Compare 2020 Medicare Health Plans
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Medicare Plans
Virginia
Charles City County
Medicare Plans
Virginia
Charles City County
Friday, September 25, 2020
Anthem Medicare Preferred Standard (PPO)
(H4909-001)
by Anthem Blue Cross and Blue Shield - Charles City County, VA
- This plan does not charge an annual deductible for all drugs. The $60.00 annual deductible only applies to drugs on certain tiers.
- The plan offers national in-network prescription coverage. This means that you will pay the same amount for your prescription drugs if you get them at an in-network pharmacy outside of the plan's service area (for instance when you travel).
Contact Information
Anthem Health Plans Of Virginia Inc.
P.O. Box 14046
Roanoke, VA 24038
Phone: 1-866-827-9866
Toll free: 1-866-827-9866
Website
http://www.anthem.com/medicare
Pharmacy
http://www.anthem.com
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Compare Plan
Plan details
| Plan Rating | 3.5 out of 5 stars |
| Premium and Other Important Information | $0 monthly plan premium in addition to your monthly Medicare Part B premium. |
| Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married couples). For more information about Part B and Part D premiums based on income call Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. You may also call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778. | |
| "Some physicians providers and suppliers that are out of a plan's network (i.e. out-of-network) accept ""assignment"" from Medicare and will only charge up to a Medicare-approved amount. If you choose to see an out-of-network physician who does NOT accept Medicare ""assignment "" your coinsurance can be based on the Medicare-approved amount plus an additional amount up to a higher Medicare ""limiting charge."" If you are a member of a plan that charges a copay for out-of-network physician services the higher Medicare ""limiting charge"" does not apply. See the publications Medicare You or Your Medicare Benefits available on www.medicare.gov for a full listing of benefits under Original Medicare as well as for explanations of the rules related to ""assignment"" and ""limiting charges"" that apply by benefit type. To find out if physicians and DME suppliers accept assignment or participate in Medicare visit www.medicare.gov/physician or www.medicare.gov/supplier. You can also call 1-800-MEDICARE or ask your physician provider or supplier if they accept assignment." | |
| $4 500 out-of-pocket limit. All plan services included. | |
| $4 500 out-of-pocket limit. All plan services included. | |
| Doctor and Hospital Choice | No referral required for network doctors specialists and hospitals. |
| You can go to doctors specialists and hospitals in or out of the network. It will cost more to get out of network benefits. | |
| Plan covers you when you travel in the U.S. | |
| Inpatient Hospital Care | No limit to the number of days covered by the plan each hospital stay. |
| For Medicare-covered hospital stays: | |
| Days 1 - 7: $205 copay per day | |
| Days 8 - 90: $0 copay per day | |
| $0 copay for additional hospital days | |
| Except in an emergency your doctor must tell the plan that you are going to be admitted to the hospital. | |
| For hospital stays: | |
| Days 1 - 7: $205 copay per day | |
| Days 8 and beyond: $0 copay per day | |
| Inpatient Mental Health Care | Contact the plan for details about coverage in a Psychiatric Hospital beyond 190 days. |
| For Medicare-covered hospital stays: | |
| Days 1 - 7: $205 copay per day | |
| Days 8 - 90: $0 copay per day | |
| $0 copay for additional hospital days | |
| Except in an emergency your doctor must tell the plan that you are going to be admitted to the hospital. | |
| For hospital stays: | |
| Days 1 - 7: $205 copay per day | |
| Days 8 and beyond: $0 copay per day | |
| Skilled Nursing Facility (SNF) | Authorization rules may apply. |
| Plan covers up to 100 days each benefit period | |
| No prior hospital stay is required. | |
| For SNF stays: | |
| Days 1 - 20: $0 copay per day | |
| Days 21 - 100: $146 copay per day | |
| For each SNF stay: | |
| Days 1 - 20: $0 copay per SNF day | |
| Days 21 - 100: $146 copay per SNF day | |
| Home Health Care | Authorization rules may apply. |
| $0 copay for each Medicare-covered home health visit | |
| $0 copay for home health visits | |
| Hospice | You must get care from a Medicare-certified hospice. Your plan will pay for a consultative visit before you select hospice. |
| Doctor Office Visits | $0 copay for each primary care doctor visit for Medicare-covered benefits. |
| $45 copay for each in-area network urgent care Medicare-covered visit | |
| $45 copay for each specialist visit for Medicare-covered benefits. | |
| $0 to $45 copay for each primary care doctor visit | |
| $45 copay for each specialist visit | |
| Chiropractic Services | Authorization rules may apply. |
| $20 copay for each Medicare-covered visit | |
| Medicare-covered chiropractic visits are for manual manipulation of the spine to correct subluxation (a displacement or misalignment of a joint or body part) if you get it from a chiropractor or other qualified providers. | |
| $20 copay for chiropractic benefits. | |
| Podiatry Services | $45 copay for each Medicare-covered visit |
| Medicare-covered podiatry benefits are for medically-necessary foot care. | |
| $45 copay for podiatry benefits. | |
| Outpatient Mental Health Care | Authorization rules may apply. |
| $40 copay for each Medicare-covered individual therapy visit | |
| $40 copay for each Medicare-covered group therapy visit | |
| $40 copay for each Medicare-covered individual therapy visit with a psychiatrist | |
| $40 copay for each Medicare-covered group therapy visit with a psychiatrist | |
| $45 copay for Medicare-covered partial hospitalization program services | |
| $40 copay for Mental Health benefits with a psychiatrist | |
| $40 copay for Mental Health benefits | |
| $45 copay for partial hospitalization program services | |
| Outpatient Substance Abuse Care | Authorization rules may apply. |
| $40 copay for Medicare-covered individual visits | |
| $40 copay for Medicare-covered group visits | |
| $40 copay for outpatient substance abuse benefits. | |
| Outpatient Services/Surgery | Authorization rules may apply. |
| $0 to $250 copay for each Medicare-covered ambulatory surgical center visit | |
| $0 to $250 copay for each Medicare-covered outpatient hospital facility visit | |
| $0 to $250 copay for outpatient hospital facility benefits. | |
| $0 to $250 copay for ambulatory surgical center benefits. | |
| Ambulance Services | Authorization rules may apply. |
| $175 copay for Medicare-covered ambulance benefits. | |
| $175 copay for ambulance benefits. | |
| Emergency Care | $65 copay for Medicare-covered emergency room visits |
| Worldwide coverage. | |
| If you are admitted to the hospital within 72-hour(s) for the same condition you pay $0 for the emergency room visit. | |
| Urgently Needed Care | $45 copay for Medicare-covered urgently-needed-care visits |
| Outpatient Rehabilitation Services | Authorization rules may apply. |
| $65 copay for Medicare-covered Occupational Therapy visits | |
| $65 copay for Medicare-covered Physical and/or Speech and Language Therapy visits | |
| $65 copay for Physical and/or Speech and Language Therapy visits | |
| $65 copay for Occupational Therapy benefits. | |
| Durable Medical Equipment | Authorization rules may apply. |
| 20% of the cost for Medicare-covered items | |
| 20% of the cost for durable medical equipment | |
| Prosthetic Devices | Authorization rules may apply. |
| 20% of the cost for Medicare-covered items | |
| 20% of the cost for prosthetic devices. | |
| Diabetes Programs and Supplies | $0 copay for Diabetes self-management training |
| $0 copay for Diabetes monitoring supplies | |
| $0 copay for Therapeutic shoes or inserts | |
| $0 copay for Diabetes self-management training | |
| $0 copay for Diabetes monitoring supplies | |
| $0 copay for Therapeutic shoes or inserts | |
| Diagnostic Tests X-Rays Lab Services and Radiology Services | Authorization rules may apply. |
| $0 copay for Medicare-covered lab services | |
| $0 to $160 copay for Medicare-covered diagnostic procedures and tests | |
| $100 copay for Medicare-covered X-rays | |
| $100 to $160 copay for Medicare-covered diagnostic radiology services (not including X-rays) | |
| 20% of the cost for Medicare-covered therapeutic radiology services | |
| If the doctor provides you services in addition to Outpatient Diagnostic Procedures Tests and Lab Services separate cost sharing of $0 to $45 may apply | |
| If the doctor provides you services in addition to Outpatient Diagnostic and Therapeutic Radiology Services separate cost sharing of $0 to $45 may apply | |
| 20% of the cost for therapeutic radiology services | |
| $100 to $160 copay for outpatient X-rays | |
| $100 to $160 copay for diagnostic radiology services | |
| $0 to $160 copay for diagnostic procedures tests and lab services | |
| Cardiac and Pulmonary Rehabilitation Services | $0 copay for Medicare-covered Cardiac Rehabilitation Services |
| $0 copay for Medicare-covered Intensive Cardiac Rehabilitation Services | |
| $0 copay for Medicare-covered Pulmonary Rehabilitation Services | |
| $0 copay for Cardiac Rehabilitation Services | |
| $0 copay for Intensive Cardiac Rehabilitation Services | |
| $0 copay for Pulmonary Rehabilitation Services | |
| Preventive Services and Wellness/Education Programs | $0 copay for all preventive services covered under Original Medicare at zero cost sharing: |
| HIV screening is covered for people with Medicare who are pregnant and people at increased risk for the infection including anyone who asks for the test. Medicare covers this test once every 12 months or up to three times during a pregnancy. Please contact plan for details. | |
| The plan covers the following supplemental education/wellness programs: | |
| $0 copay for Medicare-covered preventive services | |
| $0 copay for supplemental education/wellness programs | |
| Kidney Disease and Conditions | 20% of the cost for renal dialysis |
| $0 copay for kidney disease education services | |
| $0 copay for kidney disease education services | |
| 20% of the cost for renal dialysis | |
| Outpatient Prescription Drugs | 20% of the cost for Part B-covered chemotherapy drugs and other Part B-covered drugs. |
| 20% of the cost for Part B drugs out-of-network. | |
| This plan uses a formulary. The plan will send you the formulary. You can also see the formulary at www.anthem.com on the web. | |
| Different out-of-pocket costs may apply for people who | |
| The plan offers national in-network prescription coverage (i.e. this would include 50 states and the District of Columbia). This means that you will pay the same cost-sharing amount for your prescription drugs if you get them at an in-network pharmacy outside of the plan's service area (for instance when you travel). | |
| Total yearly drug costs are the total drug costs paid by both you and a Part D plan. | |
| The plan may require you to first try one drug to treat your condition before it will cover another drug for that condition. | |
| Some drugs have quantity limits. | |
| Your provider must get prior authorization from Anthem Medicare Preferred Standard (PPO) for certain drugs. | |
| You must go to certain pharmacies for a very limited number of drugs due to special handling provider coordination or patient education requirements that cannot be met by most pharmacies in your network. These drugs are listed on the plan's website formulary printed materials as well as on the Medicare Prescription Drug Plan Finder on Medicare.gov. | |
| If the actual cost of a drug is less than the normal cost-sharing amount for that drug you will pay the actual cost not the higher cost-sharing amount. | |
| "You pay $0 the first time you fill a prescription for certain drugs. These drugs will be listed as ""free first fill"" on the plan+s website formulary printed materials and on the Medicare Prescription Drug Plan Finder on Medicare.gov." | |
| If you request a formulary exception for a drug and Anthem Medicare Preferred Standard (PPO) approves the exception you will pay Tier 3: Non-Preferred Brand Drugs cost sharing for that drug. | |
| $60 deductible on all drugs except Tier 1: Generic Drugs Tier 4: Injectable Drugs Tier 5: Specialty Tier Drugs Tier 6: Supplemental Drugs. | |
| Supplemental drugs don't count toward your out-of-pocket drug costs. | |
| After you pay your yearly deductible you pay the following until total yearly drug costs reach $2 930: | |
| Tier 1: Generic Drugs | |
| Tier 2: Preferred Brand Drugs | |
| Tier 3: Non-Preferred Brand Drugs | |
| Tier 4: Injectable Drugs | |
| Tier 5: Specialty Tier Drugs | |
| Tier 6: Supplemental Drugs | |
| Tier 1: Generic Drugs | |
| Tier 2: Preferred Brand Drugs | |
| Tier 3: Non-Preferred Brand Drugs | |
| Tier 4: Injectable Drugs | |
| Tier 5: Specialty Tier Drugs | |
| Tier 6: Supplemental Drugs | |
| Tier 1: Generic Drugs | |
| Tier 2: Preferred Brand Drugs | |
| Tier 3: Non-Preferred Brand Drugs | |
| Tier 4: Injectable Drugs | |
| Tier 5: Specialty Tier Drugs | |
| Tier 6: Supplemental Drugs | |
| After your total yearly drug costs reach $2 930 you receive a discount on brand name drugs and pay 86% of the plan's costs for all generic drugs until your yearly out-of-pocket drug costs reach $4 700. | |
| Tier 6: Supplemental Drugs | |
| After your yearly out-of-pocket drug costs reach $4 700 you pay the greater of: | |
| Plan drugs may be covered in special circumstances for instance illness while traveling outside of the plan's service area where there is no network pharmacy. You may have to pay more than your normal cost-sharing amount if you get your drugs at an out-of-network pharmacy. In addition you will likely have to pay the pharmacy's full charge for the drug and submit documentation to receive reimbursement from Anthem Medicare Preferred Standard (PPO). | |
| After you pay your yearly deductible you will be reimbursed up to the plan's cost of the drug minus the following for drugs purchased out-of-network until your total yearly drug costs reach $2 930: | |
| Tier 1: Generic Drugs | |
| Tier 2: Preferred Brand Drugs | |
| Tier 3: Non-Preferred Brand Drugs | |
| Tier 4: Injectable Drugs | |
| Tier 5: Specialty Tier Drugs | |
| Tier 6: Supplemental Drugs | |
| You will not be reimbursed for the difference between the Out-of-Network Pharmacy charge and the plan's In-Network allowable amount. | |
| You will be reimbursed up to 14% of the plan allowable cost for generic drugs purchased out-of-network until total yearly out-of-pocket drug costs reach $4 700. You will be reimbursed up to the discounted price for brand name drugs purchased out-of-network until your total yearly out-of-pocket drug costs reach $4 700. | |
| You will not be reimbursed for the difference between the Out-of-Network Pharmacy charge and the plan's In-Network allowable amount. | |
| After your yearly out-of-pocket drug costs reach $4 700 you will be reimbursed for drugs purchased out-of-network up to the plan's cost of the drug minus your cost share which is the greater of: | |
| You will not be reimbursed for the difference between the Out-of-Network Pharmacy charge and the plan's In-Network allowable amount. | |
| Tier 6: Supplemental Drugs | |
| Dental Services | "In general preventive dental benefits (such as cleaning) not covered. However this plan covers preventive dental benefits for an extra cost (see ""Optional Benefits."")" |
| 0% of the cost for Medicare-covered dental benefits | |
| $0 copay for comprehensive dental benefits | |
| Hearing Services | In general supplemental routine hearing exams and hearing aids not covered. |
| $45 copay for hearing exams. | |
| Vision Services | "In general supplemental routine eye exams and eye wear not covered. However this plan covers some vision benefits for an extra cost (see ""Optional Benefits"")." |
| $0 copay for eye exams. | |
| $0 copay for eye wear. | |
| Over-the-Counter Items | The plan does not cover Over-the-Counter items. |
| Transportation | This plan does not cover supplemental routine transportation. |
| Acupuncture | This plan does not cover Acupuncture. |
| Premium and Other Important Information | Package: 1 - Preventive Dental Package: |
| Package: 2 - Comprehensive Dental and Vision Package: | |
| Package: 3 - Combination Package: | |
| $12 monthly premium in addition to your $0 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: | |
| $31 monthly premium in addition to your $0 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: | |
| $44 monthly premium in addition to your $0 monthly plan premium and the monthly Medicare Part B premium for the following optional benefits: | |
| Chiropractic Services | $20 copay for up to 10 supplemental routine visit(s) every year |
| $30 copay for chiropractic services | |
| Dental Services | |
| $0 copay for the following preventive dental benefits: | |
| 20% of the cost for preventive dental services | |
| 30% of the cost for preventive dental services | |
| 30% to 75% of the cost for comprehensive dental services | |
| $1 000 plan coverage limit for dental benefits every year. This limit applies to both in-network and out-of-network benefits. | |
| Contact the plan for availability of additional in-network and out-of-network comprehensive dental benefits. | |
| $500 plan coverage limit for preventive dental benefits every year. This limit applies to both in-network and out-of-network benefits. | |
| Vision Services | |
| $0 copay for: | |
| $0 copay for | |
| $0 copay for eye wear. | |
| $0 copay for eye exams. | |
| Premium and Other Important Information | In 2012 the monthly Part B Standard Premium is $99.90 and the annual Part B deductible amount is $140. |
| If a doctor or supplier does not accept assignment their costs are often higher which means you pay more. | |
| Most people will pay the standard monthly Part B premium. However some people will pay a higher premium because of their yearly income (over $85 000 for singles $170 000 for married couples). For more information about Part B premiums based on income call Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. You may also call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778. | |
| Doctor and Hospital Choice | You may go to any doctor specialist or hospital that accepts Medicare. |
| Inpatient Hospital Care | In 2012 the amounts for each benefit period are: Days 1 - 60: $1 156 deductible Days 61 - 90: $289 per day Days 91 - 150: $578 per lifetime reserve day |
| Call 1-800-MEDICARE (1-800-633-4227) for information about lifetime reserve days. | |
| Lifetime reserve days can only be used once. | |
| "A ""benefit period"" starts the day you go into a hospital or skilled nursing facility. It ends when you go for 60 days in a row without hospital or skilled nursing care. If you go into the hospital after one benefit period has ended a new benefit period begins. You must pay the inpatient hospital deductible for each benefit period. There is no limit to the number of benefit periods you can have." | |
| Inpatient Mental Health Care | In 2012 the amounts for each benefit period are: Days 1 - 60: $1 156 deductible Days 61 - 90: $289 per day Days 91 - 150: $578 per lifetime reserve day |
| You get up to 190 days of inpatient psychiatric hospital care in a lifetime. Inpatient psychiatric hospital services count toward the 190-day lifetime limitation only if certain conditions are met. This limitation does not apply to inpatient psychiatric services furnished in a general hospital. | |
| Skilled Nursing Facility (SNF) | In 2012 the amounts for each benefit period after at least a 3-day covered hospital stay are: Days 1 - 20: $0 per day Days 21 - 100: $144.50 per day |
| 100 days for each benefit period. | |
| "A ""benefit period"" starts the day you go into a hospital or SNF. It ends when you go for 60 days in a row without hospital or skilled nursing care. If you go into the hospital after one benefit period has ended a new benefit period begins. You must pay the inpatient hospital deductible for each benefit period. There is no limit to the number of benefit periods you can have." | |
| Home Health Care | $0 copay. |
| Hospice | You pay part of the cost for outpatient drugs and inpatient respite care. |
| You must get care from a Medicare-certified hospice. | |
| Doctor Office Visits | 20% coinsurance |
| Chiropractic Services | Supplemental routine care not covered |
| 20% coinsurance for manual manipulation of the spine to correct subluxation (a displacement or misalignment of a joint or body part) if you get it from a chiropractor or other qualified providers. | |
| Podiatry Services | Supplemental routine care not covered. |
| 20% coinsurance for medically necessary foot care including care for medical conditions affecting the lower limbs. | |
| Outpatient Mental Health Care | 40% coinsurance for most outpatient mental health services |
| Specified copayment for outpatient partial hospitalization program services furnished by a hospital or community mental health center (CMHC). Copay cannot exceed the Part A inpatient hospital deductible. | |
| """Partial hospitalization program"" is a structured program of active outpatient psychiatric treatment that is more intense than the care received in your doctor's or therapist's office and is an alternative to inpatient hospitalization." | |
| Outpatient Substance Abuse Care | 20% coinsurance |
| Outpatient Services/Surgery | 20% coinsurance for the doctor's services |
| Specified copayment for outpatient hospital facility services Copay cannot exceed the Part A inpatient hospital deductible. | |
| 20% coinsurance for ambulatory surgical center facility services | |
| Ambulance Services | 20% coinsurance |
| Emergency Care | 20% coinsurance for the doctor's services |
| Specified copayment for outpatient hospital facility emergency services. | |
| Emergency services copay cannot exceed Part A inpatient hospital deductible for each service provided by the hospital. | |
| You don't have to pay the emergency room copay if you are admitted to the hospital as an inpatient for the same condition within 3 days of the emergency room visit. | |
| Not covered outside the U.S. except under limited circumstances. | |
| Urgently Needed Care | 20% coinsurance or a set copay |
| NOT covered outside the U.S. except under limited circumstances. | |
| Outpatient Rehabilitation Services | 20% coinsurance |
| Durable Medical Equipment | 20% coinsurance |
| Prosthetic Devices | 20% coinsurance |
| Diabetes Programs and Supplies | 20% coinsurance for diabetes self-management training |
| 20% coinsurance for diabetes supplies | |
| 20% coinsurance for diabetic therapeutic shoes or inserts | |
| Diagnostic Tests X-Rays Lab Services and Radiology Services | 20% coinsurance for diagnostic tests and x-rays |
| $0 copay for Medicare-covered lab services | |
| Lab Services: Medicare covers medically necessary diagnostic lab services that are ordered by your treating doctor when they are provided by a Clinical Laboratory Improvement Amendments (CLIA) certified laboratory that participates in Medicare. Diagnostic lab services are done to help your doctor diagnose or rule out a suspected illness or condition. Medicare does not cover most supplemental routine screening tests like checking your cholesterol. | |
| Cardiac and Pulmonary Rehabilitation Services | 20% coinsurance Cardiac Rehabilitation services 20% coinsurance for Pulmonary Rehabilitation services 20% coinsurance for Intensive Cardiac Rehabilitation services |
| This applies to program services provided in a doctor+s office. Specified cost sharing for program services provided by hospital outpatient departments. | |
| Preventive Services and Wellness/Education Programs | No coinsurance copayment or deductible for the following: |
| Kidney Disease and Conditions | 20% coinsurance for renal dialysis |
| 20% coinsurance for kidney disease education services | |
| Outpatient Prescription Drugs | Most drugs are not covered under Original Medicare. You can add prescription drug coverage to Original Medicare by joining a Medicare Prescription Drug Plan or you can get all your Medicare coverage including prescription drug coverage by joining a Medicare Advantage Plan or a Medicare Cost Plan that offers prescription drug coverage. |
| Dental Services | Preventive dental services (such as cleaning) not covered. |
| Hearing Services | Supplemental routine hearing exams and hearing aids not covered. |
| 20% coinsurance for diagnostic hearing exams. | |
| Vision Services | 20% coinsurance for diagnosis and treatment of diseases and conditions of the eye. |
| Supplemental routine eye exams and glasses not covered. | |
| Medicare pays for one pair of eyeglasses or contact lenses after cataract surgery. | |
| Annual glaucoma screenings covered for people at risk. | |
| Over-the-Counter Items | Not covered. |
| Transportation | Not covered. |
| Acupuncture | Not covered. |
| Point of Service | You may go to any doctor specialist or hospital that accepts Medicare. |
Medicare Terms
- • Co-payment
- An amount you may be required to pay as your share of the cost for a medical service or supply, like a doctor's visit, hospital outpatient visit, or a prescription. A copayment is usually a set amount, rather than a percentage. For example, you might pay $10 or $20 for a doctor's visit or prescription.
- • Cost Plans
- A type of Medicare health plan available in some areas. In a Medicare Cost Plan, if you get services outside of the plan's network without a referral, your Medicare-covered services will be paid for under Original Medicare (your Cost Plan pays for emergency services, or urgently needed services).
- • Deductible
- The amount you must pay for health care or prescriptions before Original Medicare, your prescription drug plan, or your other insurance begins to pay.
- • HMO - Health Maintenance Organization
- Local HMOs are plans with defined networks of providers, which beneficiaries must use in order to receive coverage, serving specific geographic areas consisting of aggregations of counties.
- • HMO SNP - Special Needs Plan
- Medicare Special Needs Plans are a type of Medicare Advantage Plan (Part C) for people with certain chronic diseases and conditions or who have specialized needs (such as people who have both Medicare and Medicaid or people who live in certain institutions). Medicare SNPs provide their members with all Medicare Part A (Hospital Insurance), Medicare Part B (Medical Insurance) services, and Medicare prescription drug coverage (Part D). Medicare SNPs were created to give certain groups of people better access to Medicare with plans designed to meet their unique needs.
- • HMO with POS Option
- An HMO POS is a Medicare Advantage Plan that is a Health Maintenance Organization with a more flexible network allowing Plan Members to seek care outside of the traditional HMO network under certain situations or for certain treatment.
- • LPPO - Local Preferred Provider Organization
- Local PPOs are network based plans that serve specific geographic areas consisting of aggregations of counties, like HMOs, but with more flexibility in provider choice within the network. Beneficiaries may use providers outside the network but will pay more out of pocket cost.
Related Links
- Medicare.gov
The official U.S. Government site for Medicare - AARP
American Association of Retired Persons - HHS.gov
United States Department of Health & Human Services - CMS.gov
Centers for Medicare & Medicaid Services - Social Security Administration
The official website of the U.S. Social Security Administration
Help is available. If you have limited income and resources, you may qualify for help paying your Medicare health care and/or prescription drug coverage costs. For more information, visit socialsecurity.gov, call Social Security at 1-800-772-1213, or apply for help at your State Medical Assistance (Medicaid) office.
If you have questions about Medicare, visit medicare.gov or call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
