The major difference is that is now a Local PPO as opposed to a Regional
PPO, which means many people will lose their benefits. The plan used to cover the
entire state but now only a handful of counties will be
able to have access to Medicare Advantage PPO network. In addition. only
3 of the counties will continue to receive the "Zero Cost" option; Los
Angeles, San Diego and Ventura. All other counties will now have a
monthly premium for this plan ranging from $40-131/mo. For some this is
no problem but for many Medicare beneficiaries who are dependent upon
Social Security or on a fixed income, this raises huge issues.
Anthem Medicare Preferred has an included Part D plan with reasonable co-pays for a 30 day supply and even lower for 90 day mail-order. In addition, you will have access to Silver Sneakers, which allows a monthly gym or fitness center membership for free at participating locations. There is also optional Dental and Vision benefits for an additional premium of course.
Other
Medicare beneficiaries were not so lucky if they live in rural parts of
California. Many of the central counties in the state have very little
to no options for any Medicare Advantage plans. This means they will
have to either go back to Original Medicare and just carry a Part D
(prescription plan) or pay higher premiums for a Medicare Supplement
plan.
As for the Anthem Medicare Preferred
plan, it is expected to perform well in the available counties but has
no official rating from CMS (Center for Medicare Services) just yet. It
continues to offer the Anthem PPO network of Doctors and Hospitals, one
of the largest in the state. The plan has a $300 deductible which
applies towards Outpatient type services and does apply towards the
Maximum out-of-pocket expenses. The $3,400 maximum out of-pocket-expense
is the most you will have to spend in the calendar year, including
co-pays and deductibles, which is one of the lowest amounts compared to
most other Medicare Advantage plans.
So for those of you
seeking a low cost flexible plan that will allow you to keep your
physicians and not have to worry about asking for referrals, the Anthem
Medicare Advantage Standard PPO plan is a great value. Make sure you get
more information on specific co-pays for your county as they do differ
from one county to the next. Also be sure to complete the correct
application as those are also different and you need to use the
appropriate one per your county.
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