of-Network:
Outpatient Hospital - Surgery: $0.00 copay - 20% coinsurance
Observation Services: $0.00 copay - 20% coinsurance
Ambulatory Surgical Center: $0.00 copay - 20% coinsurance
Outpatient substance abuse careIn-Network:
Individual and Group Sessions: $0.00 copay - 20% coinsurance
Over-the-counter itemsThis plan covers certain approved, non-prescription, over-the-counter drugs and health-related items, up to $80 every quarter. Unused OTC amounts do roll over to the next quarter. Unused OTC amounts do not roll over to the next calendar year.
Podiatry services
Out-of-Network:
Medicare Covered Podiatry Services: $0.00 copay - 20% coinsurance
Routine Foot Care: $0.00 copay
Skilled Nursing Facility (SNF) care
Out-of-Network:
Days 1 - 20: $0.00 per day / Days 21 - 100: $0.00 - $188.00 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), 1 dental X-ray(s) every year.

Medicare Covered Dental: $0.00 copay - 20% coinsurance
Comprehensive Dental Services: $0.00 copay
This plan covers up to a $1,000.00 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 - 20% coinsurance
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 - 20% coinsurance
Routine Eye Wear: $0.00 copay
This plan covers up to $150.00 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 - 20% coinsurance
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 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 Shasta Sierra Solano Sonoma Sutter Tehama Tuolumne Yuba
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