H3447 042

Sep 25, 2023 · H3447_047-000_MO_HMO D-SNP Medicare Advantage and Part D Plan year: January 1 – December 31, 2024 Missouri Cape Giradeau, Greene, Ste Genevieve, Ozark, other Missouri counties. Full service area on page 2, Summary of Benefits. Anthem Dual Advantage (HMO D-SNP) of Benefits 24MOH3447047 SNP_1. Anthem Dual …

Get 2023 Medicare Advantage Part C/Part D Health and Prescription plan benefit details for any plan in any state, including premiums, deductibles, Rx cost-sharing and health benefits/cost-sharing. Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk -- Powered by Q1Group LLCRoutine Hearing Exam: $0.00 copay for routine hearing exam (s). $0.00 copay for hearing aids up to the maximum plan benefit amount. This plan covers 1 routine hearing exam every year. $300.00 maximum plan benefit for over-the-counter hearing aids OR 1 routine hearing aid fitting evaluation and a $3,000.00 maximum plan benefit for prescribed ...Observation Services: $275.00 copay. Ambulatory Surgical Center: $225.00 copay. Outpatient substance abuse care. In-Network: Individual and Group Sessions: $35.00 copay. Over-the-counter items. This plan covers certain approved, non-prescription, over-the-counter drugs and health-related items, up to $70 every quarter.H3447_042-003_IN_HMO Medicare Advantage and Part D Plan year: January 1 - December 31, 2024 Indiana Boone, Brown, Hamilton, Hancock, Hendricks, Johnson, Madison, Marion, Montgomery, Morgan, Putnam, Shelby counties Anthem Medicare Advantage (HMO) of Benefits 3447423 O_2. Anthem Medicare Advantage (HMO) of BenefitsH1607-824. Anthem Senior Advantage (HMO) 2024. H3655-801. Anthem Senior Advantage (HMO) 2024. H3655-803. Discover Anthem Medicare Insurance Plans accepted at Oak Street Health centers and find primary care doctors accepting Anthem near you.

Anthem MediBlue Plus (HMO) is a Medicare Advantage (Part C) Plan by Anthem HealthKeepers. This page features plan details for 2022 Anthem MediBlue Plus (HMO) H3447 - 036 - 1 available in Select counties in Indiana. IMPORTANT: This page features the 2022 version of this plan. See the 2024 version using the link below:Get 2024 Medicare Advantage Part C/Part D Health and Prescription plan benefit details for any plan in any state, including premiums, deductibles, Rx cost-sharing and health benefits/cost-sharing. Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk -- Powered by Q1Group LLCIn-Network: Medicare Covered Hearing Exam: $0.00 copay. Routine Hearing Exam: $0.00 copay for routine hearing exam (s). $0.00 copay for hearing aids up to the maximum plan benefit amount. This plan covers 1 routine hearing exam every year. $300.00 maximum plan benefit for over-the-counter hearing aids OR 1 routine hearing aid fitting evaluation ...The Anthem MediBlue Full Dual Advantage (HMO D-SNP) (H3447 - 011) currently has 21,684 members. There are 672 members enrolled in this plan in Prince William, Virginia, and 21,510 members in Virginia. The Centers for Medicare and Medicaid Services (CMS) has given this plan carrier a summary rating of 3.5 stars.Get 2023 Medicare Advantage Part C/Part D Health and Prescription plan benefit details for any plan in any state, including premiums, deductibles, Rx cost-sharing and health benefits/cost-sharing. Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk -- Powered by Q1Group LLC

Get 2024 Medicare Advantage Part C/Part D Health and Prescription plan benefit details for any plan in any state, including premiums, deductibles, Rx cost-sharing and health benefits/cost-sharing. Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk -- Powered by Q1Group LLC23 hours ago · Anthem MediBlue Essential (HMO) is a Medicare Advantage (Part C) Plan by Anthem HealthKeepers. This page features plan details for 2023 Anthem MediBlue Essential (HMO) H3447 – 025 – 0 available in Select Counties in Virginia. IMPORTANT: This page features the 2023 version of this plan. See the 2024 version using the link below:The Anthem MediBlue Plus (HMO) (H3447-042-2) in Grant, IN: CMS MA Region 13 which includes: IN: Star Rating Category & Measures: 2023: 2022: Overall Star Rating: 4 : 3.5: Summary Rating of Prescription Drug Plan Quality: 3.5 : 4: Drug Plan Customer Service: 5: 5: Call Center — Foreign Language Interpreter and TTY Availability; 5 :Nov 7, 2023 · H3447_042-003_IN_HMO Medicare Advantage and Part D Plan year: January 1 – December 31, 2024 Indiana Boone, Brown, Hamilton, Hancock, Hendricks, Johnson, Madison, Marion, Montgomery, Morgan, Putnam, Shelby counties Anthem Medicare Advantage (HMO) of Benefits 3447423 O_22023 Anthem MediBlue Plus (HMO) - H3447-042-3 in IN Plan Benefits Details

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Get 2023 Medicare Advantage Part C/Part D Health and Prescription plan benefit details for any plan in any state, including premiums, deductibles, Rx cost-sharing and health benefits/cost-sharing. Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk -- Powered by Q1Group LLCIn-Network: Medicare Covered Hearing Exam: $0.00 copay. Routine Hearing Exam: $0.00 copay for routine hearing exam (s). $0.00 copay for hearing aids up to the maximum plan benefit amount. This plan covers 1 routine hearing exam every year. $300.00 maximum plan benefit for over-the-counter hearing aids OR 1 routine hearing aid fitting evaluation ...Skilled Nursing Facility (SNF) 1. Doctors and facilities in our plan: SNF Days 1 - 20: $0.00 per day / Days 21 - 100: $196.00 per day. Our plan covers up to 100 days in a Skilled Nursing Facility (SNF). Your copays for SNF benefits are based on benefit periods.After the total drug costs paid by you and the plan reach $5,030, up to the out-of-pocket threshold of $6,350. Prescription Drug Tier Name. Generic drugs. 25% coinsurance. Brand-name drugs. 25% ...The Medicare plans represented are PDP, HMO, PPO or PFFS plans with a Medicare contract. Enrollment in plans depends on contract renewal. We do not offer every plan available in yThe Medicare plans represented are PDP, HMO, PPO or PFFS plans with a Medicare contract. Enrollment in plans depends on contract renewal. We do not offer every plan available in y

Routine Hearing Exam: $0.00 copay for routine hearing exam (s). $0.00 copay for hearing aids up to the maximum plan benefit amount. This plan covers 1 routine hearing exam every year. $300.00 maximum plan benefit for over-the-counter hearing aids OR 1 routine hearing aid fitting evaluation and a $3,000.00 maximum plan benefit for prescribed ...Get 2024 Medicare Advantage Part C/Part D Health and Prescription plan benefit details for any plan in any state, including premiums, deductibles, Rx cost-sharing and health benefits/cost-sharing. Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk -- Powered by Q1Group LLCGet 2024 Medicare Advantage Part C/Part D Health and Prescription plan benefit details for any plan in any state, including premiums, deductibles, Rx cost-sharing and health benefits/cost-sharing. Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk -- Powered by Q1Group LLCH3447_042-003_IN_HMO Medicare Advantage and Part D Plan year: January 1 – December 31, 2024 Indiana Boone, Brown, Hamilton, Hancock, Hendricks, Johnson, Madison, Marion, Montgomery, Morgan, Putnam, Shelby counties Anthem Medicare Advantage (HMO) of Benefits 3447423 O_2Medicare Health Plan Details for Anthem Medicare Advantage (HMO). Learn more about the coverage and benefit details for this Medicare Advantage Health Insurance plan.2024 Anthem MediBlue Plus (HMO) - H3447-042-4 in IN Plan Benefits Details3.5 out of 5 stars* for plan year 2024. Anthem Dual Advantage (HMO D-SNP) is a HMO D-SNP Medicare Advantage (Medicare Part C) plan offered by Anthem HealthKeepers. Plan ID: H3447-030-000. * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $0.00 Monthly Premium.Shop for Plans. Find Medicare Plans. Learn About5 out of 5 stars* for plan year 2023. AARP Medicare Advantage (HMO-POS) is a HMO-POS Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare. Plan ID: H4590-042-000. * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $0.00 Monthly Premium.View the coverage and benefits provided in the Anthem Medicare Advantage (HMO) plan from Anthem Blue Cross and Blue Shield. Alight Retiree Health Solutions represents Medicare plans from 59 insurers nationwide.H3447_042-004_IN_HMO Medicare Advantage and Part D Plan year: January 1 – December 31, 2024 Indiana Bartholomew, Carroll, Clay, Greene, Harrison, other Indiana counties. Full service area on page 2, Summary of Benefits. Anthem Medicare Advantage (HMO) of Benefits 3447424 O_2Get 2023 Medicare Advantage Part C/Part D Health and Prescription plan benefit details for any plan in any state, including premiums, deductibles, Rx cost-sharing and health benefits/cost-sharing. Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk -- Powered by Q1Group LLC

Anthem Kidney Care (HMO C-SNP) Location: Halifax, Virginia Click to see other locations. Plan ID: H3447 - 033 - 0 Click to see other plans. Member Services: 1-844-395-1019 TTY users 711. Medicare Contact Information: Please go to Medicare.gov or call 1-800-MEDICARE (1-800-633-4227) to get information on all of your options.

2023 Anthem MediBlue Plus (HMO) - H3447-042-4 in IN Plan Benefits DetailsAnthem Dual Advantage (HMO D-SNP) is a HMO D-SNP Medicare Advantage (Medicare Part C) plan offered by Anthem Blue Cross and Blue Shield. Plan ID: H3447-047-000. * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $26.90 Monthly Premium.Get 2023 Medicare Advantage Part C/Part D Health and Prescription plan benefit details for any plan in any state, including premiums, deductibles, Rx cost-sharing and health benefits/cost-sharing. Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk -- Powered by Q1Group LLCH3447_047-000_MO_HMO D-SNP Medicare Advantage and Part D Plan year: January 1 - December 31, 2024 Missouri Cape Giradeau, Greene, Ste Genevieve, Ozark, other Missouri counties. Full service area on page 2, Summary of Benefits. Anthem Dual Advantage (HMO D-SNP) of Benefits 24MOH3447047 SNP_1. Anthem Dual Advantage (HMO D-SNP) of BenefitsObservation Services: $275.00 copay. Ambulatory Surgical Center: $225.00 copay. Outpatient substance abuse care. In-Network: Individual and Group Sessions: $35.00 copay. Over-the-counter items. This plan covers certain approved, non-prescription, over-the-counter drugs and health-related items, up to $70 every quarter.2023 Anthem MediBlue Plus (HMO) - H3447-042-4 in IN Plan Benefits DetailsHearing Benefits. In-Network: Medicare Covered Hearing Exam: $0.00 copay. Routine Hearing Exam: $0.00 copay for routine hearing exam (s). $0.00 copay for hearing aids up to the maximum plan benefit amount. This plan covers 1 routine hearing exam every year. $300.00 maximum plan benefit for over-the-counter hearing aids OR 1 routine hearing aid ...

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H3447:042-2 Anthem Medicare Advantage (HMO) H3447:042-3 Anthem Medicare Advantage (HMO) H3447:042-4 Anthem Medicare Advantage (HMO) H3536:002-0 Anthem Medicare Advantage (HMO) H3536:004-0 Anthem Medicare Advantage 2 (HMO) H3536:006-0 Anthem Select (HMO) H3655:034-0 Anthem Medicare Advantage 3 (HMO) H3655:041-0 Anthem Extra Help (HMO) H3655:042 ...Get ratings and reviews for the top 7 home warranty companies in Bellefontaine Neighbors, MO. Helping you find the best home warranty companies for the job. Expert Advice On Improv...Nuclear Submarines in the Cold War - Nuclear submarines in the Cold War, known as SSNs and SSBNs, served in special operations and patrol missions. Read about nuclear submarines i...2022 Medicare Advantage Plan Details. Medicare Plan Name: Anthem MediBlue Diabetes and Heart Care (HMO C-SNP) Location: Chesterfield, Virginia Click to see other locations. Plan ID: H3447 - 004 - 0 Click to see other plans. Member Services: 1 …Jan 1, 2018 · H3447_011-000_VA-HMO-SNP 1 Anthem MediBlue Dual Advantage (HMO SNP) What you should know about our plan Anthem MediBlue Dual Advantage (HMO SNP) is a Medicare Advantage and prescription drug plan. It includes hospital, medical and prescription drug benefits in one plan. To join this plan, you must:2023 Anthem MediBlue Plus (HMO) - H3447-042-4 in IN Plan Benefits Details2 days ago · H3447 - 039 - 0. (3.5 / 5) Anthem Grocery (HMO) is a Medicare Advantage (Part C) Plan by Anthem HealthKeepers. Premium: $0.00. Enroll Now. This page features plan details for 2024 Anthem Grocery (HMO) H3447 – 039 – 0 available in Select counties in Virginia. IMPORTANT: This page has been updated with plan and premium data for …H3447_042-001_IN_HMO Anthem MediBlue Plus (HMO) Anthem MediBlue Plus (HMO) Anthem MediBlue Plus (HMO) Our service area includes these counties in IN: Elkhart, Fulton ... ….

2024 Anthem MediBlue Plus (HMO) - H3447-042-4 in IN Plan Benefits DetailsH3447-020: Anthem MediBlue Extra (HMO) 2024: H3447-024: Anthem MediBlue Service (PPO) 2024: H7093-001: Anthem MediBlue Access (PPO) 2024: H7093-002: Anthem Medicare Advantage (HMO) 2024: H3447-042: Anthem Chronic Care (HMO C-SNP) 2024: H3447-043: Anthem Dual Advantage (HMO D-SNP) 2024: H3447-046: Anthem Full Dual Advantage Aligned (HMO D-SNP ...2023 Anthem MediBlue Plus (HMO) - H3447-042-4 in IN Plan Benefits Details2023 Anthem MediBlue Plus (HMO) - H3447-042-4 in IN Plan Benefits DetailsPlan ID: H3447-042-004 * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $0.00 Monthly Premium. Indiana Medicare beneficiaries may want to consider reviewing their Medicare Advantage (Medicare Part C) plan options. ...The Anthem MediBlue Plus (HMO) (H3447 - 038) currently has 30,854 members. There are 268 members enrolled in this plan in Shannon, Missouri, and 30,627 members in Missouri. The Centers for Medicare and Medicaid Services (CMS) has given this plan carrier a summary rating of 3.5 stars. The detail CMS plan carrier ratings are as follows:5 out of 5 stars* for plan year 2023. AARP Medicare Advantage (HMO-POS) is a HMO-POS Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare. Plan ID: H4590-042-000. * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $0.00 Monthly Premium.The table below outlines some of the specific plan details for Anthem Blue Cross and Blue Shield Medicare Advantage prescription drug plans available in Indiana in 2024. Plan Name. Plan Code. Monthly Premium. Deductible. Out of. Pocket Max. Prescription Drug Coverage. Medicare. H3447 042, Get 2024 Medicare Advantage Part C/Part D Health and Prescription plan benefit details for any plan in any state, including premiums, deductibles, Rx cost-sharing and health benefits/cost-sharing. Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk -- Powered by Q1Group LLC, Sep 25, 2023 · H3447_042-004_IN_HMO Medicare Advantage and Part D Plan year: January 1 – December 31, 2024 Indiana Bartholomew, Carroll, Clay, Greene, Harrison, other Indiana counties. Full service area on page 2, Summary of Benefits. Anthem Medicare Advantage (HMO) of Benefits 3447424 O_2, 2023 Anthem MediBlue Plus (HMO) - H3447-042-4 in IN Plan Benefits Details, Sep 25, 2023 · 1 Routine hearing services: This plan covers 1 routine hearing exam every year. $300.00 maximum plan benefit for over-the-counter hearing aids OR 1 routine hearing aid fitting evaluation and a $3,000.00 maximum …, The Anthem MediBlue Full Dual Advantage (HMO D-SNP) (H3447 - 011) currently has 21,684 members. There are 672 members enrolled in this plan in Prince William, Virginia, and 21,510 members in Virginia. The Centers for Medicare and Medicaid Services (CMS) has given this plan carrier a summary rating of 3.5 stars., Aug 23, 2023 · (H3447-042-2) $0 NA $0 $3,900 1-855-679-0538 TTY Users should call: 711 Anthem MediBlue Plus Boone, Brown, Hamilton, Hancock, Hendricks, Johnson, Madison, Marion, Montgomery, Morgan, Putnam, Shelby Anthem HealthKeepers -Local HMO (H3447-042-3) $0 NA $0 $3,900 1 -855 679 0538, After the total drug costs paid by you and the plan reach $5,030, up to the out-of-pocket threshold of $6,350. Prescription Drug Tier Name. Generic drugs. 25% coinsurance. Brand-name drugs. 25% ..., The Anthem MediBlue Plus (HMO)’s formulary is divided into 6 tiers. Every plan can name their tiers differently, and can place medications on any tier. The cost-sharing for this plan is divided as follows: Tier 1 ( Preferred Generic) contains 0 drugs and has a co-payment of $2.00. Tier 2 ( Generic) contains 0 drugs and has a co-payment of $9.00., Plan ID: H3447-042-003 * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $0.00 Monthly Premium. Indiana Medicare beneficiaries may want to consider reviewing their Medicare Advantage (Medicare Part C) plan options. ..., Get help from a licensed insurance agent. Call 1-877-354-4611 TTY 711. 8am - 11pm EST. 7 days a week, Plan ID: H3447-042-004 * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $0.00 Monthly Premium. Indiana Medicare beneficiaries may want to consider reviewing their Medicare Advantage (Medicare Part C) plan options. ..., Get 2023 Medicare Advantage Part C/Part D Health and Prescription plan benefit details for any plan in any state, including premiums, deductibles, Rx cost-sharing and health benefits/cost-sharing. Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk -- Powered by Q1Group LLC, Plan ID: H3447-042-001 * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $0.00 Monthly Premium. Indiana Medicare beneficiaries may want to consider reviewing their Medicare Advantage (Medicare Part C) plan options. ..., Get 2023 Medicare Advantage Part C/Part D Health and Prescription plan benefit details for any plan in any state, including premiums, deductibles, Rx cost-sharing and health benefits/cost-sharing. Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk -- Powered by Q1Group LLC, 2023 Anthem MediBlue Plus (HMO) - H3447-042-4 in IN Plan Benefits Details, This plan is a HMO Medicare Advantage plan offered by Anthem Blue Cross and Blue Shield in 2024. It covers various health care services and medical supplies, and has a monthly premium of $0.00 and a deductible of $0., H3447-020: Anthem MediBlue Extra (HMO) 2024: H3447-024: Anthem Medicare Preferred (PPO) 2024: H4036-805: Anthem MediBlue Service (PPO) 2024: H7093-001: Anthem MediBlue Access (PPO) ... H0271-042: UnitedHealthcare Chronic Complete Assure (PPO C-SNP) 2024: H0271-043: UnitedHealthcare Dual Complete Choice (PPO D-SNP) 2024:, Get 2024 Medicare Advantage Part C/Part D Health and Prescription plan benefit details for any plan in any state, including premiums, deductibles, Rx cost-sharing and health benefits/cost-sharing. Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk -- Powered by Q1Group LLC, TTY users 1-877-486-2048. or contact your local SHIP for assistance. Email a copy of the Anthem Full Dual Advantage Support (HMO D-SNP) benefit details. — Medicare Plan Features —. Monthly Premium: $0.00 for people who qualify for both Medicare and Medicaid. (see Plan Premium Details below) Annual Deductible: $0 for people who …, Routine Hearing Exam: $0.00 copay for routine hearing exam (s). $0.00 copay for hearing aids up to the maximum plan benefit amount. This plan covers 1 routine hearing exam every year. $300.00 maximum plan benefit for over-the-counter hearing aids OR 1 routine hearing aid fitting evaluation and a $3,000.00 maximum plan benefit for prescribed ..., 由于此网站的设置，我们无法提供该页面的具体描述。, Get 2023 Medicare Advantage Part C/Part D Health and Prescription plan benefit details for any plan in any state, including premiums, deductibles, Rx cost-sharing and health benefits/cost-sharing. Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk -- Powered by Q1Group LLC, Nov 7, 2023 · H3447_042-004_IN_HMO Medicare Advantage and Part D Plan year: January 1 – December 31, 2024 Indiana Bartholomew, Carroll, Clay, Greene, Harrison, other Indiana counties. Full service area on page 2, Summary of Benefits. Anthem Medicare Advantage (HMO) of Benefits 3447424 O_2, H3447-020: Anthem MediBlue Extra (HMO) 2024: H3447-024: Anthem MediBlue Service (PPO) 2024: H7093-001: Anthem MediBlue Access (PPO) 2024: H7093-002: Anthem Medicare Advantage (HMO) ... H0271-042: UnitedHealthcare Chronic Complete Assure (PPO C-SNP) 2024: H0271-043: UnitedHealthcare Dual Complete Choice (PPO D-SNP) 2024:, 2023 Anthem MediBlue Plus (HMO) - H3447-042-4 in IN Plan Benefits Details, 2023 Anthem MediBlue Plus (HMO) - H3447-042-4 in IN Plan Benefits Details, Routine hearing services:1. This plan covers 1 routine hearing exam(s) and hearing aid fitting/evaluation(s) every year. $3,000.00 maximum plan benefit for hearing aids every year. Doctors in our plan: $0.00 copay for routine hearing exam(s). $0.00 copay for hearing aids up to the maximum plan benefit amount., Get 2023 Medicare Advantage Part C/Part D Health and Prescription plan benefit details for any plan in any state, including premiums, deductibles, Rx cost-sharing and health benefits/cost-sharing. Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk -- Powered by Q1Group LLC, Sep 16, 2022 · Skilled Nursing Facility (SNF) 1. Doctors and facilities in our plan: SNF Days 1 - 20: $0.00 per day / Days 21 - 100: $196.00 per day. Our plan covers up to 100 days in a Skilled Nursing Facility (SNF). Your copays for SNF benefits are based on benefit periods., Plan ID: H3447-042-003 * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $0.00 Monthly Premium, 2023 Anthem MediBlue Plus (HMO) - H3447-042-2 in IN Plan Benefits Details, Gap Coverage Phase. After the total drug costs paid by you and the plan reach $5,030, up to the out-of-pocket threshold of $6,350. Prescription Drug Tier Name. Generic drugs. 25% coinsurance ..., In-Network: Days 1-5: $325.00 per day, per admission / Days 6-90: $0.00 per day, per admission. Additional Hospital Days: Unlimited additional days. Urgent care. Urgent Care: $50.00 copay. Emergency room visit. Emergency Care: $90.00 copay. Worldwide Coverage: This plan covers urgent care and emergency services when traveling outside of the ...