Anthem MediBlue Access (PPO)

Medicare Advantage Plan for Colorado

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PARTCRX

Plan Summary

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderAnthem BCBS
Plan IDH4069-1-0
CMS RatingNot Rated1
Plan TypePPO
Annual Deductible$320.00

What To Know About This Plan

  • This plan has health and drug coverage

Why We Like This Plan

  • has both Health and Drug Coverage

Plan Details

Costs and Other Important Information

Plan Year:
2018
Optional Supplemental Benefits
No
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)
$10,000 In and Out-of-network $6,700 In-network
Other health plan deductibles?
No
Health Plan Deductible
$900 annual deductible
Monthly Drug Plan Premium
$83.10
Monthly Health Plan Premium
$92.90

Benefits

Service
Cost
Inpatient hospital coverage
In-Network:
$95 for days 1 through 5
$0 for days 6 through 90
Out-of-Network:
15% per stay
Outpatient hospital coverage
In-Network:
$0-95 per visit
Out-of-Network:
50% per visit
Doctor visits
Primary:
In-Network:
$5 per visit
Out-of-Network:
$35 per visit
Specialist:
In-Network:
$35 per visit
Out-of-Network:
$50 per visit
Preventive care
In-Network:
$0 copay
Out-of-Network:
40%
Emergency care/Urgent care
Emergency:
$80 per visit (always covered)
Urgent care:
$30 per visit (always covered)
Diagnostic procedures/lab services/imaging
Diagnostic tests and procedures:
In-Network:
$0-125
Out-of-Network:
$0 or 50%
Lab services:
In-Network:
$0-10
Out-of-Network:
50%
Diagnostic radiology services (e.g., MRI):
In-Network:
$130
Out-of-Network:
50%
Outpatient x-rays:
In-Network:
$25
Out-of-Network:
50%
Mental health services
In-Network:
$95 for days 1 through 5
$0 for days 6 through 90
Out-of-Network:
20% per stay
Outpatient group therapy visit with a psychiatrist:
In-Network:
$35
Out-of-Network:
$50
Outpatient individual therapy visit with a psychiatrist:
In-Network:
$35
Out-of-Network:
$50
Outpatient group therapy visit:
In-Network:
$35
Out-of-Network:
$50
Outpatient individual therapy visit:
In-Network:
$35
Out-of-Network:
$50
Skilled Nursing Facility
In-Network:
Tier 1
$0 for days 1 through 20
$65 for days 21 through 100
Tier 2
$0 for days 1 through 20
$95 for days 21 through 100
Out-of-Network:
15% per stay
Rehabilitation services
Occupational therapy visit:
In-Network:
$25
Out-of-Network:
$50
Physical therapy and speech and language therapy visit:
In-Network:
$25
Out-of-Network:
$50
Ambulance
In-Network:
$325 or 20%
Out-of-Network:
$325 or 20%
Transportation
Not covered
Foot care (podiatry services)
Foot exams and treatment:
In-Network:
$35
Out-of-Network:
$50
Routine foot care:
Not covered
Medical equipment/supplies
Durable medical equipment (e.g., wheelchairs, oxygen):
In-Network:
15% per item
Out-of-Network:
35% per item
Prosthetics (e.g., braces, artificial limbs):
In-Network:
15% per item
Out-of-Network:
35% per item
Diabetes supplies:
In-Network:
$0 copay
Out-of-Network:
35% per item
Wellness programs (e.g., fitness, nursing hotline)
Covered
Medicare Part B drugs
Chemotherapy:
In-Network:
20%
Out-of-Network:
40%
Other Part B drugs:
In-Network:
20%
Out-of-Network:
40%

Coverage Area for Anthem MediBlue Access (PPO)

StateColorado
CountyDenver

Cost Sharing Information

All cost-sharing assumes in-network healthcare providers.

Prescription Drug Copay/Coninsurance Details - Initial Coverage Limit

30 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$5 copay$10 copayNot offered
Tier 2: Non-Preferred Generic$10 copay$15 copayNot offered
Tier 3: Preferred Brand Name$42 copay$47 copayNot offered
Tier 4: Non-Preferred Brand Name$95 copay$100 copayNot offered
Tier 5: Specialty Tier26% coinsurance26% coinsuranceNot offered
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$15 copay$30 copayNot offered
Tier 2: Non-Preferred Generic$30 copay$45 copayNot offered
Tier 3: Preferred Brand Name$126 copay$141 copayNot offered
Tier 4: Non-Preferred Brand Name$285 copay$300 copayNot offered
Tier 5: Specialty Tier

Physician Finder

Physicians that accept Anthem MediBlue Access (PPO) for Colorado

/
TRAN, QUY
1023 S FEDERAL BLVD
DENVER, CO 80219
GARRETT, RAYMOND
1930 S FEDERAL BLVD
DENVER, CO 80219
MCCRANIE, KATHY
1380 S SANTA FE DR
DENVER, CO 80223
DRAPER, DARLA
205 S GARRISON ST
LAKEWOOD, CO 80226
COLORADO PAIN SPECIALISTS PC
325 S TELLER ST
LAKEWOOD, CO 80226
JOHANNES, ROBERT
96 WADSWORTH BLVD UNIT 100
LAKEWOOD, CO 80226
PEARSON, LESLIE
8383 W ALAMEDA AVE
LAKEWOOD, CO 80226
NEUMANN, ALICE
9423 W KENTUCKY PL
LAKEWOOD, CO 80226
PHAM, LOAN
8405 W ALAMEDA AVE
LAKEWOOD, CO 80226
BRODY, HOLLY
620 S VANCE ST
LAKEWOOD, CO 80226
NGUYEN, LISA
8015 W ALAMEDA AVE
LAKEWOOD, CO 80226
RESKE, MERILEE
7500 W MISSISSIPPI AVE
LAKEWOOD, CO 80226
CLARK, JOHN
8383 W ALAMEDA AVE
LAKEWOOD, CO 80226
LAUBACH, SHERRI
8405 W ALAMEDA AVE
LAKEWOOD, CO 80226
COAKLEY, LEEANNE
8383 W ALAMEDA AVE
LAKEWOOD, CO 80226
SEEFELDT, BRIEANNA
8015 W ALAMEDA AVE
LAKEWOOD, CO 80226
Details
QUY TRAN, M.D.
Phone Number
(303) 936-4966
Office Locations
1023 S FEDERAL BLVD
DENVER, CO 80219
1023 S FEDERAL BLVD DENVER CO, 80219

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