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

Anthem MediBlue Access (PPO)

Medicare Advantage Plan for Maine

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PARTCRX

Plan Summary

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderAnthem BCBS
Plan IDH6786-2-0
CMS RatingNot Rated1
Plan TypePPO
Annual Deductible$400.00

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
Yes
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

Service
Cost
Inpatient hospital coverage
In-Network:
$305 for days 1 through 5
$0 for days 6 through 90
Out-of-Network:
30% per stay
Outpatient hospital coverage
In-Network:
$0 or 20% per visit
Out-of-Network:
40% per visit
Doctor visits
Primary:
In-Network:
$5 per visit
Out-of-Network:
$55 per visit
Specialist:
In-Network:
$35 per visit
Out-of-Network:
$65 per visit
Preventive care
In-Network:
$0 copay
Out-of-Network:
40%
Emergency care/Urgent care
Emergency:
$80 per visit (always covered)
Urgent care:
$25 per visit (always covered)
Diagnostic procedures/lab services/imaging
Diagnostic 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 services
In-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 Facility
In-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 services
Occupational therapy visit:
In-Network:
$40
Out-of-Network:
$65
Physical therapy and speech and language therapy visit:
In-Network:
$40
Out-of-Network:
$65
Ambulance
In-Network:
$210 or 20%
Out-of-Network:
$210 or 20%
Transportation
Not covered
Foot care (podiatry services)
Foot exams and treatment:
In-Network:
$35
Out-of-Network:
$65
Routine foot care:
Not covered
Medical equipment/supplies
Durable 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 drugs
Chemotherapy:
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

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$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
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

CMS Ratings

Staying healthy - screenings, tests and vaccines

Breast cancer screening
Not Rated
Colorectal cancer screening
Not Rated
Annual flu vaccine
Not Rated
Improving or maintaining physical health
Not Rated
Improving or maintaining mental health
Not Rated
Monitoring physical ability
Not Rated
Adult BMI assessment
Not Rated

Managing Chronic Conditions

Special needs plan care management
Not Rated
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
Not Rated
Diabetes care – eye exam
Not Rated
Diabetes care – kidney disease monitoring
Not Rated
Diabetes care – blood sugar controlled
Not Rated
Controlling blood pressure
Not Rated
Rheumatoid arthritis management
Not Rated
Reducing the risk of falling
Not Rated
Plan all-cause readmissions
Not Rated

Member Experience with Health Plan

Getting needed care
Not Rated
Getting appointments and care quickly
Not Rated
Customer service
Not Rated
Overall rating of health care quality
Not Rated
Overall rating of plan
Not Rated
Care Coordination
Not Rated

Member Complaints, and Changes in Health Plan's Performance

Complaints about the health plan
Not Rated
Members choosing to leave the health plan
Not Rated
Beneficiary access and performance problems
Not Rated
Health plan quality improvement
Not Rated

Health Plan Customer Service

Plan makes timely decision about appeals
Reviewing appeals decisions
Not Rated
Call center – foreign language interpreter and TTY/TDD availability - Medical
Not Rated

Drug Plan Customer Service

Call center – foreign language interpreter and TTY/TDD availability - Drugs
Not Rated
Appeals auto-forward
Appeals upheld

Member Complaints, and Changes in Drug Plan's Performance

Complaints about the drug plan
Not Rated
Members choosing to leave the drug plan
Not Rated
Beneficiary access and performance problems
Not Rated
Drug plan quality improvement
Not Rated

Member Experience with Drug Plan

Rating of drug plan
Getting needed prescription drugs
Not Rated

Drug Pricing and Patient Safety

MPF Price Accuracy
Not Rated
High risk medication
Not Rated
Part D medication adherence for diabetes
Part D medication adherence for hypertension
Not Rated
Part D medication adherence for cholesterol
Not Rated
Medication Therapy Management program completion rate
Not Rated

Physician Finder

Physicians that accept Anthem MediBlue Access (PPO) for Maine

/
Thompson, Peter
1365 Broadway
Bangor, ME 04401
Haggerty, Danielle
840 Hammond St Ste 2
Bangor, ME 04401
Boutaugh, Thomas
2402 Route 2
Hermon, ME 04401
Carr, Michael
2263 Route 2
Hermon, ME 04401
Beebe, Thomas
992 Union St
Bangor, ME 04401
Wierzbinski, Erin
157 Park St
Bangor, ME 04401
Wise, Eric
1365 Broadway
Bangor, ME 04401
Joshi, Sandesh
489 State St
Bangor, ME 04401
Settele, Alison
992 Union St
Bangor, ME 04401
Dani, Sourbha
1 Northeast Dr
Bangor, ME 04401
Kelly, Cavenaugh
1048 Union St Ste 5
Bangor, ME 04401
Bruehl, Michael
133 Corporate Dr
Bangor, ME 04401
Khasani, Sina
498 Essex St
Bangor, ME 04401
Martin, Thomas
417 State St Ste 305
Bangor, ME 04401
Alsindi, Fahad
1 Northeast Dr
Bangor, ME 04401
Martin, Kara
840 Hammond St Ste 2
Bangor, ME 04401
Requena Armas, Carlos
489 State St
Bangor, ME 04401
Douglas, Barton
489 State St
Bangor, ME 04401
Schellinger, Rebecca
895 Union St
Bangor, ME 04401
Allen, Amy
1 Cumberland Pl
Bangor, ME 04401
Creed, Wanda
263 State St Ste 21
Bangor, ME 04401
Khadka, Poonam
900 Broadway
Bangor, ME 04401
Details
Peter Thompson, MD
Phone Number
(207) 942-6226
Office Locations
1365 Broadway
Bangor, ME 04401
1365 Broadway Bangor ME, 04401

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