A non-government entity
Anthem Blue Cross and Blue Shield
Plan ID: H3655-45-3
Anthem Medicare Advantage (HMO)
2024 Anthem Medicare Advantage (HMO) H3655 — 045— 3 is a Medicare Advantage plan with drug coverage. It has received a 3.5-out-of-5 star rating from CMS for 2024.
Learn more about Anthem Medicare Advantage (HMO) H3655 - 045 - 3, including the health and drug services it covers, by reading our easy-to-use guide. Or contact a licensed insurance agent for help now.
3.5 / 5 stars for 2024
$0.00 /mo
Monthly premium
$0
Health deductible
$0
Drug deductible
$4200.00
Out-of-pocket maximum
Enroll online
Call to enroll
OR
Get personalized help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week!
Plan Overview
2024 Anthem Medicare Advantage (HMO) H3655 — 045— 3 is a Local HMO offered in Columbus OH by Anthem Blue Cross and Blue Shield. It has a monthly premium of $0.00.
Premium Breakdown
Standard Part B Premium
$174.70
Part B premium reduction
- $0
Monthly Plan Premium
$0.00
Total Premium:
$174.70
Note:
The standard Part B premium for 2024 is $174.70. Your Part B premium may differ based on factors including late enrollment, income, and disability status. Higher-income beneficiaries may pay an income-related monthly adjustment amount (IRMAA). The Part B premium is required to be paid by everyone enrolled in Medicare Part B.
Special needs plan type
No
Out-of-pocket maximum
$4200.00
Plan Organization:
Anthem Blue Cross and Blue Shield
Plan Type:
Local HMO
Location:
Columbus OH
Drugs Covered:
Yes
Drug Formulary:
Pharmacies:
Doctor Choice:
Plan Doctors for Most Services
Doctors Link:
Deductibles
The amount you must pay each year before your plan starts to pay for covered services or drugs.
Health deductible
$0
Drug deductible
$0
Sign up for Anthem Medicare Advantage (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
Anthem Medicare Advantage (HMO) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.
Drug Benefit Type
Enhanced
Prescription drug deductible
$0
Increased initial coverage limit
No
Additional gap coverage
Yes
Part D Premium Reduction
This plan's premium may be reduced for you if you qualify for the low-income subsidy (also known as LIS or "Extra help"). The following is what you'll pay for with LIS.
Part D | LIS 25% | LIS 50% | LIS 75% | LIS Full |
|---|---|---|---|---|
$0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
Initial Coverage Phase
After you pay your $0.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $4,660.00. Once you reach that amount, you will enter the next coverage phase.
Tier | Preferred Pharmacy | Standard Pharmacy | Preferred Mail | Standard Mail |
|---|---|---|---|---|
1. Preferred Generic | $0.00 copay | $0.00 copay | - | $0.00 copay |
2. Standard Generic | $0.00 copay | $0.00 copay | - | $0.00 copay |
3. Preferred Brand | $42.00 copay | $47.00 copay | - | $42.00 copay |
4. Non-Preferred Drug | $95.00 copay | $100.00 copay | - | $95.00 copay |
5. Specialty Tier | 33% | 33% | - | 33% |
Gap Coverage Phase
After your total drug costs (including what this plan has paid and what you have paid) reach $4,660.00, you will pay no more than the amounts below for any drug tier until you reach $7,400.00.
Tier | Preffered Pharmacy | Standard Pharmacy | Preffered Mail | Standard Mail |
|---|---|---|---|---|
Preferred Generic | $0.00 copay | $0.00 copay | - | $0.00 copay |
Generic | $0.00 copay | $0.00 copay | - | $0.00 copay |
Select Care Drugs | $0.00 copay | $0.00 copay | - | $0.00 copay |
Catastrophic Coverage Phase
After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $7,400.00, you will pay no more than the greater of the two amounts listed below for generic and brand-name drugs.
Generic Drugs
$4.15 copay or 5% (whichever costs more)
Brand-name
$10.35 copay or 5% (whichever costs more)
Additional Benefits
Anthem Medicare Advantage (HMO) also provides the following benefits.
Note:
Limits, Authorizations, and Referrals may apply for the benefits below. Contact the plan for details.
Comprehensive dental
Preventive dental
Diagnostic procedures/lab services/imaging
Doctor visits
Emergency care/Urgent care
Foot care (podiatry services)
Ground ambulance
Hearing
Inpatient hospital coverage
Outpatient hospital coverage
Outpatient prescription drugs
Anthem Medicare Advantage (HMO) does not provide this type of benefit.
Optional benefits
Anthem Medicare Advantage (HMO) does not provide this type of benefit.
Medical equipment/supplies
Medicare Part B drugs
Mental health services
Preventive care
Rehabilitation services
Skilled Nursing Facility
Transportation
Vision
Wellness programs (eg, fitness, nursing hotline)
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Anthem Blue Cross, Aspire Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, GlobalHealth, Health Care Service Corporation, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Baylor Scott & White Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
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