Anthem MediBlue Access (PPO) H8552-020-000 is a 2021 Medicare Advantage plan with drug coverage provided by Anthem Blue Cross Life and Health Insurance Co..

In terms of networks, this plan is a Local PPO. With a PPO, you don’t need to choose a primary care doctor and can utilize healthcare providers inside or outside your network (although you'll typically pay less for providers in a plan's network). Local PPOs cover only a small service area, such as a part of a county, a single county, or a group of counties. If you need a wider area of coverage, you may want to look at Regional PPO plans if any are available in your region.

When it comes to cost-sharing, you’ll want to consider both monthly costs and out-of-pocket costs. This plan has a monthly premium of $172, which covers both the health and drug portions of the plan.

The drug plan portion of this plan provides Enhanced Alternative (EA) benefits, which are benefits that exceed the required standard.

When it comes to out-of-pocket costs for drugs, this plan has a Part D drug Deductible of $370.00 and an Initial Coverage Limit of $4130. Each drug tier may be subject to different cost-sharing in each coverage phase, so keep that in mind when considering out-of-pocket costs. Check out the drug formulary below for more information, or reach out to a licensed Medicare agent for help using the call number on this page. Alternatively, if you know what plan you want, you can enroll online yourself using our site as well.


Plan Basics
Contract Year 2021
Medicare Type Medicare Advantage Plan (Part C)
CMS Plan ID H8552-020-000
Plan Organization Anthem Blue Cross Life and Health Insurance Co.
Plan Type Local PPO
Plan Name Anthem MediBlue Access (PPO)
Plan Organization Type Local CCP
Drugs Covered Yes
Doctors Choice Any Doctor
Benefit Type Enhanced Alternative
Special Needs Plan No
Overall Star Rating 3.5
Plan Cost Sharing
Premium $172.00
Total Premium (Includes Part B) $307.50
Monthly Part C Premium $84.60
Monthly Part D Basic Premium $80.50
Monthly Part D Supplemental Premium $6.90
Monthly Part D Total Premium $87.40
Monthly Part D Premium Full Assistance $55.90
Monthly Part D Premium 75% Assistance $63.80
Monthly Part D Premium 50% Assistance $71.70
Monthly Part D Premium 25% Assistance $79.50
Part D Drug Deductible $370.00
Annual Drug Deductible $370.00
Tiers Excluded From Deductible 1
Part D Initial Coverage Limit $4130.00
Part D Catastrophic Coverage Threshold $6550.00
Maximum Out-of-Pocket Limit for Parts A & B (MOOP) $6700.00
Gap Coverage No

Medicare Advantage Plan Health Benefits


Additional Benefits And/or Reduced Cost-sharing For Enrollees With Certain Health Conditions?
Service Cap Network Auth. Req. Ref. Req. Cost Share
- In-Network - - No
Comprehensive Dental
Service Cap Network Auth. Req. Ref. Req. Cost Share
Diagnostic services No - - - Not covered
Endodontics No - - - Not covered
Extractions No - - - Not covered
Non-routine services No - - - Not covered
Periodontics No - - - Not covered
Prosthodontics, other oral/maxillofacial surgery, other services No - - - Not covered
Restorative services No - - - Not covered
Diagnostic Procedures/lab Services/imaging
Service Cap Network Auth. Req. Ref. Req. Cost Share
Diagnostic radiology services (e.g., MRI) - Out-of-Network Yes Yes 50% coinsurance
Diagnostic tests and procedures - Out-of-Network Yes Yes 50% coinsurance
Lab services - Out-of-Network Yes Yes 50% coinsurance
Outpatient x-rays - Out-of-Network Yes Yes 50% coinsurance
Doctor Visits
Service Cap Network Auth. Req. Ref. Req. Cost Share
Primary - Out-of-Network - - $30 copay per visit
Specialist - Out-of-Network Yes Yes $50 copay per visit
Emergency Care/Urgent Care
Service Cap Network Auth. Req. Ref. Req. Cost Share
Emergency - - - - $90 copay per visit (always covered)
Urgent care - - - - $30 copay per visit (always covered)
Foot Care (podiatry Services)
Service Cap Network Auth. Req. Ref. Req. Cost Share
Foot exams and treatment - Out-of-Network Yes Yes $50 copay
Routine foot care - - - - Not covered
Ground Ambulance
Service Cap Network Auth. Req. Ref. Req. Cost Share
- Out-of-Network - - $325 copay
Health Plan Deductible
Service Cap Network Auth. Req. Ref. Req. Cost Share
- - - - $590 annual deductible
Hearing
Service Cap Network Auth. Req. Ref. Req. Cost Share
Fitting/evaluation No - - - Not covered
Hearing aids - inner ear No - - - Not covered
Hearing aids - outer ear No - - - Not covered
Hearing aids - over the ear No - - - Not covered
Hearing exam - Out-of-Network Yes Yes 40% coinsurance
Inpatient Hospital Coverage
Service Cap Network Auth. Req. Ref. Req. Cost Share
- Out-of-Network Yes No 40% per stay
Maximum Out-of-pocket Enrollee Responsibility (does Not Include Prescription Drugs)
Service Cap Network Auth. Req. Ref. Req. Cost Share
- - - - $10,000 In and Out-of-network$6,700 In-network
Medical Equipment/supplies
Service Cap Network Auth. Req. Ref. Req. Cost Share
Diabetes supplies - Out-of-Network Yes - 30% coinsurance per item
Durable medical equipment (e.g., wheelchairs, oxygen) - Out-of-Network Yes - 30% coinsurance per item
Prosthetics (e.g., braces, artificial limbs) - Out-of-Network Yes - 30% coinsurance per item
Medicare Part B Drugs
Service Cap Network Auth. Req. Ref. Req. Cost Share
Chemotherapy - Out-of-Network Yes - 20% coinsurance
Other Part B drugs - Out-of-Network Yes - 20% coinsurance
Mental Health Services
Service Cap Network Auth. Req. Ref. Req. Cost Share
Inpatient hospital - psychiatric - Out-of-Network Yes No 40% per stay
Outpatient group therapy visit - Out-of-Network Yes Yes $50 copay
Outpatient group therapy visit with a psychiatrist - Out-of-Network Yes Yes $50 copay
Outpatient individual therapy visit - Out-of-Network Yes Yes $50 copay
Outpatient individual therapy visit with a psychiatrist - Out-of-Network Yes Yes $50 copay
Optional Supplemental Benefits
Service Cap Network Auth. Req. Ref. Req. Cost Share
- - - - Yes
Other Health Plan Deductibles?
Service Cap Network Auth. Req. Ref. Req. Cost Share
- In-Network - - No
Outpatient Hospital Coverage
Service Cap Network Auth. Req. Ref. Req. Cost Share
- Out-of-Network Yes Yes 40% coinsurance per visit
Preventive Care
Service Cap Network Auth. Req. Ref. Req. Cost Share
- Out-of-Network No No 40% coinsurance
Preventive Dental
Service Cap Network Auth. Req. Ref. Req. Cost Share
Cleaning Yes Out-of-Network No No 20% coinsurance
Dental x-ray(s) No - - - Not covered
Fluoride treatment No - - - Not covered
Oral exam Yes Out-of-Network No No 20% coinsurance
Rehabilitation Services
Service Cap Network Auth. Req. Ref. Req. Cost Share
Occupational therapy visit - Out-of-Network Yes Yes $50 copay
Physical therapy and speech and language therapy visit - Out-of-Network Yes Yes $50 copay
Skilled Nursing Facility
Service Cap Network Auth. Req. Ref. Req. Cost Share
- Out-of-Network Yes No 15% per stay
Transportation
Service Cap Network Auth. Req. Ref. Req. Cost Share
- - - - Not covered
Vision
Service Cap Network Auth. Req. Ref. Req. Cost Share
Contact lenses No - - - Not covered
Eyeglass frames No - - - Not covered
Eyeglass lenses No - - - Not covered
Eyeglasses (frames and lenses) No - - - Not covered
Other No - - - Not covered
Routine eye exam Yes Out-of-Network No No $0 copay
Upgrades - - - - Not covered
Wellness Programs (e.g., Fitness, Nursing Hotline)
Service Cap Network Auth. Req. Ref. Req. Cost Share
- - No No Covered

Medicare Plan Packages


Package #1
Category Cost Sharing Type Cost Share
Preventive dental Monthly Premium $23.00
Package #2
Category Cost Sharing Type Cost Share
Comprehensive dental Monthly Premium $35.00
Eyewear Monthly Premium $35.00
Preventive dental Monthly Premium $35.00
Package #3
Category Cost Sharing Type Cost Share
Comprehensive dental Monthly Premium $58.00
Eyewear Monthly Premium $58.00
Preventive dental Monthly Premium $58.00
Plan Drug Info
Formulary Link Drug Formulary Directory
Official Medicare Contact
Medicare Phone 1-800-MEDICARE (1-800-633-4227)
Medicare TTY User 1-877-486-2048
Plan Available in these Counties
Orange County, California

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