What Medicare Advantage Plans Does Anthem Blue Cross Have in California?
This article was updated on: 09/09/2018
If you’re looking for an alternative way to receive your Original Medicare (Part A and Part B) benefits, you might want to look at Medicare Advantage plans offered by Anthem Blue Cross of California. Anthem Medicare Advantage plans offer all the same coverage as Original Medicare (except for hospice care, which is still covered under Part A), but many include additional benefits and cost saving with the convenience of purchasing one single plan. Here’s an overview of what Anthem Blue Cross offers when it comes to Medicare Advantage plans.
What Anthem Blue Cross California Medicare Advantage plans are available?
As with all Medicare-approved private insurance companies, Anthem Blue Cross California may choose to offer several Medicare Advantage plan options, every plan option may not be available in all locations. In addition, plan benefits and premiums may vary by location. Here are some of the most common Anthem Medicare Advantage plans available in California:
Anthem Blue Cross California Medicare Advantage Health Maintenance Organization (HMO) Plan
HMOs, or Health Maintenance Organizations, are one of the most affordable Medicare Advantage plans. In exchange for lower costs, however, beneficiaries are expected to get their care from Anthem’s provider network (with some exceptions; see below). Here are other features of an HMO:
- You need to choose a primary care doctor to oversee your medical care; you’ll also need a referral to see a specialist.
- You must get your health care from in-network providers, or you may have to pay the full cost yourself. Please note that if you need emergency care, or urgent care while traveling out of town, your Anthem Blue Cross of California HMO still covers your care.
- Most HMOs include coverage for prescription drugs contained in their formulary, or list of covered medications. Remember, the formulary may change at any time, but your plan will notify you if necessary.
Anthem Blue Cross of California Medicare Advantage Preferred Provider Organization (PPO) Plan
A PPO** (Preferred Provider Organization) Medicare Advantage plan gives the flexibility to see any doctor and use any hospital you prefer, but you may pay more for that greater provider flexibility. Other things to know:
- PPOs often have a preferred provider network, and your cost sharing is lowest if you use doctors and hospitals in the plan network. You may go out of network, but your copayments and coinsurance costs may be higher.
- In general, out-of-pocket costs are usually higher with a PPO than an HMO.
- You don’t need to choose a primary care doctor, and there are usually no referrals for specialist care.
- Anthem PPOs usually cover prescription drugs; to learn which medications are covered under a specific plan, check the formulary.
Anthem Blue Cross of California Medicare Advantage Special Needs (SNP) Plan
SNPs, or Special Needs Plans, are Anthem Medicare Advantage plans that restrict enrollment to people with certain characteristics. This includes those who live in institutions; those who have both Medicare and Medicaid; and those with certain chronic or disabling diseases or conditions such as diabetes or end-stage renal disease. Plan providers, formularies, and other benefits are designed to meet the unique health-care needs of these individuals, and you must meet the eligibility criteria that the plan targets in order to enroll.
Other things to know:
- Special Needs Plans (SNPs) must include prescription drug coverage.
- All of your health care is managed by a primary care physician or care coordinator; in most cases, you’ll need a referral to see a specialist.
- Plan membership is limited to these specific groups under Medicare rules: a) people who live in nursing homes or who need nursing care at home, b) people who have both Medicare and Medicaid, or c) people with qualifying chronic or disabling conditions. Individual plans may restrict membership further. You can enroll in a Special Needs Plan (SNP) at any time.
Medicare Advantage plans may be a good option if you’re interested in coverage beyond the Original Medicare program. If you’d like to learn more about some of your plan options, use the Find Plans button on this page to compare and find plan options in your zip code.
** Out-of-network/non-contracted providers are under no obligation to treat Anthem plan members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
It’s important we treat you fairly. That’s why we follow federal civil rights laws in our health programs and activities. We don’t discriminate, exclude people, or treat them differently on the basis of race, color, national origin, sex, age or disability. For people with disabilities, we offer free aids and services. For people whose primary language isn’t English, we offer free language assistance services through interpreters and other written languages. Interested in these services? Call Customer Service for help (TTY: 711).
If you think we failed to offer these services or discriminated based on race, color, national origin, age, disability, or sex, you can file a complaint, also known as a grievance. You can file a complaint with our Compliance Coordinator, 4361 Irwin Simpson Rd, Mailstop: OH0205-A537; Mason, Ohio 45040-9498. Or you can file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights at 200 Independence Avenue, SW; Room 509F, HHH Building; Washington, D.C. 20201 or by calling 1-800-368-1019 (TTY: 1- 800-537-7697) or online at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf. Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html