Anthem Mediblue Preferred (HMO)

Anthem MediBlue Preferred (HMO) is a no-premium Medicare Advantage plan that includes prescription drug coverage. It has an overall four-star rating from Medicare. Sold by Anthem, a subsidiary of Blue Cross Blue Shield, it is not available in every ZIP Code in the United States.

Terry Turner, writer and researcher for RetireGuide
  • Written by
    Terry Turner

    Terry Turner

    Senior Financial Writer and Financial Wellness Facilitator

    Terry Turner has more than 30 years of journalism experience, including covering benefits, spending and congressional action on federal programs such as Social Security and Medicare. He is a Certified Financial Wellness Facilitator through the National Wellness Institute and the Foundation for Financial Wellness and a member of the Association for Financial Counseling & Planning Education (AFCPE®).

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  • Edited By
    Lamia Chowdhury
    Lamia Chowdhury, editor for RetireGuide.com

    Lamia Chowdhury

    Financial Editor

    Lamia Chowdhury is a financial content editor for RetireGuide and has over three years of marketing experience in the finance industry. She has written copy for both digital and print pieces ranging from blogs, radio scripts and search ads to billboards, brochures, mailers and more.

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  • Published: September 9, 2022
  • Updated: September 15, 2022
  • 6 min read time
  • This page features 4 Cited Research Articles
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How to Cite RetireGuide.com's Article

APA Turner, T. (2022, September 15). Anthem Mediblue Preferred (HMO). RetireGuide.com. Retrieved September 30, 2022, from https://www.retireguide.com/medicare/medicare-advantage-plans/compare/h3655-045/

MLA Turner, Terry. "Anthem Mediblue Preferred (HMO)." RetireGuide.com, 15 Sep 2022, https://www.retireguide.com/medicare/medicare-advantage-plans/compare/h3655-045/.

Chicago Turner, Terry. "Anthem Mediblue Preferred (HMO)." RetireGuide.com. Last modified September 15, 2022. https://www.retireguide.com/medicare/medicare-advantage-plans/compare/h3655-045/.

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Anthem MediBlue Preferred (HMO) CMS Star Ratings

Anthem MediBlue Preferred (HMO) received an overall four-star rating — out of a possible five stars — from the U.S. Centers for Medicare & Medicaid Services in 2022.

2022 Overall Rating - 4 Stars

CMS rates Medicare Advantage plans based on several factors for both the plans health coverage and prescription drug coverage. One star represents poor performance while five stars represents excellent performance.

Star ratings are just one of the ways you should compare Medicare Advantage plans when reviewing your coverage.

Anthem MediBlue Preferred (HMO) Health Plan Rating

The Anthem MediBlue Preferred (HMO) health plan received 4½ stars out of a possible five.

Health Plan Rating - 4 and a Half Stars

Beneficiaries rated the health plan based on 33 different criteria. It received its highest marks — five stars — for 14 of the criteria used.

Five-Star Ratings for Anthem MediBlue Preferred (HMO) Health Plan
  • Annual pain screening and management
  • Availability of TTY services and foreign language interpreters
  • Customer service
  • Diabetes eye exams
  • Ease of getting needed care and seeing specialists
  • Getting appointments and care quickly
  • Keeping members’ medications up to date after hospital release
  • Low number of complaints
  • Low number of people switching from the plan
  • Members’ rating of health care quality
  • Plan members with diabetes under control
  • Plan’s fairness in appeals decisions
  • Yearly reviews of all medications and supplements
  • Yearly flu vaccine

The plan did not receive any one-star ratings. It received its lowest ratings — two stars — in five criteria.

Two-Star Ratings for Anthem MediBlue Preferred (HMO) Health Plan
  • Improvement in the plan’s performance
  • Improving bladder control
  • Monitoring physical activity
  • Osteoporosis management in women who have had fractures
  • Reducing the risk of falling

Anthem MediBlue Preferred (HMO) Drug Plan

The Anthem MediBlue Preferred (HMO) prescription drug plan received 4 stars out of a possible five.

Prescription Drug Plan Rating - 4 Stars

The drug plan rating is based on 16 criteria.

The Anthem MediBlue Preferred (HMO) prescription drug plan received five-star ratings on six criteria.

Five-Star Ratings for Anthem MediBlue Preferred (HMO) Prescription Drug Plan
  • Availability of TTY and foreign language interpreters
  • Customer service
  • Improvement in the plan’s performance
  • Low number of complaints about the plan in general
  • Low number of member complaints and changes to the plan’s performance
  • Low number of members choosing to leave the plan

There were no one-star ratings for any criteria used in rating the drug plan. Its lowest ratings — two stars — consisted of just two items: accuracy in drug pricing information for Medicare’s Plan Finder website and members’ rating of the drug plan.

Costs and Coverage

Anthem MediBlue Preferred (HMO) is a no-premium Medicare Advantage plan. That means you pay no monthly premium for it. However, you are still responsible for the monthly Medicare Part B premium — $170.10 in 2022.

Medicare Advantage plans are not available in all counties in the United States. You should check with your plan administrator to determine if the Anthem MediBlue Preferred (HMO) plan is available where you live.

As a Medicare Advantage plan, it is required to cover everything Original Medicare — Medicare Part A and Part B — but it may also include other benefits. Anthem MediBlue Preferred (HMO) also includes a Medicare Part D prescription drug plan.

Example of Basic In-Network Costs for Anthem MediBlue Preferred (HMO), 2022
SERVICEIN-NETWORK
Deductible$0
Monthly Premiums$0
Drug Plan Deductible$0
Prescription PremiumsIncluded in plan
Maximum Out-of-Pocket (in-network)$4,200
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Health Care Services and Durable Medical Equipment (DME) Coverage

Anthem MediBlue Preferred (HMO) has a network of hospitals, doctors, durable medical equipment suppliers and other health care providers who accept its coverage. Using providers in this network means lower out-of-pocket costs for plan members.

Going to a provider out-of-network may require you to pay significantly more for the provider’s services. Check with your plan’s administrator to understand exactly what your costs will be.

Examples of Services and DME Coverage
BENEFITOUT-OF-POCKET COSTS IN-NETWORK
Ambulance servicesGround ambulance: $260 per trip Air ambulance: 20% coinsurance
Ambulatory surgical center$240 copay
Chiropractic services (Medicare covered chiropractic services only)$20 copay
Diabetes supplies$0 copay
Diagnostic tests, lab & radiology, and X-RaysDiagnostic radiological services: $130 – $250 copay Therapeutic radiological services: 20% coinsurance Lab services: $0 – $10 copay X-rays: $50 – $110 copay
Primary doctor visit$0 – $5 copay
Specialist visits$35 copay
Durable medical equipment20% coinsurance
Emergency room visit$90 copay*
Urgent care visit$30 copay
Inpatient hospital careDays 1–7: $310 per day, per admission Days 8–90: $0 per day, per admission Additional days hospitalized: Unlimited additional days
Transportation (non-ambulance)$0 copay
*This plan provides worldwide emergency and urgent care coverage if you are traveling outside the United States for six months or less. The benefit is limited to $100,000 per year.

Dental, Vision and Hearing Benefits

While Original Medicare does not cover routine dental, vision and hearing services, the Anthem MediBlue Preferred (HMO) does cover some of these services.

Examples of Services and DME Coverage*
BENEFITOUT-OF-POCKET COSTS IN-NETWORK
Preventive dental services $0 copay (includes two oral exams, two cleanings, one dental X-ray and one fluoride treatment every year) Medicare-covered dental services: $0 copay
Comprehensive dental services50% coinsurance for extraction and restorative services, 70% coinsurance for endodontics, periodontics, crowns and denture services — up to $1,000 each year
Vision servicesMedicare covered eye exam: $0 – $35 copay Medicare covered eyewear: $0 copay Routine eye exam: $0 copay (one per year) Routine eyewear: $0 copay Up to $200 for eyeglasses or contact lenses each year
Hearing ServicesMedicare covered hearing exam: $35 copay Routine hearing exam: $0 copay (one exam and fitting/evaluation per year) Hearing aids: $0 copay up to the maximum plan benefit amount of $3,000 per year

Prescription Drug Costs and Coverage

The Anthem MediBlue Preferred (HMO) plan includes a Medicare Part D prescription drug plan. You have to use in-network pharmacies to get the full coverage and lowest costs. Using an out-of-network pharmacy may result in higher out-of-pocket costs for you.

You should also check the plans formulary — or list of covered drugs — to see if prescription medications you take are covered by the plan.

Copays by Tier, Supply and In-Network Pharmacies, 2022
Tier1 Month Preferred Retail 3 Month Preferred Retail1 Month Standard Retail3 Month Standard Retail1 Month Standard Mail Order 3 Month Standard Mail Order
Tier 1 Preferred Generic$4$12$9$27$0$0
Tier 2 Generic$10$30$15$45$0$0
Tier 3 Preferred Brand Name$42$126$47$141$42$84
Tier 4 Non- Preferred Brand Name$95$285$100$300$95$190
Tier 5 Specialty Drugs33%N/A33%N/A33%N/A
Tier 6 Select Care Drugs $0$0$0$0$0$0

In addition, this plan covers certain over-the-counter (non-prescription) drugs. There is a limit of $65 every three months — but unused benefits do not roll over into the next quarter or the next calendar year.

After you pay your deductible for the year, you have a prescription benefit up to $4,430 per year. You then move into gap coverage — until your total out-of-pocket costs reach $6,350. During this gap, you will pay 25% for generic and brand name drugs.

Once you hit the $6,350 threshold, catastrophic coverage kicks in. At this point, you will pay $3.95 or 5% — whichever is greater — for generics. You will also pay $9.85 or 5% — whichever is greater — for brand name drugs.

Last Modified: September 15, 2022

4 Cited Research Articles

  1. U.S. Centers for Medicare & Medicaid Services. (2022, April 29). CY 2023 Medicare Advantage and Part D Final Rule (CMS-4192-F). Retrieved from https://www.cms.gov/newsroom/fact-sheets/cy-2023-medicare-advantage-and-part-d-final-rule-cms-4192-f
  2. U.S. Centers for Medicare & Medicaid Services. (n.d.). Medicare Costs at a Glance. Retrieved from https://www.medicare.gov/your-medicare-costs/medicare-costs-at-a-glance
  3. U.S. Centers for Medicare & Medicaid Services. (n.d.). Your Medicare Costs. Retrieved from https://www.medicare.gov/your-medicare-costs
  4. U.S. Centers for Medicare & Medicaid Services. (n.d.). 2022 Medicare Costs. Retrieved from https://www.medicare.gov/Pubs/pdf/11579-medicare-costs.pdf