How Can I Find Healthcare Providers Who Accept Anthem Medicare Plans?
This article was updated on: 10/20/2018
Are you enrolled in an Anthem Medicare Advantage plan or Anthem Medicare Part D Prescription Drug plan? You may be required to use providers and pharmacies who participate in Anthem’s network in order to access plan benefits and minimize your out-of-pocket costs.
Anthem is a private insurance company contracted with Medicare to provide health-care benefits under federal program guidelines, but it may also have separate plan requirements, including getting your care from in-network providers. Here’s how to find a doctor, specialist, hospital, pharmacy, or other provider who accepts your Anthem Medicare health plan.
Read more about Medicare Advantage plans and stand-alone Medicare Part D Prescription Drug Plans. With either type of plan, you’re still in the Medicare program and must keep paying your Medicare Part B premium.
Why do I need to go to an Anthem Medicare network provider?
Some Anthem Medicare Advantage and Anthem Medicare Part D Prescription Drug Plans offer significant cost savings to you if you use providers or pharmacies contracted with Anthem. Providers in Anthem Medicare Advantage plan networks have agreed to accept a certain payment rate for treating Anthem Medicare health plan members, which may be lower than what they would charge you if you did not have coverage with Anthem. Similarly, pharmacies in Anthem Medicare Part D Prescription Drug Plan networks agree to provide plan members’ prescription medications at prices that may be lower than for non-members.
Anthem Medicare provider networks may include primary care, specialist care, inpatient and outpatient facilities, therapists, labs, imaging centers, and pharmacists.
If you get treated in-network, your provider may only charge you a set copayment or coinsurance amount, and he or she must accept this amount as payment in full for your share of each covered benefit. You might need to pay a plan deductible amount before your plan helps pay for covered benefits.
Depending on the Anthem Medicare Advantage plan or Anthem Medicare Prescription Drug Plan you choose, you may be required to get all your health care in-network, or risk paying the full amount yourself for any treatment or medications you receive (except in emergency situations).
How can I find out who accepts my Anthem Medicare plan?
There are several ways to find Anthem Medicare network providers:
- Register for an online account with Anthem Medicare for access to online search tools and provider lists.
- Use your Anthem MedicareAdvantage or Medicare Part D Prescription Drug plan ID number to search online using Anthem’s Find a Doctor tool.
- If you are not currently an Anthem member, or just want to search plans and providers, you can use Anthem’s Find a Doctor tool to search by various criteria such as provider or facility name, city or state, health-care specialty, facility type, or plan type.
- You can also call Anthem MedicareCustomer Support directly for assistance; see Anthem’s contact information.
What happens if I don’t use an Anthem Medicare network provider?
Depending on your plan, if you get care from a provider who is not contracted with Anthem, one or more of the following things may happen:
- Your plan may not pay anything. In some cases, you must get all but medically necessary emergency treatment from an Anthem network provider in order to use your benefits.
- You may pay more out-of-pocket for your care. Your plan may pay a smaller portion of the bill or your provider may charge higher fees than those allowed by network providers. Generally, providers may not charge more than 15% above the Medicare-approved amount for the service you receive.
- Any amounts you pay may not count toward applicable deductibles required by your plan.
- You may need to get prior authorization from your plan before any benefits apply.
Would you like to start comparing plans right now? Just click Find Plans.
Anthem Blue Cross and Blue Shield serves Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri (excluding 30 counties in the Kansas City area), Nevada, New Hampshire, Ohio, Virginia (excluding the Northern Virginia suburbs of Washington, D.C.), and Wisconsin.