4

4 out of 5 stars* for plan year 2024

Plan ID: H7728-004

What You Need to Know:

  • Anthem MediBlue Access (PPO) is a Medicare Advantage Health Maintenance Organization Local PPO plan.
  • It must provide all of the same hospital and medical benefits as Medicare Part A and Part B, however, costs may be different.
  • It has additional benefits not included in Medicare Part A and Part B, including prescription drug coverage.
  • The plan's monthly premium is $38, which does not include your monthly Medicare Part B premium.
  • The annual deductible for this health plan is .
  • The plan includes an out-of-pocket maximum of $5,900 per year (in-network).
  • Anthem MediBlue Access (PPO) includes a Part D prescription drug plan for prescription medication coverage. The annual deductible is .
  • This plan's Part D Initial Coverage Limit is $33.

* Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system.

$38

Monthly Premium

Medicare Plan Features
Monthly Premium: $38.00
Part C Premium: $4.60
Monthly Premium: Part C Premium: Part D Drug Premium: Part D Supplemental Premium: Total Part D Premium: Drug Deductible: Tiers with No Deductible:
$38.00 $4.60 $33.40 $0 $33.40 $0 0.0
Gap Coverage: Yes
Benchmark: not below the regional benchmark
Type of Medicare Health: Enhanced Alternative
Health Plan Type: Local PPO
Similar Plan: H7728-005
Special Needs Type: NULL
Chronic Condition: NULL
Additional Gap Coverage: Yes, some additional gap coverage.
Maximum Out-of-Pocket Limit for Parts A & B (Moop): $5,900
Annual Deductible: NULL
Annual Initial Coverage Limit ICL: $4,130
Number of Members enrolled in this plan in Estill, Kentucky: Plans Summary Star Rating: Customer Service Rating: Drug Cost Rating:
113 members 3.5 out of 5 Stars. 4 out of 5 Stars. 3 out of 5 Stars.
Plan Offers Mail Order: Yes
Plan Health Benefits
Total # of Formulary Drugs: 3,708 drugs
Number of Members Enrolled in this Plan in Estill, Kentucky: 8,391 members
Number of Drugs Per Tier: NULL
Preferred Pharmacy Cost Sharing During Initial Coverage Phase: NULL
Special Needs Plan SNP Eligibility Requirement: NULL
Monthly Premium Split as Follows:
Part C Premium Part D Base Premium Part D Supplemental Premium Total Premium
$4.60 $33.40 $0.00 $38.00
Monthly Premium with Extra Help Low Income Subsidy:
LIS100 Subsidy Total Monthly Premium with LIS Parts CD LIS25 Subsidy Monthly PartD Premium with LIS LIS25 Subsidy Total Monthly Premium with LIS Parts CD LIS50 Monthly PartD Premium with LIS LIS50 Subsidy Total Monthly Premium with LIS Parts CD LIS75 Monthly PartD Premium with LIS LIS75 Subsidy Total Monthly Premium with LIS Parts CD
$8.40 $26.00 $30.60 $18.60 $23.20 $11.20 $15.80
Formulary Drug Details:
Tier 1 # of Drugs per Tier Tier 1 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 2 # of Drugs per Tier Tier 2 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 3 # of Drugs per Tier Tier 3 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 4 # of Drugs per Tier Tier 4 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 5 # of Drugs per Tier Tier 6 Preferred Pharmacy Cost Sharing (initial coverage phase)
306 $3.00 609 $12.00 942 $42.00 1061 $95.00 700 33%

Other Medicare Advantage Plans in Estill, Kentucky

Plan Name Type Premium MOOP Rx Deduct. Rating
HumanaChoice R0865-001 (Regional PPO) (2023)Regional PPO *$6,200$-
4
Humana Value Plus H5525-040 (PPO) (2023)Local PPO$7,550$260
4
Anthem MediBlue Access Basic (Regional PPO) (2023)Regional PPO$6,400$100
5
HumanaChoice R0865-003 (Regional PPO) (2023)Regional PPO$6,700$195
4
Anthem MediBlue Plus (HMO) (2023)Local HMO$5,300$0
5
HumanaChoice H5216-226 (PPO) (2023)Local PPO$6,700$195
4
Lasso Healthcare Growth Plus (MSA) (2023)MSA *$-$-
4
Humana Honor (PPO) (2023)Local PPO *$6,700$-
4
HumanaChoice H5525-044 (PPO) (2023)Local PPO$6,700$0
4
HumanaChoice H5216-105 (PPO) (2023)Local PPO *$4,500$-
4
Lasso Healthcare Growth (MSA) (2023)MSA *$-$-
4
Anthem MediBlue Access Core (PPO) (2023)Local PPO *$4,900$-
4
Medicare Advantage Plans by Anthem Blue Cross and Blue Shield
Anthem MediBlue Access Basic (Regional PPO) (2023)Regional PPO$6,400$100
5
Anthem MediBlue Plus (HMO) (2023)Local HMO$5,300$0
5
Anthem MediBlue Access Core (PPO) (2023)Local PPO *$4,900$-
4

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