Anthem MediBlue Dual Advantage (HMO D-SNP)
Anthem MediBlue Dual Advantage (HMO D-SNP) is a HMO D-SNP Medicare Advantage (Medicare Part C) plan offered by Anthem Blue Cross and Blue Shield
Plan ID: H9525-003-000
Wisconsin 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 Wisconsin 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 visit | In-Network: $0.00 copay |
| Specialty doctor visit | In-Network: $0.00 copay |
| Inpatient hospital care | In-Network: $0.00 copay per stay |
| Urgent care | Urgent Care: $0.00 copay |
| Emergency room visit | Emergency 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 transportation | Ground Ambulance: $0.00 copay Per Trip Air Ambulance: $0.00 copay |
Health Care Services and Medical Supplies
Anthem MediBlue Dual Advantage (HMO D-SNP) covers a range of additional benefits. Learn more about Anthem MediBlue Dual Advantage (HMO D-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: $0.00 copay |
| Diabetes supplies, training, nutrition therapy and monitoring | In-Network: Diabetic Supplies: $0.00 copay |
| Durable medical equipment (DME) | In-Network: $0.00 copay |
| Diagnostic tests, lab and radiology services, and X-rays | In-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 | In-Network: $0.00 copay |
| Mental health inpatient care | In-Network: $0.00 copay per stay |
| Mental health outpatient care | In-Network: Individual and Group Sessions: $0.00 copay |
| Outpatient services/surgery | In-Network: Outpatient Hospital - Surgery: $0.00 copay Observation Services: $0.00 copay Ambulatory Surgical Center: $0.00 copay |
| Outpatient substance abuse care | In-Network: Individual and Group Sessions: $0.00 copay |
| Over-the-counter items | You can receive a $150.00 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 services | In-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) care | In-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 care | In-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 $3,500.00 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 benefits | In-Network: Medicare Covered Eye Exam: $0.00 copay Routine Eye Exam: $0.00 copay This plan covers 1 routine eye exam(s) every year. Medicare Covered Eye Wear: $0.00 copay Routine Eye Wear: $0.00 copay This plan covers up to $450.00 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 | In-Network: Medicare Covered Hearing Exam: $0.00 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. $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 | In-Network: $0.00 copay for Medicare Covered Preventive Services |
When reviewing Wisconsin 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 Wisconsin 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 |
