Anthem Medicare Preferred Standard PPO

This is the newest Medicare Advantage plan in California for 2012, offered by Anthem Blue Cross. It has replaced the very popular Anthem Freedom Blue, and is only available in select California counties.

You must be a resident in one of the following counties listed below to enroll in the plan, however, you may receive medical services in or out of the Anthem PPO network, as long as the provider accepts medicare.*

(*Higher copays may apply)

Anthem Preferred PPO available in these counties:

(click to view benefit summaries)

• San Diego, Los Angeles, &Ventura: $0
• Orange, San Francisco, & Sonoma: $40
• Riverside, San Bernardino, and San Mateo
• Alameda, Sacramento, Santa Clara and Stanislaus

Contact us for more information, or to see if you qualify!

Anthem Preferred PPO 2012 Plan Highlights

• Freedom to go in or out of network
• Annual out-of-pocket maximum protects you in the event of catastrophic medical costs (whether in or out of network)
• Drug plan included (no need to buy an additional Part D policy)
• Go directly to a specialist with no need for a referral
• Silver Sneakers gym membership
• PPO visitor/travel program gives you “in-network” benefits in 29 states and Puerto Rico!

Visit our site’s custom Agent Connect page with Anthem Blue Cross to get quotes and enroll instantly online!

Anthem Preferred PPO Benefits at a Glance for San Diego County

(LA & Ventura counties too!)

• $0 Premium
• $15 Doctor visit
• $35 Specialist visit
• $65 ER visit
• $0 Labs
• $65-$200 Diagnostic radiology (such as CT & MRI scans)
• $0-$250 per outpatient hospital facility visit
• $800 per inpatient hospital stay

*Above copays are for in-network only, and subject to an annual $300 deductible

FAQ Frequently Asked Questions

How do I know if I qualify, and when can I enroll?

If you are new to medicare, and have enrolled in Medicare Parts A and B, you may enroll in this plan in the 7 month period that begins three months before the month you turn 65. Your effective date would be the 1st day of your birthday month, or the 1st of the month following enrollment, in the 3 months following your birthday month.

If you are under 65 and enrolled in Medicare due to a disability, you can join this plan during the 3 months before, and the three months after your 25th month of disability.

You must reside in one of the designated counties above, to enroll in this plan.

If you are enrolled in Medicare, you should have a red, white, and blue Medicare card with your Medicare number, and the effective dates of both Medicare Parts A & B.

If you are outside of your Medicare Initial Election Period, you may join this plan during the Medicare Annual Election Period from October 15th – December 7th, 2012.  Please bookmark this page and check back during that time for possible updates to this plan for 2013.

What type of plan is Anthem Medicare Preferred Standard PPO?

Anthem Preferred PPO is a Medicare Advantage Plan. It is not a Medicare Supplement (aka “Medigap” plan).

Even though it is a PPO plan, it is still managed care.

According to Merriam-Webster’s Medical Dictionary, managed care is

a system of providing health care (as by an HMO or a PPO) that is designed to control costs through managed programs in which the physician accepts constraints on the amount charged for medical care and the patient is limited in the choice of a physician.

source

Unlike HMO Medicare Advantage options, Anthem Preferred PPO does not require a referral to see a specialist. Also, the Anthem Network of doctors and hospitals is located throughout the entire state of California. You may still receive care from out-of-network doctors for a higher copay/coinsurance amount, as long as the doctor accepts medicare and it is for a medicare covered service.

Annual out-of-pocket maximum

An annual out-of-pocket maximum, or limit, generally refers to a cap or cut-off point at which your out-of-pocket expenses for medical services is fulfilled within a calendar year. Once you reach this dollar amount in deductibles and copays, you may continue to receive medical benefits at no additional out-of-pocket expense to you for the remainder of that calendar year.

The Anthem Medicare Preferred Standard PPO Plan includes an annual out-of-pocket maximum of $3400 for Medicare covered medical expenses, and does not include any prescription costs. Prescription out-of-pocket costs under Medicare Part D are figured entirely separate from medical.

When you are enrolled in Original Medicare, Parts A & B, and not in an Advantage Plan or Medicare Supplement, there is no cap or limit to your annual out-of-pocket expenses.

Questions? Still not sure what plan is best for you?

Contact Us, Visit our Ask page, or comment below.

Enroll online through our custom Agent Connect page!

Benefits of working with a independent broker like Senior Insurance Services:

• Faster, personalized service at no extra cost to you
• Talk to the same person every time
• Receive a broader understanding of Medicare, because we take the time to educate you!

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