Anthem Medicare Advantage (HMO) is a Medicare Advantage Plan by Anthem Blue Cross.
This page features plan details for 2024 Anthem Medicare Advantage (HMO) H0544 – 061 – 0 available in Orange and Los Angeles Counties.
IMPORTANT: This page features the 2024 version of this plan. See the 2025 version using the link below:
Anthem Medicare Advantage (HMO) is offered in the following locations.
Anthem Medicare Advantage (HMO) offers the following coverage and cost-sharing.
Insurer: | Anthem Blue Cross |
Health Plan Deductible: | $0.00 |
MOOP: | $7,550 In-network |
Drugs Covered: | Yes |
Ready to sign up for Anthem Medicare Advantage (HMO) ?
Get help from a licensed insurance agent.
Call 1-877-354-4611 / TTY 711.
M-F: 8:00 am – 10:00 pm EST
Sat-Sun: 8:00 am – 9:00 pm EST
Part B | Part C | Part D | Part B Give Back | Total |
---|---|---|---|---|
$174.70 | $0.00 | $0.00 | $0.00 | $ |
Anthem Medicare Advantage (HMO) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.
Drug Deductible: | $0.00 |
Initial Coverage Limit: | $5,030.00 |
Catastrophic Coverage Limit: | $8,000.00 |
Drug Benefit Type: | Enhanced Alternative |
Additional Gap Coverage: | Yes |
Formulary Link: | Formulary Link |
The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.
The table below shows how the LIS impacts the Part D premium of this plan.
Part D | LIS Full |
---|---|
$0.00 | $ |
After you pay your $0.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $5,030.00. Once you reach that amount, you will enter the next coverage phase.
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
1 (Preferred Generic) | $0.00 copay | $0.00 copay | $0.00 copay | |
2 (Generic) | $15.00 copay | $20.00 copay | $0.00 copay | |
3 (Preferred Brand) | $42.00 copay | $47.00 copay | $42.00 copay | |
4 (Non-Preferred Drug) | $95.00 copay | $100.00 copay | $95.00 copay | |
5 (Specialty Tier) | 33% | 33% | 33% |
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
1 (Preferred Generic) | ||||
2 (Generic) | ||||
3 (Preferred Brand) | ||||
4 (Non-Preferred Drug) | ||||
5 (Specialty Tier) |
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
1 (Preferred Generic) | $0.00 copay | $0.00 copay | $0.00 copay | |
2 (Generic) | $45.00 copay | $60.00 copay | $0.00 copay | |
3 (Preferred Brand) | $126.00 copay | $141.00 copay | $126.00 copay | |
4 (Non-Preferred Drug) | $285.00 copay | $300.00 copay | $285.00 copay | |
5 (Specialty Tier) |
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
1 (Preferred Generic) | $0.00 copay | $0.00 copay | $0.00 copay | |
Generic drugs | ||||
Brand-name drugs |
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
1 (Preferred Generic) | $0.00 copay | $0.00 copay | $0.00 copay | |
Generic drugs | ||||
Brand-name drugs |
Tier | Cost |
---|---|
All other tiers (Generic) | 25% |
All other tiers (Brand-name) | 25% |
After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $8,000.00, you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. Please note, that this plan has a Enhanced Alternative benefit type.
Anthem Medicare Advantage (HMO) also provides the following benefits.
$0 |
In-network | No |
$7,550 In-network |
Yes |
In-network | No |
$0-403 copay per visit (Authorization is required.) (Referral is required.) |
Primary | $20 copay per visit (Not applicable.) (Not applicable.) |
Specialist | $50 copay per visit (Authorization is required.) (Referral is required.) |
$0 copay (Authorization is not required.) (Referral is not required.) |
Emergency | $90 copay per visit (always covered) (Not applicable.) (Not applicable.) |
Urgent care | $35 copay per visit (always covered) (Not applicable.) (Not applicable.) |
Diagnostic tests and procedures | $0-235 copay (Authorization is required.) (Referral is required.) |
Lab services | $0-15 copay (Authorization is required.) (Referral is required.) |
Diagnostic radiology services (e.g., MRI) | $275 copay (Authorization is required.) (Referral is required.) |
Outpatient x-rays | $65 copay (Authorization is required.) (Referral is required.) |
Hearing exam | $50 copay (Authorization is required.) (Referral is required.) |
Fitting/evaluation | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Hearing aids – inner ear | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Hearing aids – outer ear | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Hearing aids – over the ear | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Oral exam | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Cleaning | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Fluoride treatment | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Dental x-ray(s) | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Non-routine services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Diagnostic services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Restorative services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Endodontics | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Periodontics | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Extractions | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Prosthodontics, other oral/maxillofacial surgery, other services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Routine eye exam | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Other | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Contact lenses | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Eyeglasses (frames and lenses) | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Eyeglass frames | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Eyeglass lenses | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Upgrades | Not covered (Not applicable.) (Not applicable.) |
Occupational therapy visit | $40 copay (Authorization is required.) (Referral is required.) |
Physical therapy and speech and language therapy visit | $40 copay (Authorization is required.) (Referral is required.) |
$340 copay (Not applicable.) (Not applicable.) |
Not covered (Not applicable.) (Not applicable.) |
Foot exams and treatment | $0-50 copay (Authorization is required.) (Referral is required.) |
Routine foot care | $0 copay (There are no limits.) (Authorization is required.) (Referral is required.) |
Durable medical equipment (e.g., wheelchairs, oxygen) | 0-20% coinsurance per item (Authorization is required.) (Not applicable.) |
Prosthetics (e.g., braces, artificial limbs) | 20% coinsurance per item (Authorization is required.) (Not applicable.) |
Diabetes supplies | $0 copay (Authorization is not required.) (Not applicable.) |
Covered (Authorization is not required.) (Referral is not required.) |
Chemotherapy | 0-20% coinsurance (Authorization is required.) (Not applicable.) |
Other Part B drugs | 0-20% coinsurance (Authorization is required.) (Not applicable.) |
Part B Insulin drugs | $35 copay (Authorization is required.) (Not applicable.) |
$403 per day for days 1 through 5 $0 per day for days 6 through 90 (Authorization is required.) (Referral is not required.) |
Inpatient hospital – psychiatric | $374 per day for days 1 through 5 $0 per day for days 6 through 90 (Authorization is required.) (Referral is not required.) |
Outpatient group therapy visit with a psychiatrist | $40 copay (Authorization is required.) (Referral is required.) |
Outpatient individual therapy visit with a psychiatrist | $40 copay (Authorization is required.) (Referral is required.) |
Outpatient group therapy visit | $40 copay (Authorization is required.) (Referral is required.) |
Outpatient individual therapy visit | $40 copay (Authorization is required.) (Referral is required.) |
$0 per day for days 1 through 20 $196 per day for days 21 through 100 (Authorization is required.) (Referral is not required.) |
Monthly Premium | $13.00 |
Deductible | nan |
Monthly Premium | $32.00 |
Deductible | nan |
Monthly Premium | $48.00 |
Deductible | nan |
Ready to sign up for Anthem Medicare Advantage (HMO) ?
Get help from a licensed insurance agent.
Call 1-877-354-4611 / TTY 711.
M-F: 8:00 am – 10:00 pm EST
Sat-Sun: 8:00 am – 9:00 pm EST
Need more information on Anthem Medicare Advantage (HMO)? See 2025 Anthem Medicare Advantage (HMO) at MedicareAdvantageRX.com.
Get help enrolling in a Medicare Advantage or Medicare Prescription Drug Plan by calling a licensed insurance agent today.
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Anthem Blue Cross, Aspire Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, GlobalHealth, Health Care Service Corporation, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Baylor Scott & White Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint
SMID: MULTIPLAN_HCIHNDOGMED01PY25_M
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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