Anthem Medicare Advantage (HMO)

Connecticut Medicare Advantage Plan (2024 Plan)


Monthly Premium

Your Cost
$29
by Anthem Blue Cross and Blue Shield

Additional Coverage

HearingVision

Overall Government Star Rating

 4.0
out of 5 stars

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Plan Name
Anthem Medicare Advantage (HMO)
Insurance Carrier
Anthem Blue Cross and Blue Shield
Plan Type
Medicare Advantage Plan With Part D Prescription Drug Coverage
Network Type
HMO

Anthem Medicare Advantage (HMO) is a Medicare Advantage Plan With Part D Prescription Drug Coverage, which is available in Connecticut and offered by the health insurance company Anthem Blue Cross and Blue Shield. This plan’s network type is HMO which determines in-network doctors who accept the health plan and whether a referral is needed.

Monthly Premium
$29
Annual Deductible
$0
Max Out-of-Pocket
$6,700
Primary doctor visit
$20 copay per visit
Specialist visit
$50 copay per visit
ER visit
$90 copay per visit (always covered)
Ambulance
$325 copay

Anthem Medicare Advantage (HMO) has a monthly premium cost of $29 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $6,700 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for Anthem Medicare Advantage (HMO) are defined below.

Yes
Part D Prescription Drug Coverage
No
Dental
Yes
Vision
Yes
Hearing

Anthem Medicare Advantage (HMO) is a Medicare Advantage plan which does include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. Anthem Medicare Advantage (HMO) includes coverage for hearing, vision.

Medicare Advantage health plans can offer even more additional benefits. Anthem Medicare Advantage (HMO) includes coverage for the following additional benefits:

Other benefits

Fitness benefit
Limited coverage
Over the counter drug benefits
Not covered
In-home support services
Not covered
Home and bathroom safety devices
Not covered
Meals for short duration
Not covered
Annual physical exams
Limited coverage
Telehealth
Limited coverage

Each year the federal government evaluates the quality of Medicare Advantage and Part D Prescription Drug plans based on a 5-star scoring system. For 2024, Anthem Medicare Advantage (HMO) received an overall government quality rating of 4.0 stars out of 5 stars.

Anthem Medicare Advantage (HMO) performed better than Connecticut’s State average overall quality score of 3.7 stars.

This Plan’s 5-star Gov’t Quality Score
Connecticut State Average Score
Overall Government 5 Star Quality Rating
 4.0
 3.7
Summary rating of health plan quality
 3.5
 3.7
Staying healthy: screenings, tests, & vaccines
 4
 3.9
Managing chronic (long term) conditions
 3
 3.3
Member experience with health plan
 4
 3.2
Member complaints & changes in the health plan's performance
 4
 3.9
Health plan customer service
 4
 4.3
Summary rating of drug plan quality
 4.5
 3.8
Drug plan customer service
 4
 3.9
Member complaints & changes in the drug plan's performance
 4
 3.9
Member experience with the drug plan
 4
 3.0
Drug safety & accuracy of drug pricing
 4
 3.7

The government calculates an “Overall star rating” based on ratings for sub components including “Health plan star rating” and “Drug plan star rating”, which includes further subcomponents of each.

Anthem Medicare Advantage (HMO) received 3.5 stars for its health plan quality score which is worse than the Connecticut State average health plan quality score of 3.7 stars.

Anthem Medicare Advantage (HMO) received 4.5 stars for its drug plan quality score which is better than the Connecticut State average drug plan quality score of 3.8 stars.


Monthly Premium
$29
Health Portion of Premium
$4
Drug Portion of Premium
$25
Health Plan Deductible
$0
Health Plan Max Out-of-Pocket
$6,700 In-network
Nationwide Coverage included
No
Hearing Coverage included
Yes
Vision Coverage included
Yes
Dental Coverage included
No

Doctor Services

Primary doctor visit
$20 copay per visit
Specialist visit
$50 copay per visit

Tests, labs, & imaging

Diagnostic tests & procedures
$0-100 copay
Lab services
$0-20 copay
Diagnostic radiology services (like MRI)
$200-300 copay
Outpatient x-rays
$40-85 copay
Emergency care
$90 copay per visit (always covered)
Urgent care
$55 copay per visit (always covered)

Hospital Services

Inpatient hospital coverage
$440 per day for days 1 through 4
$0 per day for days 5 through 90
Outpatient hospital coverage
$0 copay or 30% coinsurance per visit

Skilled nursing facility

Skilled nursing facility
$0 per day for days 1 through 20
$196 per day for days 21 through 100

Preventive services

Preventive services
$0 copay

Ambulance

Ground ambulance
$325 copay

Therapy services

Occupational therapy visit
$40 copay
Physical therapy & speech & language therapy visit
$40 copay

Mental health services

Outpatient group therapy with a psychiatrist
$40 copay
Outpatient individual therapy with a psychiatrist
$40 copay
Outpatient group therapy visit
$40 copay
Outpatient individual therapy visit
$40 copay

Opioid treatment services

Opioid treatment services
Covered

Other services

Durable medical equipment (like wheelchairs & oxygen)
0-20% coinsurance per item
Prosthetics (like braces, artificial limbs)
20% coinsurance per item
Diabetes supplies
$0 copay

Tier drug costs for: Standard retail pharmacy drug cost for 1-month

TiersInitial coverage phaseGap coverage phase1Catastrophic coverage phase
Preferred Generic$17.00 copay


Generic drugs :
$0 copay

Brand-name drugs :
$0 copay

Generic$20.00 copay
Preferred Brand$47.00 copay
Non-Preferred Drug$100.00 copay
Specialty Tier27%
1 For all other drugs, you pay 25% for generic drugs and 25% for brand-name drugs.

Part B Drugs

Chemotherapy drugs
0-20% coinsurance
Other Part B drugs
0-20% coinsurance

Hearing

Hearing exam
$50 copay
Fitting/evaluation
Not covered
Hearing aids - Inner ear
Not covered
Hearing aids - Outer ear
Not covered
Hearing aids - Over the ear
Not covered

Preventive Dental

Oral exam
Not covered
Cleaning
Not covered
Fluoride treatment
Not covered
Dental x-rays
Not covered

Comprehensive dental

Non-routine services
Not covered
Diagnostic services
Not covered
Restorative services
Not covered
Endodontics
Not covered
Periodontics
Not covered
Extractions
Not covered
Prosthodontics, other oral/maxillofacial surgery, other services
Not covered

Vision

Routine eye exam
$0 copay
Contact lenses
Not covered
Eyeglasses (frames & lenses)
Not covered
Eyeglass frames (only)
Not covered
Eyeglass lenses (only)
Not covered
Upgrades
Not covered

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