Plan details for Anthem MediBlue ESRD Care (PPO C-SNP), a 2021 Medicare Advantage Plan. Medicare Policy Helper. Urgent care-$25 copay per visit (always covered). Don’t forget about Anthem’s smart tools designed to help employees make the most of their group health benefits. It’s easy to find a doctor, access your virtual ID card, or get plan information, claims data, and other info with the Anthem Anywhere mobile app. Click below to explore the details on any of the Anthem plans available through.
Anthem MediBlue Care On Site (HMO I-SNP) is a 2020 Medicare Advantage Special Needs Plan plan by Anthem Blue Cross. This plan from Anthem Blue Cross works with Medicare to give you significant coverage beyond original Medicare. If you decide to sign up you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Anthem Blue Cross and not Original Medicare. All Medicare SNPs also provide Medicare additional Part-D drug coverage. Anthem MediBlue Care On Site (HMO I-SNP) EA-H0544 is an Institutional SNP (I-SNP). An Institutional SNP is for beneficiaries who live in an institution such as a nursinghome or require nursing care at home. If you live in an institution like a nursing home or hospital you can join any Medicare SNP you qualify for or switch plans at any time.
2020 Medicare Special Needs Plan Details
| Plan Name: | |
|---|---|
| Plan ID: | EA-H0544 |
| Special Needs Type: | Institutional |
| Provider: | Anthem Blue Cross |
| Plan Year: | 2020 |
| Plan Type: | Local HMO |
| Monthly Premium C+D: | $- |
The Anthem MediBlue Care On Site (HMO I-SNP) EA-H0544 is available to residents in California, and all Medicare SNPs must provide Medicare additional prescription drug (Part-D) coverage. Anthem MediBlue Care On Site (HMO I-SNP) is a Local HMO. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your PCP will serve as your personal doctor to provide all of your basic healthcare services. If you need special care for a physician specialist, your primary care physician will make the arrangements and tell you where you can go in the network. You will need your PCPs okay, called a referral. Without getting a referral or services received from out-of-network providers are not typically covered by the plan.
Part-C Premium
Anthem Blue Cross plan charges a $0.00 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.
Part-D Deductible and Premium
The Anthem MediBlue Care On Site (HMO I-SNP) plan has a monthly drug premium of -$6.20 and a $0.00 drug deductible. This Anthem Blue Cross plan offers a -$6.20 Part D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $6.20 this Premium covers any enhanced plan benefits offered by Anthem Blue Cross above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $0.00. The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lower due to negative basic or supplemental premiums.
Premium Assistance
Depending on your income level you may be eligible for full 75%, 50%, 25% premium assistance. The Anthem MediBlue Care On Site (HMO I-SNP) medicare insurance plan offers a $0.00 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $0.00 for 75% low income subsidy $0.00 for 50% and $0.00 for 25%.
| Part C Premium: | $0.00 |
|---|---|
| Part D (Drug) Premium: | -$6.20 |
| Part D Supplemental Premium | $6.20 |
| Total Part D Premium: | $0.00 |
| Drug Deductible: | $0.00 |
| Tiers with No Deductible: | 0 |
| Benchmark: | not below the regional benchmark |
| Type of Medicare Health Plan: | Enhanced Alternative |
| Drug Benefit Type: | Enhanced |
| Full LIS Premium: | $0.00 |
| 75% LIS Premium: | $0.00 |
| 50% LIS Premium: | $0.00 |
| 25% LIS Premium: | $0.00 |
| Gap Coverage: | Yes |
Gap Coverage
In 2020 once you and your plan provider have spent $4020 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA 'donut hole') You will be required to pay 25% for brand-name drugs and 25% on generic drugs unless your plan offers additional coverage. This Anthem Blue Cross plan does offer additional coverage through the gap.
Anthem Blue Cross Drug Coverage and Formulary
A formulary is divided into tiers or levels of coverage based on the type or usage of your medication or benefit categories, according to drug costs. Each tier will have a defined out-of-pocket cost that you must pay before receiving the drug. You can see complete 2020 Anthem MediBlue Care On Site (HMO I-SNP) H0544-050 Formulary here.
See the 2020 Anthem Blue Cross Formulary
(*2020 Plan services will be added when available)
Health plan deductible
| $0 |
|---|
Emergency care/Urgent care
| Emergency | $100 per visit (always covered) |
|---|---|
| Urgent care | $0 copay |
Diagnostic procedures/lab services/imaging
| Diagnostic tests and procedures | $0 copay |
|---|---|
| Lab services | $0 copay |
| Diagnostic radiology services (e.g., MRI) | $0-150 |
| Outpatient x-rays | $0 |
Hearing
| Hearing exam | $0 copay |
|---|---|
| Fitting/evaluation | $0 copay |
| Hearing aids | $0 copay |
Preventive dental
| Oral exam | $0 copay |
|---|---|
| Cleaning | $0 copay |
| Fluoride treatment | Not covered |
| Dental x-ray(s) | $0 copay |
Comprehensive dental
| Non-routine services | $0 copay |
|---|---|
| Diagnostic services | $0 copay |
| Restorative services | $0 copay |
| Endodontics | $0 copay |
| Periodontics | $0 copay |
| Extractions | $0 copay |
| Prosthodontics, other oral/maxillofacial surgery, other services | $0 copay |
Vision
| Routine eye exam | $0 copay |
|---|---|
| Other | Not covered |
| Contact lenses | $0 copay |
| Eyeglasses (frames and lenses) | Not covered |
| Eyeglass frames | $0 copay |
| Eyeglass lenses | $20 |
| Upgrades | Not covered |
Mental health services
| Inpatient hospital - psychiatric | $125 per day for days 1 through 5 $0 per day for days 6 through 90 $0 per day for days 91 |
|---|---|
| Outpatient group therapy visit with a psychiatrist | $0 copay |
| Outpatient individual therapy visit with a psychiatrist | $0 copay |
| Outpatient group therapy visit | $0 copay |
| Outpatient individual therapy visit | $0 copay |
Skilled Nursing Facility
| $0 copay per stay |
|---|
Rehabilitation services
Anthem Bcbs Urgent Care Copay
| Occupational therapy visit | $0 copay |
|---|---|
| Physical therapy and speech and language therapy visit | $0 copay |
Ground ambulance
| $195 |
|---|
Other health plan deductibles?
| In-Network | No |
|---|
Transportation
| Not covered |
|---|
Foot care (podiatry services)
| Foot exams and treatment | $0 copay |
|---|---|
| Routine foot care | $0 copay |
Medical equipment/supplies
Urgent Care Anthem Az
| Durable medical equipment (e.g., wheelchairs, oxygen) | 0-20% per item |
|---|---|
| Prosthetics (e.g., braces, artificial limbs) | 0-20% per item |
| Diabetes supplies | $0 copay |
Wellness programs (e.g., fitness, nursing hotline)
| Covered |
|---|
Medicare Part B drugs
| Chemotherapy | 20% |
|---|---|
| Other Part B drugs | 0-20% |
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)
| $3,000 In-network |
|---|
Optional supplemental benefits
| Yes |
|---|
Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?
| In-Network | No |
|---|
Inpatient hospital coverage
| $125 per day for days 1 through 5 $0 per day for days 6 through 90 $0 per day for days 91 |
|---|
Outpatient hospital coverage
| $125 per visit |
|---|
Doctor visits
| Primary | $0 copay |
|---|---|
| Specialist | $0 copay |
Preventive care
| $0 copay |
|---|
Ratings for Anthem MediBlue Care On Site (HMO I-SNP) EA
| 2019 Overall Rating |
|---|
| Part C Summary Rating |
| Part D Summary Rating |
| Staying Healthy: Screenings, Tests, Vaccines |
| Managing Chronic (Long Term) Conditions |
| Member Experience with Health Plan |
| Complaints and Changes in Plans Performance |
| Health Plan Customer Service |
| Drug Plan Customer Service |
| Complaints and Changes in the Drug Plan |
| Member Experience with the Drug Plan |
| Drug Safety and Accuracy of Drug Pricing |
Staying Healthy, Screening, Testing, & Vaccines
| Total Preventative Rating |
|---|
| Breast Cancer Screening |
| Colorectal Cancer Screening |
| Annual Flu Vaccine |
| Improving Physical |
| Improving Mental Health |
| Monitoring Physical Activity |
| Adult BMI Assessment |
Anthem Urgent Care Centers
Managing Chronic And Long Term Care for Older Adults
| Total Rating |
|---|
| SNP Care Management |
| Medication Review |
| Functional Status Assessment |
| Pain Screening |
| Osteoporosis Management |
| Diabetes Care - Eye Exam |
| Diabetes Care - Kidney Disease |
| Diabetes Care - Blood Sugar |
| Rheumatoid Arthritis |
| Reducing Risk of Falling |
| Improving Bladder Control |
| Medication Reconciliation |
| Plan All-Cause Readmissions |
| Statin Therapy |
Member Experience with Health Plan
| Total Experience Rating |
|---|
| Getting Needed Care |
| Timely Care and Appointments |
| Customer Service |
| Health Care Quality |
| Rating of Health Plan |
| Care Coordination |
Member Complaints and Changes in Anthem MediBlue Care On Site (HMO I-SNP) Plans Performance
| Total Rating |
|---|
| Complaints about Health Plan |
| Members Leaving the Plan |
| Health Plan Quality Improvement |
Health Plan Customer Service Rating for Anthem MediBlue Care On Site (HMO I-SNP)
| Total Customer Service Rating |
|---|
| Timely Decisions About Appeals |
| Reviewing Appeals Decisions |
| Call Center, TTY, Foreign Language |
Anthem MediBlue Care On Site (HMO I-SNP) Drug Plan Customer Service ratings
| Total Rating |
|---|
| Call Center, TTY, Foreign Language |
| Appeals Auto |
| Appeals Upheld |
Ratings For Member Complaints and Changes in the Drug Plans Performance
| Total Rating |
|---|
| Complaints about the Drug Plan |
| Members Choosing to Leave the Plan |
| Drug Plan Quality Improvement |
Member Experience with the Drug Plan
| Total Rating |
|---|
| Rating of Drug Plan |
| Getting Needed Prescription Drugs |
Drug Safety and Accuracy of Drug Pricing
| Total Rating |
|---|
| MPF Price Accuracy |
| Drug Adherence for Diabetes Medications |
| Drug Adherence for Hypertension (RAS antagonists) |
| Drug Adherence for Cholesterol (Statins) |
| MTM Program Completion Rate for CMR |
| Statin with Diabetes |
Coverage Area for Anthem MediBlue Care On Site (HMO I-SNP)
Source: CMS.
Plans as of September 4, 2019.
Star Rating as of October 11, 2019.
Plan Services are 2019 information as reference. 2020 information will be added when released.
Notes: Data are subject to change. All contracts for 2020 have not been finalized. For 2020, enhanced alternative plans may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part Part D benefit.
Includes 2020 approved contracts/plans. Employer sponsored 800 series plans and plans under sanction are excluded.
When The Ashe Center is closed, you still have access to care -- both online, and in the local community using your UCSHIP benefits. Our 24/7 Nurseline is available After Hours, LiveHealth Online offers telemedicine visits online, and The Ashe Center keeps a list of local urgent care centers updated for your convenience.
We realize that getting sick is not always predictable. In the event that you need to seek medical care when The Ashe Center is closed, remember that all currently registered UCLA students have access to various alternatives for urgent access to medical care, including: 24/7 Nurseline, telemedicine visits through LiveHealth Online, local urgent care centers, and in the case of an actual emergency, emergency room access.
24/7 After Hours Nurseline
All currently registered UCLA students have access to advice & information from a registered nurse through the After Hours NurseLine at (310) 825-4073. For more information, visit the NurseLine section of our website.
Weekend Telehealth Visits (NEW!)
Ashe Center primary care providers are now available for weekend telehealth video visits during the COVID-19 emergency. While social distancing and other measures to prevent infection are of the utmost importance, it's equally important to stay healthy and keep any pre-existing medical conditions under control. Instead of coming to see providers in person for an exam, consultation, or follow-up appointment, you can connect with your PCP using a HIPAA-compliant version of Zoom on your mobile device, tablet or computer. The information is securely transmitted and is treated the same way it would be if you were meeting with your provider in person. To schedule, log into the Patient Portal and select Weekend Telehealth Visit. Telehealth appointments available 9am-4pm on Saturday and Sunday.
Accessing Urgent Care Centers
In-network (Anthem Blue Cross) urgent care visits have a $25 co-payment.
Note: If you go to a non-participating Anthem Blue Cross urgent care center, deductible will be applied and the claim will be covered at 60 percent of the maximum allowed amount. You may be held liable for any amount over the maximum allowed amount.
Uber Ride Vouchers for In-person Weekend Care
The Ashe Center is pleased to work with Uber to assist students with urgent needs when our center is closed. Click an entry below for the requested date and Uber will email you a unique ride voucher to travel from The Ashe Center to UCLA Health Century City. Vouchers are available for each weekend clinic date of the quarter and will be audited to ensure proper use.
Vouchers for Spring 2020 Now Available
Upcoming Events
No upcoming events.
In Case of Emergency
Emergency room visits at participating Anthem in-network facilities have a co-payment of $125. If you are admitted, this co-payment will be waived and you will be charged the hospitalization co-insurance rate. Please visit the Plan Highlights for additional breakdown of these fees.
Additionally, the UCLA Emergency Room can be reached directly at (310) 825-2111. Remember that it is important to follow up with your Ashe Center Primary Care Provider (PCP) at least 24-48 hours after being seen in an urgent care facility to ensure continuity of care.
Mental Health Concerns
For mental health-related concerns when the Counseling & Psychological Services (CAPS) is closed, you may speak with a CAPS Crisis Clinician by calling (310) 825-0768.
Urgent Care Centers within 10 Miles of UCLA
For an up-to-date list of urgent care centers within the UCLA area, please download the PDF guide here.
Note:The Ashe Center does not promote or endorse any outside provider/facility. We also cannot confirm urgent care holiday hours. We offer this instructional information as courtesy to you. If the Urgent Care Center is closed, you can also seek medical emergency care at the Ronald Reagan Westwood or Santa Monica UCLA Medical Centers. Refer to the insurance page for a summary of urgent care plan benefits.
Emergency Room Vs. Urgent Care
A trip to the emergency Room can be costly and time-consuming.
Unless you have a life-threatening condition, it is best to go to an Urgent Care center near you.
Here is the difference between the two:
Does Urgent Care Charge A Copay
Emergency Room
- High Fever
- Difficulty Breathing
- Poisoning
- Broken Bones
- Uncontrolled Bleeding
Emergency Room wait time for non-life threatening conditions is about 2-6 hours
$125 COPAY
UCSHIP @ Ronald Reagan & Santa Monica ER
Urgent Care
- Cold/Flu
- Sore Throat
- Nausea
- Eye/Ear Infection
- Minor Cuts/Burns
Urgent Care wait time for non-life threatening conditions is about 15 Minutes
$25 COPAY
UCSHIP @ In-Network Urgent Care
Local Emergency Rooms
Ronald Reagan ER (0.9 miles away)
757 Westwood Plaza
Los Angeles, CA 90095
Mon-Sun Open 24 hours
Santa Monica ER (5.7 miles away)
1225 15th Street
Santa Monica, CA 90404
Mon-Sun Open 24 Hours
Are you outside of the UCLA area?
Please visit the Anthem Blue Cross website and click on “Find a Medical Provider” to locate an Urgent Care Center in your area.
Remember that you and your insurance company will be responsible for the total cost of any care you receive outside of The Ashe Center. It is important to carry your UC SHIP Anthem Blue Cross insurance card with you.