2018 Anthem MediBlue Access (PPO) H6786-2-0 in ME from Anthem BCBS | HealthPocket

Anthem MediBlue Access (PPO)

$1,116/mo

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Zip Code04401
Applicant10/23/1983 Male
Coverage Start10/24/2018
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Benefits & Coverage

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderAnthem BCBS
Plan IDH6786-2-0
Plan Year2018
CMS RatingNot Rated
Plan TypePPO
Annual Deductible$400.00

What To Know About This Plan
  • This plan has health and drug coverage
  • This plan is available for 2019. see plan

Why We Like This Plan
  • has both Health and Drug Coverage

Costs and Other Important Information

Plan Year2018
Optional Supplemental BenefitsYes
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)$10,000 In and Out-of-network $6,000 In-network
Other health plan deductibles?No
Health Plan Deductible$0
Monthly Drug Plan Premium$55.80
Monthly Health Plan Premium$37.20

Benefits

SERVICECOST
Inpatient hospital coverageIn-Network:
$305 for days 1 through 5
$0 for days 6 through 90
Out-of-Network:
30% per stay
Outpatient hospital coverageIn-Network:
$0 or 20% per visit
Out-of-Network:
40% per visit
Doctor visitsPrimary:
In-Network:
$5 per visit
Out-of-Network:
$55 per visit
Specialist:
In-Network:
$35 per visit
Out-of-Network:
$65 per visit
Preventive careIn-Network:
$0 copay
Out-of-Network:
40%
Emergency care/Urgent careEmergency:
$80 per visit (always covered)
Urgent care:
$25 per visit (always covered)
Diagnostic procedures/lab services/imagingDiagnostic tests and procedures:
In-Network:
$0-110
Out-of-Network:
40%
Lab services:
In-Network:
$0 or 0-20%
Out-of-Network:
40%
Diagnostic radiology services (e.g., MRI):
In-Network:
$240-250
Out-of-Network:
40%
Outpatient x-rays:
In-Network:
$60-65
Out-of-Network:
40%
Mental health servicesIn-Network:
$275 for days 1 through 4
$0 for days 5 through 90
Out-of-Network:
30% per stay
Outpatient group therapy visit with a psychiatrist:
In-Network:
$40
Out-of-Network:
$65
Outpatient individual therapy visit with a psychiatrist:
In-Network:
$40
Out-of-Network:
$65
Outpatient group therapy visit:
In-Network:
$40
Out-of-Network:
$65
Outpatient individual therapy visit:
In-Network:
$40
Out-of-Network:
$65
Skilled Nursing FacilityIn-Network:
Tier 1
$0 for days 1 through 20
$137.50 for days 21 through 100
Tier 2
$0 for days 1 through 20
$167.50 for days 21 through 100
Out-of-Network:
30% per stay
Rehabilitation servicesOccupational therapy visit:
In-Network:
$40
Out-of-Network:
$65
Physical therapy and speech and language therapy visit:
In-Network:
$40
Out-of-Network:
$65
AmbulanceIn-Network:
$210 or 20%
Out-of-Network:
$210 or 20%
TransportationNot covered
Foot care (podiatry services)Foot exams and treatment:
In-Network:
$35
Out-of-Network:
$65
Routine foot care:
Not covered
Medical equipment/suppliesDurable medical equipment (e.g., wheelchairs, oxygen):
In-Network:
20% per item
Out-of-Network:
40% per item
Prosthetics (e.g., braces, artificial limbs):
In-Network:
20% per item
Out-of-Network:
40% per item
Diabetes supplies:
In-Network:
$0 copay
Out-of-Network:
40% per item
Wellness programs (e.g., fitness, nursing hotline)Covered
Medicare Part B drugsChemotherapy:
In-Network:
20%
Out-of-Network:
30%
Other Part B drugs:
In-Network:
20%
Out-of-Network:
30%

Coverage Area for Anthem MediBlue Access (PPO)

StateMaine
CountyPenobscot

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$3 copay$8 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 Tier25% coinsurance25% coinsuranceNot offered

60 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$6 copay$16 copayNot offered
Tier 2: Non-Preferred Generic$20 copay$30 copayNot offered
Tier 3: Preferred Brand Name$84 copay$94 copayNot offered
Tier 4: Non-Preferred Brand Name$190 copay$200 copayNot offered
Tier 5: Specialty Tier
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$9 copay$24 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

Staying healthy - screenings, tests and vaccines

Breast cancer screeningNot Rated
Colorectal cancer screeningNot Rated
Annual flu vaccineNot Rated
Improving or maintaining physical healthNot Rated
Improving or maintaining mental healthNot Rated
Monitoring physical abilityNot Rated
Adult BMI assessmentNot Rated

Managing Chronic Conditions

Special needs plan care managementNot Rated
Care for older adults – medication reviewNot Rated
Care for older adults – functional status assessmentNot Rated
Care for older adults – Pain screeningNot Rated
Osteoporosis management in women who had a fractureNot Rated
Diabetes care – eye examNot Rated
Diabetes care – kidney disease monitoringNot Rated
Diabetes care – blood sugar controlledNot Rated
Controlling blood pressureNot Rated
Rheumatoid arthritis managementNot Rated
Reducing the risk of fallingNot Rated
Plan all-cause readmissionsNot Rated

Member Experience with Health Plan

Getting needed careNot Rated
Getting appointments and care quicklyNot Rated
Customer serviceNot Rated
Overall rating of health care qualityNot Rated
Overall rating of planNot Rated
Care CoordinationNot Rated

Member Complaints, and Changes in Health Plan's Performance

Complaints about the health planNot Rated
Members choosing to leave the health planNot Rated
Beneficiary access and performance problemsNot Rated
Health plan quality improvementNot Rated

Health Plan Customer Service

Plan makes timely decision about appeals
Reviewing appeals decisionsNot Rated
Call center – foreign language interpreter and TTY/TDD availability - MedicalNot Rated

Drug Plan Customer Service

Call center – foreign language interpreter and TTY/TDD availability - DrugsNot Rated
Appeals auto-forward
Appeals upheld

Member Complaints, and Changes in Drug Plan's Performance

Complaints about the drug planNot Rated
Members choosing to leave the drug planNot Rated
Beneficiary access and performance problemsNot Rated
Drug plan quality improvementNot Rated

Member Experience with Drug Plan

Rating of drug plan
Getting needed prescription drugsNot Rated

Drug Pricing and Patient Safety

MPF Price AccuracyNot Rated
High risk medicationNot Rated
Part D medication adherence for diabetes
Part D medication adherence for hypertensionNot Rated
Part D medication adherence for cholesterolNot Rated
Medication Therapy Management program completion rate Not Rated

Physicians that accept Anthem MediBlue Access (PPO) for Maine

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Bruno, Edwin
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Mcguire, D
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Phillips, Lewis
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Gilbert, Marcia
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Carr, Michael
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Beebe, Thomas
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Slike, Michelle
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Newman, David
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Martin, Kara
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Stacey, Amanda
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Perry, Jaimee
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Malik, Sapna
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Wierzbinski, Erin
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Deabay, Noelle
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Johnson, Anne
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Davis, Karie
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Smythe, Kara
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Beaton, Aimee
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Schellinger, Rebecca
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Wise, Eric
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Hooge, John
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Hetland, Allison
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Martin, David
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Wilks, Janet
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Edwin Bruno, D.P.M.
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  • Phone Number
    (207) 942-3988
  • Office Locations
    277 State St
    Bangor, ME 04401
277 State St Bangor ME, 04401

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