| Summary | Amount |
|---|
| Monthly plan premium | $0.00 |
| Medical deductible | $0 |
| Out-of-network maximum out-of-pocket | N/A |
| In-network maximum out-of-pocket | $6,700 |
| Combined maximum out-of-pocket | N/A |
Health plan disclaimers:
Anthem Blue Cross and Blue Shield
Anthem Blue Cross and Blue Shield is a Medicare Advantage plan with a Medicare contract. For Dual-Eligible Special Needs Plans: Anthem Blue Cross and Blue Shield is an HMO D-SNP with a Medicare contract and a contract with the State Medicaid program. Enrollment in Anthem Blue Cross and Blue Shield depends on contract renewal. Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. HMO plans are administered by Anthem Health Plans of New Hampshire, Inc. and underwritten by Matthew Thornton Health Plan, Inc. In 17 southeastern counties of New York: Anthem HealthChoice Assurance, Inc., and Anthem HealthChoice HMO, Inc. In these same counties Anthem Blue Cross and Blue Shield HP is the trade name of Anthem HP, LLC. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia with its affiliate Healthkeepers, Inc., and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin (BCBSWI), underwrites or administers PPO and indemnity policies and underwrites the out-of-network benefits in POS policies offered by Compcare Health Services Insurance Corporation (Compcare) or Wisconsin Collaborative Insurance Corporation (WCIC). Compcare underwrites or administers HMO or POS policies; WCIC underwrites or administers Well Priority HMO or POS policies. Independent licensees of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc. Anthem Blue Cross Anthem Blue Cross, Anthem Blue Cross Partnership Plan, and Anthem Blue Cross Life and Health Insurance Company are Medicare Advantage Organizations with Medicare contracts. For Dual-Eligible Special Needs Plans in CA: Anthem Blue Cross is an HMO D-SNP and Anthem Blue Cross Life and Health Insurance Company is an LPPO D-SNP with a Medicare contract and a contract with the California Medicaid program. For Dual-Eligible Special Needs Plans in NY: Anthem Blue Cross is an HMO D-SNP with a Medicare contract and either a contract or a coordination of benefits agreement with the New York State Department of Health. Enrollment in Anthem Blue Cross, Anthem Blue Cross Partnership Plan, and Anthem Blue Cross Life and Health Insurance Company depends on contract renewal. Anthem Blue Cross is the trade name of: In California: Blue Cross of California. Anthem Blue Cross Partnership Plan, Anthem BC Health Insurance Company and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association. In 11 northeastern counties of New York: Anthem Blue Cross is the trade name of Anthem HealthChoice Assurance, Inc., and Anthem HealthChoice HMO, Inc. Independent licensees of the Blue Cross Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc. General disclaimers We do not offer every plan available in your area. Currently we represent 6 organizations which offer 44 products in your area. Please contact Medicare.gov, 1–800–MEDICARE, or your local State Health Insurance Program to get information on all of your options. Agency represents Medicare HMO, PPO, and PFFS organizations and stand-alone PDP prescription drug plans that have a Medicare contract. Enrollment depends on the plan’s contract renewal. The plans we represent do not discriminate on the basis of race, color, national origin, age, disability, or sex. To learn more about a plan’s nondiscrimination policy, please click any of the Nondiscrimination links above in the Health plan disclaimers section. This information is not a complete description of benefits. Call 1-800-215-3128 (TTY: 711) for more information. Medicare beneficiaries may also enroll in the plan through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov. For a complete list of available plans please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov. Every year, Medicare evaluates plans based on a 5-star rating system. Out-of-network/non-contracted providers are under no obligation to treat Plan members, except in emergency situations. Please call the Plan’s customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. Total annual cost is calculated by adding up the total annual cost of any monthly premiums, applicable plan deductible(s) and estimates for all co-pay and co-insurance amounts that will be due for the medications and health benefits used throughout the year. Costs for medications and health benefits vary across pharmacies and health systems, so the costs provided are only estimates. Actual costs could vary. For plans with Part D Coverage: You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 8 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778 or consult www.socialsecurity.gov; or your Medicaid Office. You must have both Part A and B to enroll in a Medicare Advantage plan. Members may enroll in the plan only during specific times of the year. Contact the plan for more information. The purpose of this communication is the solicitation of insurance. Contact will be made by an insurance agent/producer or insurance company. If the plan you are reviewing is a Medicare Advantage with drug coverage or a prescription drug plan then the next two disclaimers apply. Important Message About What You Pay for Vaccines – Our plan covers most Part D vaccines at no cost to you, even if you haven’t paid your deductible. Call Pharmacy Member Services for more information. Important Message About What You Pay for Insulin – You won’t pay more than $35 for a one-month supply of each insulin product covered by our plan, no matter what cost-sharing tier it’s on, even if you haven’t paid your deductible. To send a complaint to a Medicare Health Plan, call the Plan or the number on your member ID card. To send a complaint to Medicare, call 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week). If your complaint involves a broker or agent, be sure to include the name of the person when filing your grievance.
Anthem Blue Cross and Blue Shield
Anthem Blue Cross and Blue Shield is a Medicare Advantage plan with a Medicare contract. For Dual-Eligible Special Needs Plans: Anthem Blue Cross and Blue Shield is an HMO D-SNP with a Medicare contract and a contract with the State Medicaid program. Enrollment in Anthem Blue Cross and Blue Shield depends on contract renewal. Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. HMO plans are administered by Anthem Health Plans of New Hampshire, Inc. and underwritten by Matthew Thornton Health Plan, Inc. In 17 southeastern counties of New York: Anthem HealthChoice Assurance, Inc., and Anthem HealthChoice HMO, Inc. In these same counties Anthem Blue Cross and Blue Shield HP is the trade name of Anthem HP, LLC. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia with its affiliate Healthkeepers, Inc., and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin (BCBSWI), underwrites or administers PPO and indemnity policies and underwrites the out-of-network benefits in POS policies offered by Compcare Health Services Insurance Corporation (Compcare) or Wisconsin Collaborative Insurance Corporation (WCIC). Compcare underwrites or administers HMO or POS policies; WCIC underwrites or administers Well Priority HMO or POS policies. Independent licensees of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc. Anthem Blue Cross Anthem Blue Cross, Anthem Blue Cross Partnership Plan, and Anthem Blue Cross Life and Health Insurance Company are Medicare Advantage Organizations with Medicare contracts. For Dual-Eligible Special Needs Plans in CA: Anthem Blue Cross is an HMO D-SNP and Anthem Blue Cross Life and Health Insurance Company is an LPPO D-SNP with a Medicare contract and a contract with the California Medicaid program. For Dual-Eligible Special Needs Plans in NY: Anthem Blue Cross is an HMO D-SNP with a Medicare contract and either a contract or a coordination of benefits agreement with the New York State Department of Health. Enrollment in Anthem Blue Cross, Anthem Blue Cross Partnership Plan, and Anthem Blue Cross Life and Health Insurance Company depends on contract renewal. Anthem Blue Cross is the trade name of: In California: Blue Cross of California. Anthem Blue Cross Partnership Plan, Anthem BC Health Insurance Company and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association. In 11 northeastern counties of New York: Anthem Blue Cross is the trade name of Anthem HealthChoice Assurance, Inc., and Anthem HealthChoice HMO, Inc. Independent licensees of the Blue Cross Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc. General disclaimers We do not offer every plan available in your area. Currently we represent 6 organizations which offer 44 products in your area. Please contact Medicare.gov, 1–800–MEDICARE, or your local State Health Insurance Program to get information on all of your options. Agency represents Medicare HMO, PPO, and PFFS organizations and stand-alone PDP prescription drug plans that have a Medicare contract. Enrollment depends on the plan’s contract renewal. The plans we represent do not discriminate on the basis of race, color, national origin, age, disability, or sex. To learn more about a plan’s nondiscrimination policy, please click any of the Nondiscrimination links above in the Health plan disclaimers section. This information is not a complete description of benefits. Call 1-800-215-3128 (TTY: 711) for more information. Medicare beneficiaries may also enroll in the plan through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov. For a complete list of available plans please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov. Every year, Medicare evaluates plans based on a 5-star rating system. Out-of-network/non-contracted providers are under no obligation to treat Plan members, except in emergency situations. Please call the Plan’s customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. Total annual cost is calculated by adding up the total annual cost of any monthly premiums, applicable plan deductible(s) and estimates for all co-pay and co-insurance amounts that will be due for the medications and health benefits used throughout the year. Costs for medications and health benefits vary across pharmacies and health systems, so the costs provided are only estimates. Actual costs could vary. For plans with Part D Coverage: You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 8 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778 or consult www.socialsecurity.gov; or your Medicaid Office. You must have both Part A and B to enroll in a Medicare Advantage plan. Members may enroll in the plan only during specific times of the year. Contact the plan for more information. The purpose of this communication is the solicitation of insurance. Contact will be made by an insurance agent/producer or insurance company. If the plan you are reviewing is a Medicare Advantage with drug coverage or a prescription drug plan then the next two disclaimers apply. Important Message About What You Pay for Vaccines – Our plan covers most Part D vaccines at no cost to you, even if you haven’t paid your deductible. Call Pharmacy Member Services for more information. Important Message About What You Pay for Insulin – You won’t pay more than $35 for a one-month supply of each insulin product covered by our plan, no matter what cost-sharing tier it’s on, even if you haven’t paid your deductible. To send a complaint to a Medicare Health Plan, call the Plan or the number on your member ID card. To send a complaint to Medicare, call 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week). If your complaint involves a broker or agent, be sure to include the name of the person when filing your grievance.
Qualified, Licensed Insurance Professionals
Curious about how a private Medicare Advantage plan can benefit you? Contact us today to speak with a licensed insurance agent who can guide you through your options. Alternatively, click “Compare Plans” to explore available Medicare Advantage plans in your area online. Your coverage is important—let us assist you in finding the plan that best fits your needs.