Anthem Veteran (HMO)

H8432 - 037 - 1
3 out of 5 stars (3 / 5)

empire-bluecross-blueshield medicare provider logo

Anthem Veteran (HMO) is a Medicare Advantage Plan by Empire BlueCross BlueShield.

This page features plan details for 2024 Anthem Veteran (HMO) H8432 – 037 – 1 available in Select Counties in New York.

IMPORTANT: This page features the 2024 version of this plan. See the 2025 version using the link below:

No 2025 version found. You can use the location links below to find 2025 plans in your area.

Locations

Anthem Veteran (HMO) is offered in the following locations.

Plan Overview

Anthem Veteran (HMO) offers the following coverage and cost-sharing.

Insurer:Empire BlueCross BlueShield
Health Plan Deductible:
MOOP:$8,300.00
Drugs Covered:No

Ready to sign up for Anthem Veteran (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

Premium Breakdown

Anthem Veteran (HMO) has a monthly premium of $0.00. This amount includes your Part C premium but does not include your Part B premium.
Part B Part C Part B Give Back Total
$174.70 $0.00 $0.00 $
Please Note:
  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.

Additional Benefits

Anthem Veteran (HMO) also provides the following benefits.

Health plan deductible

$0

Other health plan deductibles?

In-network No

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

$8,300 In-network

Optional supplemental benefits

Yes

Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

In-network No

Outpatient hospital coverage

$0 copay or 30% coinsurance per visit (Authorization is required.) (Referral is required.)

Doctor visits

Primary$20 copay per visit (Not applicable.) (Not applicable.)
Specialist$50 copay per visit (Authorization is required.) (Referral is required.)

Preventive care

$0 copay (Authorization is not required.) (Referral is not required.)

Emergency care/Urgent care

Emergency$90 copay per visit (always covered) (Not applicable.) (Not applicable.)
Urgent care$55 copay per visit (always covered) (Not applicable.) (Not applicable.)

Diagnostic procedures/lab services/imaging

Diagnostic tests and procedures$0-150 copay (Authorization is required.) (Referral is required.)
Lab services$0 copay (Authorization is required.) (Referral is required.)
Diagnostic radiology services (e.g., MRI)$200-250 copay (Authorization is required.) (Referral is required.)
Outpatient x-rays$60-100 copay (Authorization is required.) (Referral is required.)

Hearing

Hearing exam$50 copay (Authorization is required.) (Referral is required.)
Fitting/evaluationNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Hearing aids – inner earNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Hearing aids – outer earNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Hearing aids – over the earNot covered (There are no limits.) (Not applicable.) (Not applicable.)

Preventive dental

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$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
Dental x-ray(s)$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)

Comprehensive dental

Non-routine services$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
Diagnostic services$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
Restorative services$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
Endodontics$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
Periodontics$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
Extractions$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
Prosthodontics, other oral/maxillofacial surgery, other services$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)

Vision

Routine eye exam$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
OtherNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Contact lensesNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Eyeglasses (frames and lenses)Not covered (There are no limits.) (Not applicable.) (Not applicable.)
Eyeglass framesNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Eyeglass lensesNot covered (There are no limits.) (Not applicable.) (Not applicable.)
UpgradesNot covered (Not applicable.) (Not applicable.)

Rehabilitation services

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.)

Ground ambulance

$270 copay (Not applicable.) (Not applicable.)

Transportation

Not covered (Not applicable.) (Not applicable.)

Foot care (podiatry services)

Foot exams and treatment$50 copay (Authorization is required.) (Referral is required.)
Routine foot careNot covered (Not applicable.) (Not applicable.)

Medical equipment/supplies

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.)

Wellness programs (e.g., fitness, nursing hotline)

Covered (Authorization is not required.) (Referral is not required.)

Medicare Part B drugs

Chemotherapy0-20% coinsurance (Authorization is required.) (Not applicable.)
Other Part B drugs0-20% coinsurance (Authorization is required.) (Not applicable.)
Part B Insulin drugs$35 copay (Authorization is required.) (Not applicable.)

Inpatient hospital coverage

$400 per day for days 1 through 5
$0 per day for days 6 through 90 (Authorization is required.) (Referral is not required.)

Mental health services

Inpatient hospital – psychiatric$465 per day for days 1 through 4
$0 per day for days 5 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.)

Skilled Nursing Facility

$0 per day for days 1 through 20
$196 per day for days 21 through 100 (Authorization is required.) (Referral is not required.)

Package #1

Monthly Premium$16.00
Deductiblenan

Package #2

Monthly Premium$26.00
Deductiblenan

Package #3

Monthly Premium$47.00
Deductiblenan

Ready to sign up for Anthem Veteran (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

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