Medicare Plans Offered By Anthem

Anthem’s Medicare Advantage Plans

If you want a Medicare plan that provides coverage for both your inpatient and outpatient healthcare needs, you have two basic ways to get it.

You can either sign up for Original Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) and obtain your benefits directly from the federal government, or you can elect to go with a health plan offered through a private insurance company that contracts with Medicare.

The latter is called Medicare Advantage—commonly referred to as Medicare Part C or MA Plans—but why would you choose this type of plan versus Original Medicare?

The Benefits Of Medicare Advantage

One of the reasons people like Medicare Advantage is because these types of plans often include Part A and Part B benefits, as well as prescription drug coverage, according to Anthem.

This enables participants to have an all-in-one insurance plan that covers a majority of their healthcare needs, some of which also include benefits related to vision, dental, and hearing.

Plus, while Original Medicare does pay 80 percent of doctor visit costs, Anthem says that Medicare Advantage plans simply charge a copay. This takes the guesswork out of how much to budget for healthcare services because you’ll always know beforehand what your portion of the bill will be.

The same is true when it comes to any stay you may have in a hospital, because Original Medicare will only pay a maximum amount per day (up to 150 days), whereas Medicare Advantage plans typically have copay amounts that tend to lower out-of-pocket expenses.

Anthem And Medicare Advantage

When it comes to Anthem Medicare Advantage plans specifically, in addition to providing Part A and Part B benefits, they each also offer participants a number of different preventative services at no additional cost. These services include:

Immunization Shots:

Pneumococcal and flu. Also, if the person is at medium or high risk for hepatitis B, these shots are covered as well.

Regular Exams:

A one-time “Welcome to Medicare” preventive visit within the first 12 months is covered, as well as yearly wellness visits thereafter.

Health Screenings:

Screenings for a number of health conditions including breast cancer, cardiovascular disease, and prostate cancer.

Counseling Or Therapy:

For cardiovascular disease, obesity, and medical nutrition therapy for those with diabetes or renal disease.

HMOs Vs PPOs

Under Medicare Advantage, Anthem offers two basic types of plans: HMOs and PPOs. What’s the difference?

With an HMO plan, you are required to name a primary care physician who you will see for all of your basic healthcare needs. If you need to see another doctor (such as a specialist) for any reason, it is up to your primary care doctor to make a referral first.
With a PPO plan, you still get to pick your primary care physician, but you can also see any other healthcare providers you’d like (specialists included) without a referral. They just need to be in your plan’s network to be covered.

If you’re not sure which one is best for you, it helps to understand the pros and cons to both types of insurance. For instance, some people prefer PPOs because they’re able to see the doctors and specialists they want without having to go through the steps of obtaining a referral first.

This gives them the freedom to hand pick their healthcare team as long as each provider they choose is in the plan’s network. However, having that ability does come at a cost.

PPO plan premiums and out-of-pocket expenses tend to be higher than those associated with HMOs. This is because, under an HMO, the healthcare provider is given a monthly fee (called a capitation fee) for each member who signs up and names him or her as the primary provider. The same type of fee is paid to referred specialists under an HMO plan.

Anthem’s Special Needs Plans

If you receive both Medicare and Medicaid, Anthem offers another Medicare Advantage option called a Dual Eligible Special Needs Plan. These HMO-based plans have zero-dollar premiums, no copays, no deductibles, and maximums for out-of-pocket expenses, while including prescription drug coverage, too.

In a 2014 press release that shared the availability of these types of plans in Connecticut, Anthem explained that Dual Eligible Special Needs Plans were designed to meet the “complex health care needs” of individuals receiving both forms of medical assistance. The goal of offering a Special Needs Plan is to coordinate the participant’s benefits, an action which hopefully provides the patient with a better outcome, according to the press release.

Anthem’s Medicare Prescription Drug Coverage Options (Part D)

If you purchase one of Anthem’s Medicare Advantage plans, it’s likely that the plan also includes prescription drug coverage, hence the name “all-in-one” plan.

However, Anthem also provides a variety of stand-alone prescription drug policies, commonly referred to as Medicare Part D. Purchasing this type of plan can give you more access to the medications you need simply by reducing your out-of-pocket costs. According to Anthem, a Medicare Prescription Drug Plan is beneficial for anyone who is:

• Enrolled in Original Medicare (parts A and B) and wants additional drug coverage
• Enrolled in a Medicare Advantage or some other type of supplemental insurance plan, yet still needs drug coverage to complement that plan
• Not currently enrolled in an employer-sponsored drug coverage plan

Anthem’s Prescription Drug Benefits

With Anthem plans, each drug covered by the plan is placed in a tier system. Generic drugs are on the lowest tier, which also makes them the lowest price, and brand names are on the higher tiers, which means they cost more.

Some conditions also qualify members to participate in step therapy. In this case, if you try a lower tier drug and it doesn’t work, you’re able to potentially move up to a more expensive medication that does.

Select prescriptions received under an Anthem plan may require prior authorization, which means that your doctor has to clear that particular medication with Anthem before it can be prescribed.

Quantity limits may also be put in place by Anthem, preventing you from refilling your medications too early without first getting approval from your doctor. These limits may also be used if your prescription is in a higher amount than what is typically prescribed.

Anthem’s Medication Therapy Management Program

If you have three or more chronic health conditions, take at least eight medications per day, and spend a minimum of $3,507 per year on drugs covered under Medicare Part D, you may qualify for Anthem’s Medication Therapy Management Program.

This program is offered at no additional cost and provides members with a comprehensive medication review and one-on-one contact with a pharmacist. As a participant, you also receive a summary of all of the medications you’re on and an action plan you can take with you to all of your doctor’s appointments.

Additionally, Anthem says that the premiums for prescription drug coverage sometimes depend on your income level. The more money you make, the higher your drug plan premiums can be.

Anthem’s Medicare Supplement Insurances (Medigap)

While Original Medicare provides benefits for a number of different healthcare services and needs, there are other costs that you must pay as a participant. These include deductibles, copayments, and coinsurance. Purchasing a Medicare Supplement Plan, known as Medigap, can help offset some of these costs.

Anthem says that benefits provided under Medicare Supplements also bring extra value to those who travel because they help cover the additional costs if you’re not in your area, need medical treatment, and are unable to find a doctor who accepts Medicare insurance.

It’s also beneficial to anyone who likes a little flexibility when it comes to choosing doctors who are either not in the network or charge more than the Medicare-approved amount because it helps offset some of these extra costs.

Additionally, Anthem gives its participants a few “extras.” One is the ability to join their fitness program called SilverSneakers at no additional cost. With this program, participants have access to group fitness classes and equipment at more than 13,000 locations across the U.S.

And if you’re looking for dental-only or vision-only coverage (or both) to supplement your Medicare plan, Anthem has some options available. However, they are not available in all states.

Using Anthem’s Website to Purchase Your Medicare Plan

When using Anthem’s website to purchase your Medicare plan, all you have to do is type in your zip code, county, and the coverage year and you’ll be directed to a page that lists all of the available plans in your area.

Some sections are more detailed and ask for more information about what you’re looking for to better direct you to the plans most suited to your desires and needs. For each one, the site tells you:

• The name of the plan
• The plan’s rating on a 5-star scale
• What the copays are (for primary care physicians and specialists)
• The annual deductible
• Out-of-pocket maximum
• Total monthly premium

Under each plan option, Anthem tells you the additional benefits of that particular plan, such as hearing, dental, prescription drugs, or access to other types of care centers.

If you find one that you like, you can click on the links to view the plan details or documents, or you can simply select the plan. The site provides the option to compare up to three different plans at one time, providing you with an easy-to-read chart so you can quickly see their similarities and difference.