This article looks at the Anthem Medicare Advantage plans and their coverage. It also discusses the benefits and typical costs of the plans, as well as where they are available.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Anthem are a private health insurance company based in Indianapolis, IN, in the United States. They are one of the independent licensees of the Blue Cross Blue Shield (BCBS) Association.
In 2004, WellPoint Health Networks and Anthem merged, initially under the name of WellPoint. In 2014, the company changed their name to Anthem.
The company provide integrated healthcare plans and life and disability insurance benefits. They also offer dental, vision, and behavioral health benefit services through their affiliated companies. People can choose from a range of Anthem Medicare Advantage plans.
Medicare is a federally funded healthcare program that lowers healthcare costs for people over the age of 65 years or for younger people living with specific disabilities.
Medicare has four parts:
- Part A, which is hospital coverage
- Part B, which is medical insurance
- Part C, also known as Medicare Advantage
- Part D, which is optional prescription drug coverage
Beneficiaries can enroll in either original Medicare (parts A and B) or a Medicare Advantage plan (Part C). These bundled plans provide the same coverage as original Medicare, plus supplemental benefits, which vary among plans but may include:
- annual physical examinations
- dental, hearing, and vision care
- fitness and wellness benefits, such as gym membership
- prescription drug coverage
People can use this online tool to assess the Medicare Advantage plans that are available in their location.
Private insurance companies administer Medicare Advantage plans. More than 24 million people in the U.S. were enrolled in Advantage plans in 2020, according to the Kaiser Family Foundation.
Anthem offer a variety of Medicare Advantage plans, including health maintenance organization (HMO) plans, HMO Chronic Condition Special Needs Plans (C-SNP), HMO Dual SNPs, Preferred Provider Organization (PPO) plans, and SNPs.
With HMO plans, a person must use the plan’s network of healthcare providers, unless they are in a medical emergency. A primary care doctor coordinates the person’s healthcare, preventive services, and referrals to specialists.
HMO plans typically cost less than PPO plans, providing the person gets care from providers within the plan’s network.
Anthem HMO plans include:
- dental, vision, and hearing coverage
- prescription drug coverage
- over-the-counter (OTC) items
- access to SilverSneakers, a fitness program
- optional supplemental benefits
HMO C-SNPs are for people with certain medical conditions.
For example, the Anthem MediBlue ESRD Care (HMO C-SNP) plan in Los Angeles, CA, is available to a person with end stage renal disease (ESRD) that requires dialysis. The plan has a zero monthly premium, zero annual deductible, and zero in-network copay. The plan’s out-of-pocket in-network limit is $900. Its optional benefits include vision and dental care.
An HMO D-SNP helps meet the needs of a person who is enrolled in original Medicare and also gets assistance from the state Medicaid program.
For example, Anthem’s MediBlue Connect (HMO D-SNP) plan has a zero monthly premium, zero annual deductible, and zero in-network copay. The in-network out-of-pocket limit is $7,550.
PPO plans use a specific network of healthcare providers. A person can also use providers outside the plan’s network, but that will incur higher out-of-pocket costs.
With a PPO plan, a person does not need to choose a primary care doctor, and they do not require referrals to see a specialist. However, as PPO plans are more flexible than HMO plans, they may have higher costs.
As an example, the Anthem MediBlue Access Plus (PPO) plan in Waukesha, WI, has a zero monthly premium and deductible, but the copays for going to a primary provider range from zero for an in-network primary provider to $35 for an out-of-network primary provider.
The plan’s out-of-pocket maximum ranges from an in-network limit of $4,500 to a combined in- and out-of-network limit of $10,000.
SNPs are HMO or PPO plans for people living with certain health conditions. The plans provide extra coverage for some health resources, such as specialists, OTC healthcare, and health screenings.
People may also refer to these plans as dual eligible SNPs.
Conditions for qualifying for an SNP include:
- living with a chronic condition, such as diabetes or ESRD
- having enrolled in both Medicare and Medicaid
- living in an Anthem nursing home or assisted living community
Where are Anthem plans available?
Anthem Medicare Advantage plans are available in 14 states:
- New Hampshire
- New York
Anthem offer specialty plans to members in other states.
To ensure that all Medicare Advantage plans provide a high quality service, the Centers for Medicare & Medicaid Services (CMS) have a rating system.
The Five-Star Quality Rating System uses a scale of one to five stars to measure Medicare beneficiaries’ experiences with their Medicare Advantage plan. One star represents poor performance, whereas a rating of five stars is excellent.
Anthem Medicare Advantage plans consistently have four or five stars.
Anthem Medicare Advantage plans involve various costs.
The company’s HMO plans generally have zero deductibles and fixed copays. The premium cost ranges upward from zero.
Anthem PPO plans provide the flexibility to choose an in-network provider. Alternatively, people can choose from providers outside the plan’s network, but the costs may be higher.
The table below shows some example costs of Anthem Medicare Advantage plans:
|Plan||Location||Monthly premium||Out-of-pocket maximum||PCP visit copay||Specialist visit copay|
|MediBlue Value Plus (HMO)||Beverly Hills, CA||$0||$900 in-network||$0||$0|
|MediBlue Coordination Plus (HMO)||Beverly Hills, CA||$12.20||$7,550 in-network||20% coinsurance||20% coinsurance|
|MediBlue Access Plus (PPO)||Dodge, WI||$0||$4,500 in-network and $10,000 combined in- and out-of-network||$0 in-network and $35 out-of-network||$35 in-network and $55 out-of-network|
Anthem are a U.S. insurance company offering Medicare Advantage plans to residents of 14 states. People can choose from HMO, PPO, and SNP options.
Anthem Medicare Advantage plan coverage equals that of original Medicare and provides additional benefits, such as gym membership, vision and hearing exams, and prescription drugs.
People can use the government tool or Anthem’s online service to compare the available plans in their area.