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.
- Written by 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®).Read More
- Edited BySavannah Hanson
Senior Financial Editor
Savannah Hanson is a professional writer and content editor with over 16 years of professional experience across multiple industries. She has ghostwritten for entrepreneurs and industry leaders and been published in mediums such as The Huffington Post, Southern Living and Interior Appeal Magazine.Read More
- Reviewed ByAflak Chowdhury
Aflak Chowdhury is a Medicare expert and independent insurance broker specializing in group health insurance. He has worked for major providers including Humana and Principal Financial Group and today works mainly in the small group market.Read More
- Published: September 9, 2022
- Updated: January 17, 2023
- 6 min read time
- This page features 5 Cited Research Articles
- Edited By
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.
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.
Beneficiaries rated the health plan based on 33 different criteria. It received its highest marks — five stars — for 14 of the criteria used.
- 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.
- 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.
The drug plan rating is based on 16 criteria.
The Anthem MediBlue Preferred (HMO) prescription drug plan received five-star ratings on six criteria.
- 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 — $164.90 in 2023.
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.
|Drug Plan Deductible||$0|
|Prescription Premiums||Included in plan|
|Maximum Out-of-Pocket (in-network)||$4,200|
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.
|BENEFIT||OUT-OF-POCKET COSTS IN-NETWORK|
|Ambulance services||Ground 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-Rays||Diagnostic 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 equipment||20% coinsurance|
|Emergency room visit||$90 copay*|
|Urgent care visit||$30 copay|
|Inpatient hospital care||Days 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|
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.
|BENEFIT||OUT-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 services||50% coinsurance for extraction and restorative services, 70% coinsurance for endodontics, periodontics, crowns and denture services — up to $1,000 each year|
|Vision services||Medicare 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 Services||Medicare 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.
|Tier||1 Month Preferred Retail||3 Month Preferred Retail||1 Month Standard Retail||3 Month Standard Retail||1 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 Drugs||33%||N/A||33%||N/A||33%||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.
5 Cited Research Articles
- U.S. Centers for Medicare & Medicaid Services. (2022, September 27). 2023 Medicare Parts A and B Premiums and Deductibles 2023 Medicare Part D Income-Related Monthly Adjustment Amounts. Retrieved from https://www.cms.gov/newsroom/fact-sheets/2023-medicare-parts-b-premiums-and-deductibles-2023-medicare-part-d-income-related-monthly
- 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
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Medicare Costs at a Glance. Retrieved from https://www.medicare.gov/basics/costs/medicare-costs
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Your Medicare Costs. Retrieved from https://www.medicare.gov/basics/costs
- U.S. Centers for Medicare & Medicaid Services. (n.d.). 2022 Medicare Costs. Retrieved from https://www.medicare.gov/Pubs/pdf/11579-medicare-costs.pdf
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