Anthem Senior Advantage Basic (HMO)

Medicare Advantage Plan (Part C w/ RX)

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PARTCRX

Plan Summary

Insurance Type
Medicare Advantage Plan (Part C w/ RX)
Insurance Provider
Anthem BCBS
CMS Rating
Plan Type
HMO
Annual Deductible
$60.00

What To Know About This Plan

  • This plan has health and drug coverage

Why We Like This Plan

  • has both Health and Drug Coverage
  • has no additional premium costs outside of your Medicare Part B premium

Plan Details

Costs and Other Important Information

Plan Year:
2013
Optional Supplemental Benefits?
Yes
Choice of Doctors?
Plan Doctors Only
Prescription Drugs Covered?
Yes
Out-Of-Pocket Spending Limit
$3,400 In-Network
Other Deductibles?
In Network: No. Out of Network: No
Health Plan Deductible
$0
Monthly Drug Plan Premium
$0.00
Monthly Health Plan Premium
$0.00

Benefits

Service
In Network
Out of Network
Doctor Office Visits
$25 maximum per visit
Not Applicable
Specialist Office Visit
$40 maximum per visit
Not Applicable
Outpatient Services
$200 maximum per visit
Not Applicable
Emergency Care
$65 maximum per visit
Not Applicable
Ambulance Services
$150 maximum
Not Applicable
Kidney Disease and Conditions
20% maximum per visit
Not Applicable
Home Health Care
$0 maximum per visit
Not Applicable
Durable Medical Equipment
20% maximum per item
Not Applicable
Inpatient Hospital Care
Days 1-8: $220 copay per day. Days 9-90: $0 copay per day
Not Applicable
Skilled Nursing Facility (SNF)
Days 1-20: $45 copay per day. Days 21-100: $95 copay per day
Not Applicable
Inpatient Mental Health Care
Days 1-8: $220 copay per day. Days 9-90: $0 copay per day
Not Applicable

Cost Sharing Information

Prescription Drug Copay/Coninsurance Details - Initial Coverage Limit

30 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$4 copay$4 copay$4 copay
Tier 2: Non-Preferred Generic$11 copay$11 copay$11 copay
Tier 3: Preferred Brand Name$45 copay$45 copay$45 copay
Tier 4: Non-Preferred Brand Name$95 copay$95 copay$95 copay
Tier 5: Specialty Tier33% coinsurance33% coinsurance33% coinsurance
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$12 copay$12 copay$6 copay
Tier 2: Non-Preferred Generic$33 copay$33 copay$16.5 copay
Tier 3: Preferred Brand Name$135 copay$135 copay$112.5 copay
Tier 4: Non-Preferred Brand Name$285 copay$285 copay$237.5 copay
Tier 5: Specialty Tier33% coinsurance33% coinsurance33% coinsurance

CMS Ratings

Staying healthy - screenings, tests and vaccines

Breast cancer screening
Not Rated
Colorectal cancer screening
Cholesterol screening for patients with heart disease
Glaucoma testing
Annual flu vaccine
Pneumonia vaccine
Improving or maintaining physical health
Improving or maintaining mental health
Monitoring physical ability
Access to primary care doctor visits
Adult BMI assessment

Managing Chronic Conditions

Care for older adults – medication review
Not Rated
Care for older adults – functional status assessment
Not Rated
Care for older adults – Pain screening
Not Rated
Osteoporosis management in women who had a fracture
Diabetes care – eye exam
Diabetes care – kidney disease monitoring
Diabetes care – blood sugar controlled
Diabetes care – cholesterol controlled
Controlling blood pressure
Rheumatoid arthritis management
Improving bladder control
Reducing the risk of falling
Plan all-cause readmissions

Ratings of Plan Responsiveness and Care

Getting needed care
Getting appointments and care quickly
Customer service
Overall rating of health care quality
Overall rating of plan

Member Complaints, Problems Getting Services, and Choosing to Leave the Plan

Complaints about the health plan
Beneficiary access and performance problems
Members choosing to leave the plan
Plan makes timely decision about appeals
Reviewing appeals decisions
Call center – foreign language interpreter and TTY/TDD availability

Physician Finder

Physicians that accept Anthem Senior Advantage Basic (HMO) for Ohio

/
HEILMAN, ROBERT
4300 CLIME RD
COLUMBUS, OH 43228
KING, GRETZEL
104 N MURRAY HILL RD
COLUMBUS, OH 43228
ABOU-AMRO, AREF
5131 BEACON HILL RD
COLUMBUS, OH 43228
LOWE, ROBERT
5100 W BROAD ST
COLUMBUS, OH 43228
SMITH, MARK
750 MOUNT CARMEL MALL
COLUMBUS, OH 43222
LUKEN, THERESA
4300 CLIME RD
COLUMBUS, OH 43228
JOHNSTON, PETER
5131 BEACON HILL RD
COLUMBUS, OH 43228
HARD, WESLEY
100 N MURRAY HILL RD
COLUMBUS, OH 43228
RAPP, THOMAS
106 N MURRAY HILL RD
COLUMBUS, OH 43228
MORALES-YURIK, TERESITA
5100 W BROAD ST
COLUMBUS, OH 43228
RASHWAN, AHMED
5100 W BROAD ST
COLUMBUS, OH 43228
PEPONIS, NICHOLAS
3525 OLENTANGY RIVER RD
COLUMBUS, OH 43214
HAMILTON, DANA
111 INAH AVE
COLUMBUS, OH 43228
SCOTT, MARY
4488 WEST BROAD STREET
COLUMBUS, OH 43228
MCELDOWNEY, THOMAS
5100 W BROAD ST
COLUMBUS, OH 43228
BLAIS, FRANCIS
5109 WEST BROAD STREET
COLUMBUS, OH 43228
ASHTON, NICOLA
4821 ROBERTS ROAD
COLUMBUS, OH 43228
FOSS, PETER
5131 BEACON HILL RD
COLUMBUS, OH 43228
JOHNSEN, RONALD
5100 W BROAD ST
COLUMBUS, OH 43228
JONES, PAULA
5100 W BROAD ST
COLUMBUS, OH 43228
VINCENT, KAREN
5100 W BROAD ST
COLUMBUS, OH 43228
HINCKLEY, JOHN
5100 W BROAD ST
COLUMBUS, OH 43228
JONES, BRUCE
5100 W BROAD ST
COLUMBUS, OH 43228
JORDAN, KEVIN
5100 W BROAD ST
COLUMBUS, OH 43228
RAHALL, TRACY
2200 RANDALLIA DR
FORT WAYNE, IN 46805
Details
ROBERT HEILMAN, M.D.
Phone Number
(614) 308-9066
Office Locations
4300 CLIME RD
COLUMBUS, OH 43228
4300 CLIME RD COLUMBUS OH, 43228

Community Q&A

Do you have questions about this plan?

Get answers from the HealthPocket community.
1 question| 1 answer
vision
Q:who is in the network
Asked by Anonymous 

1 answer

Know the Answer? Answer this Question
A: Currently on our website, we only have the tools for you to locate the network providers, for vision providers, you may try the following links for more details: https://www.anthem.com/providerfinder/main.aspx?ProvDirURL=https://www.geoaccess.com/awp/landing.asp%3Fmp%3Dtrue
Answered on 1/26/2014 by davina

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