Anthem Medicare Advantage (PPO) 2025 Plan Details for King George County, Virginia Residents
Anthem Medicare Advantage (PPO) 2025 Plan Details for King George County, Virginia Residents
Navigating your Medicare Advantage options in King George County for 2025 can be overwhelming, but we're here to help. With Anthem Medicare Advantage (PPO) included in your plan options, you can evaluate it alongside other plans to make an informed decision. Enroll online quickly, or consult with a licensed agent if you need assistance.
Anthem Medicare Advantage Overview
Plan ID H4909-014-0 Overview | |
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Health Plan ID: | H4909-014-0 |
Medicare Advantage Plan Type: | Local PPO |
Plan Year: | 2024 |
Monthly Premium: | $0.00 Plus your Medicare Part B premium. |
Health Plan Deductible: | $750.00 |
Annual Out-of-Pocket Maximum: | $7,550 |
Part B Give Back: | $0.00/mo |
Part D Drug Plan Benefit: | Enhanced, $95.00 deductible |
Part D Gap Coverage: | Yes |
Supplemental Benefits: | Vision, Hearing |
Availability: | King George County, VA |
Insured By: | Anthem Blue Cross and Blue Shield |
Why Choose Anthem Medicare Advantage?
Anthem Medicare Advantage is a Medicare Advantage Prescription Drug (MAPD) Preferred Provider Organization (PPO) plan offering flexibility and comprehensive healthcare coverage. With a monthly premium of $0.00, this plan provides all the benefits of Medicare Part A and Part B, along with additional services like prescription drug coverage. The annual Part D deductible is $95.00. As a PPO plan, you have the option to see providers both in and out of the plan’s network, though using in-network providers typically results in lower costs.
One of the valuable features of Anthem Medicare Advantage is its protection against high medical expenses. The annual maximum out-of-pocket (MOOP) limit is $7,550, ensuring that once you reach this amount, the plan covers 100% of your in-network healthcare costs for the rest of the year. This makes Anthem Medicare Advantage a flexible and reliable choice for those seeking comprehensive coverage with the freedom to choose their healthcare providers.
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Out-of-Pocket Costs
Anthem Medicare Advantage has cost-sharing, meaning you'll have out-of-pocket costs when using approved healthcare services. The table below details the most common in-network out-of-pocket expenses for plan H4909-014-0.
Service | Enrollee Cost |
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Doctor's Office Visit (In-Network) | |
Primary: | $0 Copay |
Specialist: | $40 Copay Prior Authorization Required |
Wellness & Preventive Programs: | None |
Preventive care: | $0 Copay |
Foot Care (In-Network) | |
Foot Exams and Treatments (Medicare-covered): | $40 Copay Prior Authorization Required |
Routine Foot Care: | Not Covered |
Chiropractic Treatment (In-Network) | |
Medicare-covered chiropractic: | $15 Copay Prior Authorization Required |
Routine chiropractic: | Not Covered |
Emergency and Urgent Care | |
Emergency room care: | $90 Copay |
Urgent care: | $45 Copay |
Ground ambulance: | $350 Copay |
Inpatient hospital care: | $350.00 per day for days 1 through 7 $0.00 per day for days 8 and beyond |
Outpatient hospital care: | $245 Copay Prior Authorization Required |
Skilled Nursing Facility: | $0.00 per day for days 1 through 20 $196.00 per day for days 21 and beyond |
Optional supplemental benefits: | |
Mental Health Services (In-Network) | |
Outpatient individual therapy: | $40 Copay |
Outpatient group therapy: | $40 Copay |
Inpatient psychiatric hospital care: | $440.00 per day for days 1 through 4 $0.00 per day for days 5 and beyond |
Outpatient group therapy: | $40 Copay |
Outpatient individual therapy: | $0 |
Rehabilitation Services (In-Network) | |
Physical therapy and speech and language therapy: | $30 Copay Prior Authorization Required |
Occupational therapy: | $30 Copay Prior Authorization Required |
Medical Equipment and Supplies (In-Network) | |
Diabetes supplies: | $0 Copay |
Durable medical equipment: | 20% Coinsurance Prior Authorization Required |
Prosthetics: | 20% Coinsurance |
Diagnostics, Lab Services, and Imaging (In-Network) | |
Diagnostic radiology services: | $200 Copay Prior Authorization Required |
Lab services: | $15 Copay Prior Authorization Required |
Outpatient x-rays: | $110 Copay Prior Authorization Required |
Diagnostic tests and procedures: | $140 Copay Prior Authorization Required |
Medicare Part B Drugs (In-Network) | |
Chemotherapy: | 20% Coinsurance |
Other Part B drugs (Medicare-covered) | 20% Coinsurance |
Most preventive services are covered 100% by Anthem Medicare Advantage as a Part B benefit.
Supplemental Benefits
Here’s an overview of the additional benefits that Anthem Blue Cross and Blue Shield offers with this plan:
Supplemental Healthcare Service | Member Cost |
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Preventive Dental | |
Oral exam (In-Network) | Not Covered |
Fluoride treatment (In-Network) | Not Covered |
Dental x-ray(s) (In-Network) | Not Covered |
Cleaning (In-Network) | Not Covered |
Comprehensive Dental | |
Periodontics (In-Network) | Not Covered |
Non-routine services (In-Network) | Not Covered |
Diagnostic services (In-Network) | Not Covered |
Extractions (In-Network) | Not Covered |
Endodontics (In-Network) | Not Covered |
Restorative services (In-Network) | Not Covered |
Prosthodontics, other oral/maxillofacial surgery, other services (In-Network) | Not Covered |
Hearing Aids | |
Fitting/evaluation (In-Network) | $0 Copay Prior Authorization Required |
Hearing aids (In-Network) | Covered Limits may apply |
Hearing exam (In-Network) | $0 Copay Prior Authorization Required |
Vision | Maximum vision benefit: | $100.00 Every year |
Eyeglasses (frames and lenses) (In-Network) | $0 Copay |
Routine eye exam (In-Network) | $0 Copay |
Contact lenses (In-Network) | $0 Copay |
Additional Benefits
None specified.
Part D Prescription Drug Costs & Benefits
Anthem Medicare Advantage includes an enhanced benefit Medicare Part D plan (PDP), which offers greater coverage than basic plans. An enhanced benefit plan has a higher actuarial value, meaning it covers a larger percentage of your healthcare costs.
Part D Plan Premium
While the prescription drug plan (Part D) premium is included in the overall plan cost, some plans may have additional costs or provide assistance through the Low-Income Subsidy (LIS) program. Also known as Extra Help, LIS is a Social Security program that assists individuals with limited income and resources in reducing or eliminating Part D expenses.
The following table outlines the prescription drug plan premium details of this plan.
Basic Part D Premium: | $0.00 |
Supplemental Part D Premium: | $0.00 |
Total Part D Premium: | $0.00 |
Part D Premium with Full LIS Assistance: | $0.00 |
If you would like more information about the Extra Help program, you can refer to the Social Security Extra Help page.
Prescription Drug Plan Deductible
The Medicare Part D annual deductible with this plan is $95.00. You must pay this amount at the pharmacy before Anthem Blue Cross and Blue Shield begins paying its share.
NOTE: The deductible does not apply to one or more drug tiers in this plan (see "Prescription Drug Plan Out-of-Pocket Costs" below).
Prescription Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, Anthem Medicare Advantage has out-of-pocket costs that you must pay when you pick up your prescriptions.
Drug Tier | Preferred | Standard |
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1 (Preferred Generic) | $4.00 copay (deductible does not apply) | $9.00 copay (deductible does not apply) |
2 (Generic) | $13.00 copay | $18.00 copay |
3 (Preferred Brand) | $42.00 copay | $47.00 copay |
4 (Non-Preferred Drug) | $95.00 copay | $100.00 copay |
5 (Specialty Tier) | 31% | 31% |
6 (Select Care Drugs) | $0.00 copay | $0.00 copay |
How CMS Star Ratings Guide Your Choice
Each year, the Centers for Medicare & Medicaid Services (CMS) assesses health plans (Part C) and drug plans (Part D) based on a 5-star rating system. These ratings provide an overview of the plan’s performance in areas such as preventive care, managing chronic conditions, and member experience.
Considering a plan’s star rating can be an important part of your decision-making process, as higher ratings often reflect stronger performance in key areas of healthcare and customer service.
CMS Measure | Star Rating |
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2024 Overall Rating | |
Staying Healthy: Screenings, Tests, Vaccines | |
Managing Chronic (Long Term) Conditions | |
Member Experience with Health Plan | |
Complaints and Changes in Plans Performance | |
Health Plan Customer Service | |
Drug Plan Customer Service | |
Complaints and Changes in the Drug Plan | |
Member Experience with the Drug Plan | |
Drug Safety and Accuracy of Drug Pricing |
Eligibility Requirements for Anthem Medicare Advantage
To enroll in Anthem Medicare Advantage, you must meet the following criteria:
- Be eligible for Medicare Part A and Part B.
- Reside in the plan’s service area.
- Not have End-Stage Renal Disease (ESRD), with some exceptions.
If you meet these requirements, you are eligible to enroll in Anthem Medicare Advantage and benefit from its comprehensive coverage options.
Enrollment Periods for Anthem Medicare Advantage
Knowing when you can enroll in Anthem Medicare Advantage is essential. Here are the main enrollment periods:
- Initial Enrollment Period (IEP): Your IEP starts three months before your 65th birthday and ends three months after, giving you a seven-month window to enroll in Medicare.
- Annual Enrollment Period (AEP): The AEP, from October 15 to December 7, allows you to make changes to your Medicare Advantage plan.
- Medicare Advantage Open Enrollment Period (MA OEP): Running from January 1 to March 31, the MA OEP lets you switch plans or return to Original Medicare.
- Special Enrollment Periods (SEPs): Life events such as moving or losing coverage may qualify you for a SEP, enabling you to enroll or make changes outside the usual periods.
If you're uncertain about the right time to enroll, Call HealthCompare (our trusted enrollment partner) at 1-877-388-0596 (TTY 711) for expert guidance from a licensed insurance agent.
How to Enroll in Anthem Medicare Advantage
Joining Anthem Medicare Advantage is straightforward. Here are the steps you can take:
- Online: Use our online enrollment partner's Secure Online Enrollment Form to sign up.
- By Phone: Reach out to HealthCompare (our trusted enrollment partner) at 1-877-388-0596 (TTY 711). A licensed insurance agent will help you with the enrollment process and answer any questions you might have.
- Through Medicare.gov: Enroll directly through the official Medicare website. Visit Medicare.gov, log in or create an account, and follow the steps to join Anthem Medicare Advantage.
- Direct Enrollment: You can also choose to enroll directly with Anthem Medicare Advantage. The contact information can be found below in the "Contact" section.
Make sure you enroll during the appropriate period to activate your coverage as soon as possible.
Contact Anthem Blue Cross and Blue Shield
Website: | http://shop.anthem.com/medicare |
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Formulary: | https://shop.anthem.com/medicare |
Pharmacy: | Anthem Blue Cross and Blue Shield Pharmacy Page |
New Members: | (855)679-0550 |
TTY Users: | 711 |
If you're eligible for Medicare but haven't enrolled or need to verify your enrollment status, you can do so on the Social Security Administration website. For more information about the Medicare Part C program, visit the official Medicare website or call 1-800-MEDICARE.
Plans Offered
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, GlobalHealth, Health Care Service Corporation, Cigna Healthcare, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Scott and White Health Plan now part of Baylor Scott & White Health, UnitedHealthcare(R), and Wellcare.
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