Summary of benefits for anthem mediblue access core

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summary of benefits

Summary of Benefits

Medicare Advantage

Plan year: January 1 ? December 31, 2019



Anthem MediBlue Access Core (Regional PPO)*


Thank you for your interest in our Medicare Advantage plans

Anthem Blue Cross and Blue Shield offers a variety of benefits designed to help keep you healthy while protecting you from unexpected medical costs. This booklet tells you what we cover, what you may pay and more. If you have questions, please call your agent. *This plan has no prescription drug coverage.

Y0114_19_35653_U_M_201 Accepted R5941_013-000_OH_RPPO

Anthem MediBlue Access Core (Regional PPO)


summary of benefits

Anthem MediBlue Access Core (Regional PPO)

Our service area includes the following counties: OHIO Have questions?

If you are not a member of our plan, please call us toll-free 1-866-803-5169 (TTY: 711), and follow the instructions to be connected to a representative. If you are a member of our plan, please call us toll-free at 1-800-467-1199 (TTY: 711). We are open 8 a.m. to 8 p.m., seven days a week (except Thanksgiving and Christmas) from October 1 through March 31, and Monday to Friday (except holidays) from April 1 through September 30. You can learn more about us on our website at .

While the Summary of Benefits does not include every service, limit or exclusion, the Evidence of Coverage does. Just give us a call to request a copy. Anthem MediBlue Access Core (Regional PPO) is a Medicare Advantage plan. It includes hospital and medical benefits in one plan. To join this plan, you must:

Be entitled to Medicare Part A, Enrolled in Medicare Part B, and Live in our service area. With this plan, you can go to any doctor or facility in or outside of our plan. If you go to a doctor or facility in our plan, your out-of-pocket costs may be lower than using providers not in our plan. Ask your current doctor if he or she is in our plan.

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summary of benefits

Medicare coverage that goes beyond Original Medicare

Like all Medicare Advantage health plans, we cover everything that Original Medicare covers -- Part A (hospital services) and Part B (medical services), plus more. For some of these benefits, you may pay more in our plan than you would in Original Medicare. For others, you may pay less (see benefits section for more details). Medicare Part B drugs (such as chemotherapy and some drugs administered by your provider). However, this plan does not cover Part D prescription drugs.

This is a Preferred Provider Organization (PPO) plan. That means:

You can see any doctor or specialist, in or out of our plan,1 no referrals needed. You can use doctors in or outside your plan, but your costs may be higher if you use doctors outside your plan.1


1 Doctors not in our plan or not contracted with us, do not have to treat Anthem Blue Cross and Blue Shield members, unless it's an emergency. If you want to find out if we'll cover an out-of-network service, we encourage you or your doctor to ask us for a pre-service organization determination (prior approval) before you get the service. For more details or to find out if you will have a share of the cost, please call us or see your Evidence of Coverage.

Anthem MediBlue Access Core (Regional PPO) 3

summary of benefits

Is your PCP in our plan's network of doctors?

If, for any reason, you need to change your PCP, give us a call ? we can help you! A doctor or PCP can join or leave our plan at any time, so be sure to ask if he or she is in our Medicare Advantage plan, taking new patients and accepts Medicare. You can find a PCP in our plan or check their status online. Just follow the steps below.

How to find a doctor/PCP in our plan: Go to 1. Scroll to the Useful Tools section and choose the tab labeled Find a Doctor. 2. Enter your ZIP code, county and the date you want your coverage to begin and select Continue. 3. Fill in the details of your search (city, doctor's name, distance, etc.). 4. Be sure to check that the doctor displays as "In-Network" for these plans. Or you can call us and ask for a copy of the Provider Directory. The phone number is on page 2.

Optional supplemental dental and/or vision benefits

You can add an Optional Supplemental Benefits (OSB) package to our plan for an additional monthly premium. (Optional Supplemental Benefits may not be available with every Medicare Advantage plan in this enrollment guide. See the "Optional Supplemental Dental and Vision Plans" section of the medical benefits chart for more details, including costs.)

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summary of benefits

Summary of 2019 medical benefits

On the following pages, you can review more about our plan benefits to help you choose the right plan for you. If you want to compare our plan with other Medicare health plans, call and ask the other plans for a copy of their Summary of Benefits.

Be in the know

Before you continue, here are some important things to know as you review our plan benefits:

Services listed on the following pages with a 1 may require prior authorization (pre-approval). 3 Medicare-covered services from providers or facilities that are not in our plan, are subject to the medical deductible.

Anthem MediBlue Access Core (Regional PPO) 5

summary of benefits

Anthem MediBlue Access Core (Regional PPO)

How much is my premium (monthly payment)? $15.00 per month You must continue to pay your Medicare Part B premium. If you get Extra Help from Medicare, your monthly plan premium will be lower or you might pay nothing.

How much is my deductible? $250 for out-of-network Medicare-covered services per year

This plan has a deductible that applies to Medicare-covered hospital and medical services from doctors and facilities that are not in our plan. These services will have a 3 next to the benefit throughout this Summary of Benefits.

Is there a limit on how much I will pay for my covered medical services? (does not include Part D drugs) $5,400 per year from doctors and facilities in our plan. $5,400 per year from doctors or facilities both in and out of our plan. Like all Medicare health plans, our plan protects you by having yearly limits on your out-of-pocket costs for medical and hospital care. Services you get from doctors or facilities, both in and out of our plan, goes toward your yearly limit. If you reach the limit on out-of-pocket costs, you will not have to pay any out-of-pocket costs for covered Part A and Part B services (in or outside of our plan) for the rest of the year.

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