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Anthem MediBlue PPO

Medicare Advantage plans bundle all the benefits of Medicare Part A and Medicare Part B into one convenient plan. Plus, these plans often have extras, such as coverage for prescription drugs, vision, dental, and hearing aids.

A Medicare Advantage PPO plan is a Part C plan that works like a Preferred Provider Organization (PPO) plan. Anthem MediBlue PPO is a  Medicare Advantage plan that gives you the flexibility to work with any doctor or specialist, in or out of network, no referrals needed. If you choose to see a provider outside your plan, your costs may be higher.

Are all Medicare Advantage Plans PPOs?

A Medicare Advantage PPO plan is one type of Medicare Advantage plan. Keep reading to see if it's the right fit for you.

Plan de Medicare Advantage

A Medicare Advantage plan, also known as a Part C plan, conveniently bundles all the benefits of Parts A and B. Most plans also include Part D (Prescription Drug) coverage.

Planes PPO (Organización de Proveedores Preferidos)

When you choose a Preferred Provider Organization (PPO) plan, you choose a primary care physician (PCP) for check-ups. You don't need a referral if you need to see a specialist or want to see another doctor. You can see doctors who are out of network but you may pay more.

Medicare Advantage PPO Plans

A Medicare Advantage PPO is both a Medicare Advantage plan and a PPO. Anthem MediBlue PPO is one type of Medicare Advantage plan that combines the benefits of a Medicare Advantage plan with the choice of a PPO. You receive all the benefits of the Medicare Advantage plan and can choose from our complete network of doctors and facilities. If you prefer to see someone out of network, you may pay a bit more.

Can Anyone Enroll in a Medicare Advantage PPO?

If you are eligible for Medicare , you can choose a Medicare Advantage PPO. If you like the freedom to see specialists without a referral, you may want to choose a Medicare Advantage Plan that is a PPO. Also, if you don’t mind paying extra to see a doctor or health care provider who is out of network, a Medicare Advantage PPO might be a good fit.

What’s the Difference Between Medicare Advantage PPO Out-of-Network Providers and In-Network Providers?

Medicare Advantage PPO In-Network Providers

An Anthem MediBlue PPO plan will have a list of providers you can choose from. These doctors, health care professionals, and other health care facilities have agreed to work with us. These are considered in-network providers. 

The providers in our network bill us directly for your care. When you see a network provider, you pay a lower share of the cost.

Medicare Advantage PPO Out-of-Network Providers

Other doctors and health care providers who have not agreed to work with us are considered out of network. When you choose an Anthem MediBlue PPO plan you can choose to visit an out-of-network provider.

Your share of the cost for covered services may be higher when visiting a Medicare Advantage PPO out-of-network provider. You may pay additional deductibles, copays or coinsurance for services.

Other Types of Medicare Advantage Plans: HMOs and SNPs

The main difference between a Medicare Advantage PPO and a Medicare Advantage HMO is that with an HMO you can only see doctors or specialists who are in network. Also, when you want to see a specialist in an HMO, you must get a referral from your primary care physician (PCP), which you do not need in a PPO.

People with Medicare and Medicaid may enroll in a Medicare Advantage Special Needs Plan (SNP) plan. This plan specializes in the diseases of those enrolled. Members have access to a network of doctors specialized in their conditions and may receive other benefits such as home-delivered meals and transportation. 

What do MediBlue PPO Plans Cover?

Anthem MediBlue PPO plans bring your medical and prescription coverage together in a convenient plan where you may select from our robust network of doctors and care providers or choose to see another out-of-network provider and pay more. All Anthem MediBlue PPO plans include benefits similar to our Medicare Advantage HMO plans:

Many preventive services, such as regular check-ups, tests, shots and screenings, are included at no extra cost.
Original Medicare doesn't cover prescriptions and medications that most people need. Most Medicare Advantage plans include Part D coverage.
Some Medicare Advantage Plans (Part C) may include vision and/or dental benefits that Medicare doesn't cover. You may also add an optional supplemental benefit package for more coverage than what is included in a Medicare Advantage plan.
Some Medicare Advantage PPO plans cover routine hearing tests, hearing aid fittings, and hearing aids. Costs outside the network may be higher.
Some Medicare Advantage plans cover non-prescription over-the-counter (OTC) medicines and health-related items, such as pain relievers, cold medicine, and other first-aid care, at specific retailers.
As part of your Anthem MediBlue PPO plan, you may also have access to SilverSneakers®, a popular fitness program for adults age 65+.
Star Ratings measure Medicare Advantage plans on a number of categories including customer service and quality of care. Medicare evaluates plans and assigns stars based on a 5-star rating system. Las Calificaciones por estrellas se calculan cada año y pueden cambiar de un año al otro.

We make it easy to find and compare the details of Anthem MediBlue PPO plans available in your area.

What are the Costs of a Medicare Advantage PPO Plan?

Medicare Advantage plans can help you save money. Since you may decide to receive care in network or out of network with an Anthem MediBlue PPO, some costs, such as deductibles, coinsurance or copays, may vary within the plan.

Typical Costs of an Anthem MediBlue PPO

Monthly Costs

Monthly costs for Anthem MediBlue PPO may be higher since you may make more choices about your care.


Some plans have $0 deductibles for medical costs. Your deductibles for out-of-network costs may be higher.

Copays or Coinsurance

The amount of copays or coinsurance you pay when you visit a doctor or specialist varies whether they are in network or out of network.

You’ll pay the lowest cost when visiting in-network providers, but have the option to pay a little more when you want to see an out-of-network provider.

Is a Medicare Advantage PPO Plan Right for Me?

A Medicare Advantage PPO plan may be right for you if you agree with the following statements:

  • I want the freedom to choose doctors or facilities out-of-the network.
  • I would rather see a specialist on my own without getting a referral from a PCP.
  • My providers and facilities are participating in a number of different networks.
  • I don’t mind paying more sometimes if I want to see a doctor outside the network.
We have more information to help you understand the differences between Medicare Advantage PPOs and Medicare Advantage HMOs.

Comparar planes de Medicare Advantage

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Y0114_20_116987_U Aceptado por los CMS el 12/12/2019
Benefits, premiums, copays and plan may vary by county. Es posible que los planes de Medicare Advantage no estén disponibles en todos los condados.
Los planes Medicare Advantage y Medicare parte D son planes de salud con un contrato de Medicare o un plan de medicamentos recetados independiente con un contrato de Medicare. El contrato de Medicare se renueva una vez por año y la disponibilidad de la cobertura después del término del año actual no está garantizada.
Anthem Blue Cross and Blue Shield is the trade name of: In Colorado Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. En Nevada: Rocky Mountain Hospital y Medical Service, Inc. Los productos del plan HMO están suscritos por HMO Colorado, Inc., cuyo nombre comercial es HMO Nevada. En New Hampshire: Anthem Health Plans of New Hampshire, Inc. Los planes HMO están administrados por Anthem Health Plans of New Hampshire, Inc. y suscritos por Matthew Thornton Health Plan, Inc. En Ohio: Community Insurance Company. En Virginia: Anthem Health Plans of Virginia, Inc. opera comercialmente con el nombre Anthem Blue Cross and Blue Shield en Virginia, y su área de servicio abarca todo Virginia con excepción de Fairfax, Vienna y el área este de State Route 123. En Wisconsin: Blue Cross Blue Shield of Wisconsin (“BCBSWI”), que suscribe o administra las pólizas del plan PPO y las pólizas de indemnización, y suscribe los beneficios fuera de la red de las pólizas POS ofrecidas por Compcare o WCIC; Compcare Health Services Insurance Corporation (Compcare) suscribe o administra las pólizas HMO y Wisconsin Collaborative Insurance Company (WCIC) suscribe o administra las pólizas HMO o POS de Well Priority. Licenciatarios independientes de Blue Cross and Blue Shield Association. Anthem es una marca comercial registrada de Anthem Insurance Companies, Inc. Los nombres y los símbolos de Blue Cross and Blue Shield son marcas comerciales registradas de Blue Cross and Blue Shield Association. La utilización de los sitios web de Anthem constituye su aceptación de nuestros términos de uso.
El programa de bienestar físico SilverSneakers es ofrecido por Tivity Health, una compañía independiente. Tivity Health y SilverSneakers son marcas comerciales registradas o marcas comerciales de Tivity Health, Inc. y/o sus subsidiarias y/o afiliadas en Estados Unidos y/u otros países. © 2019 Tivity Health, Inc. Todos los derechos reservados.
Para Planes de Necesidades Especiales para Personas con Doble Elegibilidad: este plan está disponible para toda persona que tenga asistencia médica del estado y Medicare.
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