PARTCRX

Plan Summary

Insurance Type
Medicare Advantage Plan (Part C w/ RX)
Insurance Provider
Anthem BCBS
CMS Rating
Plan Type
PPO
Annual Deductible
$150.00

What To Know About This Plan

  • This plan has health and drug coverage

Plan Details

Costs and Other Important Information

Plan Year:
2014
Optional Supplemental Benefits?
No
Choice of Doctors?
Any Doctor
Prescription Drugs Covered?
Yes
Out-Of-Pocket Spending Limit
$5,100 In-Network$5,100 In and Out-of-Network
Other Deductibles?
In Network: No. Out of Network: No
Health Plan Deductible
$0
Monthly Drug Plan Premium
$46.30
Monthly Health Plan Premium
$8.70

Benefits

Service
In Network
Out of Network
Doctor Office Visits
$15 maximum per visit
$25 maximum per visit
Specialist Office Visit
$30 maximum per visit
$40 maximum per visit
Outpatient Services
$30 maximum or 20% maximum per visit
$40 maximum or 30% maximum per visit
Emergency Care
$65 maximum per visit
Not Applicable
Ambulance Services
$150 maximum
$150 maximum
Kidney Disease and Conditions
20% maximum per visit
20% maximum per visit
Home Health Care
$0 maximum per visit
$0 maximum per visit
Durable Medical Equipment
20% maximum per item
35% maximum per item
Inpatient Hospital Care
Days 1-6: $235 copay per day. Days 7-90: $0 copay per day
Days 1-10: $350 copay per day. Days 11 and beyond: $0 copay per day
Skilled Nursing Facility (SNF)
Days 1-20: $40 copay per day. Days 21-100: $80 copay per day
25%
Inpatient Mental Health Care
Days 1-6: $235 copay per day. Days 7-90: $0 copay per day
Days 1-10: $350 copay per day. Days 11 and beyond: $0 copay per day

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$9 copay$4 copay
Tier 2: Non-Preferred Generic$14 copay$19 copay$14 copay
Tier 3: Preferred Brand Name$40 copay$45 copay$40 copay
Tier 4: Non-Preferred Brand Name$90 copay$95 copay$90 copay
Tier 5: Specialty Tier33% coinsurance33% coinsurance33% coinsurance
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$12 copay$27 copay$8 copay
Tier 2: Non-Preferred Generic$42 copay$57 copay$28 copay
Tier 3: Preferred Brand Name$120 copay$135 copay$120 copay
Tier 4: Non-Preferred Brand Name$270 copay$285 copay$270 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 Medicare Preferred Standard (PPO) for Ohio

/
WANKO, THOMAS
104 N MURRAY HILL RD
COLUMBUS, OH 43228
KAUFMAN, JEFFREY
104 N MURRAY HILL RD
COLUMBUS, OH 43228
PALMA, ROBERT
104 N MURRAY HILL RD
COLUMBUS, OH 43228
AMIGO, ROGER
5131 BEACON HILL RD
COLUMBUS, OH 43228
HARRIS, PAUL
15 NORTON RD
COLUMBUS, OH 43228
KING, GRETZEL
104 N MURRAY HILL RD
COLUMBUS, OH 43228
ALEXIS, THOMAS
4310 CLIME RD
COLUMBUS, OH 43228
FINNIE, DOUGLAS
4310 CLIME ROAD
COLUMBUS, OH 43228
ABOU-AMRO, AREF
5131 BEACON HILL RD
COLUMBUS, OH 43228
LOWE, ROBERT
5100 W BROAD ST
COLUMBUS, OH 43228
HEILMAN, ROBERT
4300 CLIME RD
COLUMBUS, OH 43228
SMITH, MARK
750 MOUNT CARMEL MALL
COLUMBUS, OH 43222
HILTBRAND, JEFFERY
4300 CLIME RD
COLUMBUS, OH 43228
GUPTA, AKASH
4300 CLIME RD
COLUMBUS, OH 43228
NARVEL, FAOZAN
100 N MURRAY HILL RD
COLUMBUS, OH 43228
PUE, CHARLES
5100 W BROAD ST
COLUMBUS, OH 43228
JOHNSTON, PETER
5131 BEACON HILL RD
COLUMBUS, OH 43228
DILLINGER, DAWN
111 INAH AVE
COLUMBUS, OH 43228
KUPER, ALICIA
4766 W BROAD ST
COLUMBUS, OH 43228
WHITE, MATTHEW
111 INAH AVE
COLUMBUS, OH 43228
HUTCHISON, JEFFREY
5131 BEACON HILL ROAD
COLUMBUS, OH 43228
RYAN, TIMOTHY
108 N MURRAY HILL RD
COLUMBUS, OH 43228
CHOWDHURY, LUCIA
5100 W BROAD ST
COLUMBUS, OH 43228
EMLICH, WILLIAM
4930 W BROAD ST
COLUMBUS, OH 43228
BIEDERMAN, BERNARD
17 NORTON RD
COLUMBUS, OH 43228
Details
THOMAS WANKO, DO
Phone Number
(614) 878-6413
Office Locations
104 N MURRAY HILL RD
COLUMBUS, OH 43228
104 N MURRAY HILL RD COLUMBUS OH, 43228

Community Q&A

Do you have questions about this plan?

Get answers from the HealthPocket community.
2 question| 1 answer
medicare plans
Q:I enrolled in the Basic plan -0- pre. the preferred plan is -50- but deductable is more Ido you feel I made the best choice compared to savings and benefits thank you Eleanor
Asked by Anonymous 

1 answer

Know the Answer? Answer this Question
A: Hi Eleanor, We cannot make health plan recommendations for you as we are only a source of information for health insurance products and not an actual health insurance company or a licensed agent. However, I'd be happy to direct you to one of our partners who are also licensed medicare agents. For questions regarding Medicare plans in Ohio, please contact (800) 981-7690, 8am-8pm EST, 7 days a week.
Answered on 11/11/2013 by Duncan 
hospitals
Q:What major health systems/hospitals in Summit/Cuyahoga counties are in-network for 2014?
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, as for metwork hospitals, 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 1/6/2014 by Anonymous 

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