Anthem Prime (HMO) 2024 Benefit Details for Plan H4161-004-0 by Anthem Blue Cross Partnership Plan
Anthem Prime is a 2024 HMO Medicare Advantage plan with Part D drug plan benefits. Delivery of healthcare services and costs are different than in Original Medicare, but this Medicare Advantage plan, by Anthem Blue Cross Partnership Plan, may offer extra benefits.
Plan Basics | |
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Plan ID: | H4161 004 0 |
Plan Type: | Local HMO |
Plan Year: | 2024 |
Premium: | $0.00/mo Plus your Medicare Part B premium. |
Health Plan Deductible: | $0.00 |
Out-of-Pocket Maximum: | $2,500/yr |
Part B Reduction: | $0.00/mo |
Drug Plan Benefit: | Enhanced, $0.00 deductible |
Rx Gap Coverage: | Yes |
Supplemental Benefits: | Vision, Hearing |
Availability: | See List |
Insured By: | Anthem Blue Cross Partnership Plan |
Summary of Benefits |
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Health Plan Cost Sharing
This Anthem Blue Cross Partnership Plan Medicare Advantage plan has cost-sharing. These are costs you must pay out-of-pocket when you use approved health services.
NOTE: Most preventive services are covered 100% by the plan as a Part B benefit.
The following table summarizes the most common out-of-pocket costs you will incur if you join this plan unless you go out-of-network:
Healthcare Service | Member Cost |
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Doctor Visits (In-Network) | |
Primary: | $0 Copay |
Specialist: | $25 Copay Prior Authorization Required, Referral Required |
Wellness programs (e.g., fitness, nursing hotline): | None |
Preventive care: | $0 Copay |
Foot Care (In-Network) | |
Foot exams and treatment (Medicare-covered): | $25 Copay Prior Authorization Required, Referral Required |
Routine foot care: | $0 Copay Prior Authorization Required, Referral Required |
Chiropractic Care (In-Network) | |
Medicare-covered chiropractic care: | $20 Copay Prior Authorization Required, Referral Required |
Routine chiropractic care: | Not Covered |
Emergency Care / Urgent Care | |
Emergency room care: | $90 Copay |
Urgent care: | $35 Copay |
Ground ambulance: | $250 Copay |
Inpatient hospital coverage: | $250.00 per day for days 1 through 4 $0.00 per day for days 5 and beyond |
Outpatient hospital coverage: | $100 Copay Prior Authorization Required, Referral Required |
Skilled Nursing Facility: | $0.00 per day for days 1 through 20 $188.00 per day for days 21 and beyond |
Optional supplemental benefits: | |
Mental Health Services (In-Network) | |
Outpatient individual therapy visit with a psychiatrist: | $40 Copay |
Outpatient group therapy visit with a psychiatrist: | $40 Copay |
Inpatient hospital - psychiatric: | $250.00 per day for days 1 through 4 $0.00 per day for days 5 and beyond |
Outpatient group therapy visit: | $40 Copay |
Outpatient individual therapy visit: | $0 |
Rehabilitation Services (In-Network) | |
Physical therapy and speech and language therapy visit: | $25 Copay Prior Authorization Required, Referral Required |
Occupational therapy visit: | $25 Copay Prior Authorization Required, Referral Required |
Medical Equipment / Supplies (In-Network) | |
Diabetes supplies: | $0 Copay |
Durable medical equipment (e.g., wheelchairs, oxygen): | 20% Coinsurance Prior Authorization Required |
Prosthetics (e.g., braces, artificial limbs): | 20% Coinsurance |
Diagnostic Procedures / Lab Services / Imaging (In-Network) | |
Diagnostic radiology services (e.g., MRI): | $175 Copay Prior Authorization Required, Referral Required |
Lab services: | $10 Copay Prior Authorization Required, Referral Required |
Outpatient x-rays: | $10 Copay Prior Authorization Required, Referral Required |
Diagnostic tests and procedures: | $50 Copay Prior Authorization Required, Referral Required |
Medicare Part B Drugs (In-Network) | |
Chemotherapy: | 20% Coinsurance |
Other Part B drugs (Medicare-covered) | 20% Coinsurance |
Feel free to download our Anthem Prime Summary of Benefits information.
Supplemental Benefits
The following is a summary of the supplemental benefits Anthem Blue Cross Partnership Plan includes with this plan:
Supplemental Healthcare Service | Member Cost |
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Preventive Dental | |
Oral exam (In-Network) | Not Covered |
Fluoride treatment (In-Network) | Not Covered |
Dental x-ray(s) (In-Network) | Not Covered |
Cleaning (In-Network) | Not Covered |
Comprehensive Dental | |
Periodontics (In-Network) | Not Covered |
Non-routine services (In-Network) | Not Covered |
Diagnostic services (In-Network) | Not Covered |
Extractions (In-Network) | Not Covered |
Endodontics (In-Network) | Not Covered |
Restorative services (In-Network) | Not Covered |
Prosthodontics, other oral/maxillofacial surgery, other services (In-Network) | Not Covered |
Hearing Aids | |
Fitting/evaluation (In-Network) | $0 Copay Prior Authorization Required, Referral Required |
Hearing aids (In-Network) | Covered Limits may apply |
Hearing exam (In-Network) | $0 Copay Prior Authorization Required, Referral Required |
Vision | Maximum vision benefit: | $100.00 Every year |
Eyeglasses (frames and lenses) (In-Network) | $0 Copay |
Routine eye exam (In-Network) | $0 Copay |
Contact lenses (In-Network) | $0 Copay |
Additional Benefits
None specified.
Prescription Drug Plan Costs & Benefits
Anthem Prime includes an enhanced benefit Medicare Part D plan (PDP). Enhanced plans have a higher actuarial value than basic plans. Actuarial value simply refers to the percentage of cost that's covered by the plan.
Prescription Drug Plan Premium
Although the prescription drug plan (Part D) premium is bundled with the total plan cost, some plans have supplemental costs and/or offer low-income subsidy (LIS) assistance. LIS, also known as Extra Help, is a Social Security program that helps people with limited income and resources lower or cut Part D costs.
The following table outlines the prescription drug plan premium details of this plan.
Basic Part D Premium: | $0.00 |
Supplemental Part D Premium: | $0.00 |
Total Part D Premium: | $0.00 |
Part D Premium with Full LIS Assistance: | $0.00 |
If you would like more information about the Extra Help program, you can refer to the Social Security Extra Help page.
Prescription Drug Plan Deductible
The Medicare Part D annual deductible with this plan is $0.00. You must pay this amount at the pharmacy before Anthem Blue Cross Partnership Plan begins paying its share.
Prescription Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, Anthem Prime has out-of-pocket costs that you must pay when you pick up your prescriptions.
Drug Tier | Preferred | Standard |
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1 (Preferred Generic) | $0.00 copay | $5.00 copay |
2 (Generic) | $7.00 copay | $12.00 copay |
3 (Preferred Brand) | $42.00 copay | $47.00 copay |
4 (Non-Preferred Drug) | $95.00 copay | $100.00 copay |
5 (Specialty Tier) | 33% | 33% |
CMS Rating Marks for 2024
Each year Medicare rates health plans (Part C) and drug plans (Part D) in several major categories based on a 5-star rating system. These ratings are designed to help you understand the quality of care and service you can expect if you join this Anthem Blue Cross Partnership Plan plan.
CMS Measure | Star Rating |
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2024 Overall Rating | |
Staying Healthy: Screenings, Tests, Vaccines | Plan too new to be measured |
Managing Chronic (Long Term) Conditions | Plan too new to be measured |
Member Experience with Health Plan | Plan too new to be measured |
Complaints and Changes in Plans Performance | Plan too new to be measured |
Health Plan Customer Service | Plan too new to be measured |
Drug Plan Customer Service | |
Complaints and Changes in the Drug Plan | Plan too new to be measured |
Member Experience with the Drug Plan | Plan too new to be measured |
Drug Safety and Accuracy of Drug Pricing | Plan too new to be measured |
Anthem Prime is new, so it does not yet have a Medicare rating. However, we can offer our input on value.
Anthem Prime offers some vision and hearing benefits, but not dental.
With no additional monthly premium, this plan can save you money if you're healthy. We love it when we see a plan with a maximum out-of-pocket (MOOP) limit less than $3,000, and this plan brings it in at $2,500 per year. The MOOP does not include prescriptions, but the good news is that a 5-day stay in the hospital with Anthem Prime will probably cost less than Original Medicare. With no annual deductible, members of this health plan have first dollar coverage, which is comforting on a fixed budget.
Plan Availability
Anthem Prime (H4161-004-0) is available in the following locations (click to open):
Additional Medicare Advantage Plan Options
The Medicare Advantage program offers a myriad of options, including these plans:
- H4161-013-0: Anthem I Carelon Medicare Advantage (HMO)
- H4161-012-0: Anthem I Carelon Premium Savings (HMO)
- H4161-002-0: Anthem Prime (HMO)
- H4161-011-0: Anthem I Carelon Medicare Advantage (HMO)
- H4161-005-0: Anthem Prime (HMO)
Contact Anthem Blue Cross Partnership Plan
Plan Website: | https://shop.anthem.com/medicare |
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Formulary Information: | https://www.shop.anthem.com/medicare |
Pharmacy Information: | Anthem Blue Cross Partnership Plan Pharmacy Page |
Prospective Members: | (855)593-0898 |
TTY Users: | 711 |
If you qualify for Medicare benefits but have not yet enrolled or verified your enrollment status, you can do so on the Social Security Administration website. You can learn more about the Medicare Advantage program on www.medicare.gov or call 1-800-MEDICARE.
Medicare Part C Compatibility
Medicare Part C plans (HMO, PPO, PFFS) typically do not work with other types of health insurance. If you have Medicare Part A and/or Part B and decide to join a Part C plan, you will be removed from Original Medicare.
If you are enrolled in a Part C plan with prescription drug coverage, you cannot be enrolled in a stand-alone Medicare Part D plan, regardless of your chosen insurance company.
You cannot be enrolled in a Part C health plan and simultaneously hold Medicare Supplement Insurance (Medigap). Medicare Supplement plans are only compatible with Medicare Parts A and B.
Veterans enrolled in a Part C plan who also have VA Health Benefits may be able to receive care at their local VA healthcare facility. However, depending on the plan, the plan may or may not cover VA out-of-pocket healthcare or drug costs. Speak with a licensed insurance agent to discuss your options.
Plans Offered
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, GlobalHealth, Health Care Service Corporation, Cigna Healthcare, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Scott and White Health Plan now part of Baylor Scott & White Health, UnitedHealthcare(R), and Wellcare.
Citations & References
- Anthem Blue Cross Partnership Plan, https://shop.anthem.com/medicare, Last Accessed February 20, 2024
- Medicare.gov, "Understanding Medicare Advantage Plans", Last Accessed January 21, 2024
- Medicare.gov, "Your Medicare coverage choices", Last Accessed February 19, 2024
- Medicare.gov, "Medicare & You in Different Formats", Last Accessed February 19, 2024
- Medicare.gov, "Your Medicare Coverage", Last Accessed April 11, 2023
- CMS.gov, Landscape Source Files, Last Accessed February 21, 2024
- CMS.gov, Medicare Part C & D Performance, Last Accessed February 21, 2024
- CMS.gov, Plan Benefits Package, Last Accessed February 21, 2024
About This H4161-004-0 Plan Detail Page
The data on this Anthem Prime plan detail page is derived from the 2024 Landscape Source Files, Plan Benefit Package, and Medicare Part C and Part D Performance Data published by CMS.
The author interprets these files, and their associated data dictionary, with great care, making every attempt to communicate the data submitted by Anthem Blue Cross Partnership Plan to CMS as clearly and accurately as possible. Given the complexity of the data, the author recommends that all potential enrollees request an official Summary of Benefits from Anthem Blue Cross Partnership Plan, at (855)593-0898, prior to enrollment.