Anthem MediBlue Service (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Anthem Blue Cross and Blue Shield
Plan ID: H4909-023-000
Kentucky 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 Kentucky Medicare Advantage plans like the one below and find a plan that offers the benefits you want at an affordable price.
|Monthly plan premium||$0.00|
|Initial drug coverage limit||$0.00|
|Catastrophic drug coverage limit||$7,400.00|
|Primary care doctor visit||In-Network:|
|Specialty doctor visit|
|Inpatient hospital care||In-Network:|
Days 1-7: $295.00 per day, per admission / Days 8-90: $0.00 per day, per admission
Additional Hospital Days: Unlimited additional days
|Urgent care||Urgent Care: $25.00 copay|
|Emergency room visit||Emergency Care: $90.00 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: $290.00 copay Per Trip|
Air Ambulance: $290.00 copay
Anthem MediBlue Service (PPO) covers a range of additional benefits. Learn more about Anthem MediBlue Service (PPO) benefits, some of which may not be covered by Original Medicare (Part A and Part B).
Medicare Covered Chiropractic Services: 30% coinsurance
|Diabetes supplies, training, nutrition therapy and monitoring||In-Network:|
Diabetic Supplies: $0.00 copay
|Durable medical equipment (DME)||In-Network:|
|Diagnostic tests, lab and radiology services, and X-rays||In-Network:|
Lab Services: $0.00 - $50.00 copay
X-Rays: $50.00 - $110.00 copay
Therapeutic Radiological Services: 20% coinsurance
Outpatient Diagnostic Procedures/Tests: $0.00 - $100.00 copay
Diagnostic Radiological Services: $180.00 - $275.00 copay
|Home health care||In-Network:|
|Mental health inpatient care||In-Network:|
Days 1-6: $295.00 per day, per admission / Days 7-90: $0.00 per day, per admission
Additional Hospital Days: Unlimited additional days
|Mental health outpatient care||In-Network:|
Individual and Group Sessions: $40.00 copay
Outpatient Hospital - Surgery: $275.00 copay
Observation Services: $275.00 copay
Ambulatory Surgical Center: $245.00 copay
|Outpatient substance abuse care||In-Network:|
Individual and Group Sessions: $45.00 - $100.00 copay
|Over-the-counter items||This plan covers certain approved, non-prescription, over-the-counter drugs and health-related items, up to $150 every quarter. Unused OTC amounts do roll over to the next quarter. Unused OTC amounts do not roll over to the next calendar year.|
Medicare Covered Podiatry Services: $0.00 - $45.00 copay
Routine Foot Care: $0.00 copay
Unlimited routine foot care visits each year.
|Skilled Nursing Facility (SNF) care|
30% coinsurance per stay
The following dental services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.
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 $2,000.00 allowance for covered comprehensive dental services every year.
The following vision services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.
Medicare Covered Eye Exam: $60.00 copay
Routine Eye Exam: $0.00 copay
Medicare Covered Eye Wear: $0.00 copay
Routine Eye Wear: $0.00 copay
The following hearing services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.
Medicare Covered Hearing Exam: $45.00 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.
The following services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.
|Preventive services and health/wellness education programs|
When reviewing Kentucky 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 Kentucky 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.
|Links to plan documents|
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