What is Anthem MediBlue HMO?

Because of the popularity of Anthem products and their relationship with BlueCross BlueShield, customers have frequent questions about their various Medicare products. Anthem has a wide variety of plans from various Medicare Advantage plans to Medicare Supplement plans. For this article, we are going to focus primarily on Anthem’s MediBlue product, and touch briefly on their other options.

Who is Anthem?

Before delving into their products, let’s give you a brief introduction to the company.

Anthem was founded in the 1940s in Indianapolis, Indiana, and has grown into one of the largest health insurance companies in the United States.

Prior to 1995, the company was called American General Insurance. Anthem was a small subsidiary. After purchasing the Community Mutual Insurance of Ohio in 1995, they changed the name of the parent company to the Anthem Insurance Company.

Since the rebranding, Anthem has continued to grow acquiring Wellpoint in 2003. In 2015, Anthem attempted to merge with Cigna but the merger was blocked by federal regulators.

Anthem is part of the BlueCross BlueShield Association. People often confuse the two organizations. BlueCross BlueShield is a federation of 36 health insurance companies, often referred to as the “Association”. Anthem is the largest for-profit managed health care company in the BCBS association.

Anthem offers Medicare products in California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, New Hampshire, New York, Ohio, Virginia and Wisconsin.

Depending on your state, Anthem may operate under different brands. In California, it operates under Anthem Blue Cross. In New York, it is Empire BlueCross BlueShield. In the other states, it uses Anthem BlueCross and BlueShield.

They are highly rated among financial rating organizations. The BBB gives them an A+, and AM Best has given them an A rating.

Because of Anthem’s growth, it has climbed the Fortune 500 list to 33rd place as of the end of 2020.

Healthcare among the senior population is important to Anthem. Over the past several years, it has begun focusing specifically on products for seniors.


Set Appointment

This appointment is meant to alleviate any concerns and there is no-cost or obligation to make a change.


What is Anthem MediBlue?

Anthem MediBlue is one of several Medicare Advantage products that they offer.
The 3 different types of Medicare products are:

Anthem Medicare HMO Plans

These are Health Maintenance Organization plans assigning a primary care physician to coordinate you healthcare within their network. MediBlue is an HMO plan.


Anthem Medicare PPO Plans

PPO refers to a Preferred Provider Organization that like HMO’s assign a primary care doctor for regular check-ups, but members are allowed to choose and schedule care with specialist visits without a referral. You are even to go outside of network and receive partial coverage. However, you do have lower out-of-pocket costs by using in-network providers.


Anthem Medicare SNP Plans

An SNP is a Special Needs Plan that is a Medicare Advantage plan designed for people with certain medical conditions or for those who qualify for both Medicare and Medicaid.



Basics of Medicare Advantage products

There are two primary products people use to cover out of pocket costs not covered by Medicare: Medicare Advantage plans and Medicare Supplement plans.

At MedicareNationwide, we offer both Advantage and Supplement plans from a wide range of companies. Because Anthem MediBlue is a Medicare Advantage product, understanding the basics of how Medicare Advantage works will help you make the best decision on if this product is a good fit for your needs..

Medicare Advantage is also known as Medicare Part C. It was originally created by Medicare to pick up all the out-of-pocket costs that Medicare does not cover.

Medicare is made of 4 different part: Part A, B, C, & D. Part A of Medicare covers hospitalization. Part B covers primary care such as your doctors and specialists. Part D is prescription drug coverage. Medicare Advantage is Part C.

Even though Medicare Advantage is a component of Medicare it is administered and managed by private insurance companies.

The easiest way to understand Part C is to think of it as a bundled “all in one” plan. Medicare Advantage policies package Part A, B, extra medical coverage, and sometimes prescription drugs (Part D), vision, and dental into one policy.

Today, 33% of all Medicare participants are enrolled in a Medicare Advantage plan.

Within Medicare Advantage there are three common plans:

  • Health Maintenance Organizations (HMOs)
  • Preferred Provider Organizations (PPOs)
  • Private Fee-For-Service (PFFS)

Some plans, will include benefits that Medicare does not offer such as dental and vision coverage. There are certain restrictions that can vary by companies.

The Kaiser Family foundation has an extensive article on Medicare Advantage coverage throughout the United States. The article provides a snapshot of the location and popularity of plans are available through the country.


What does Anthem Blue Cross HMO cover?

Anthem’s HMO Medicare Advantage option is called Anthem MediBlue HMO. As an HMO you must choose a primary care provider who will provide the majority of your care and also manages your total healthcare offerings. Your primary care provider will refer you to any specialist inside of Anthem’s network that you may need.

All MediBlue plans use the same Anthem network of healthcare facilities and doctors. Many preventative services, such as chek-ups, tests, shots, and screening are included at no extra cost. Prescription drug coverages are included along with vision and dental. Some plans will also give you access to vision and dental benefits that are not covered by Original Medicare such as hearing aids.

Each Medicare Advantage plan also comes with the SilverSneakers benefit. This is a unique program to promote healthy lifestyles among seniors by providing gym membership, exercise programs, and nutritional resources.

There are four MediBlue plans.

MediBlue Plus

This is a $0 premium plan with a $20 primary care copay and a $50 specialist copay.  Prescription drug covered is included in the plan and start a $7 copay. Dental, hearing, and vision can be added for an additional premium.


MediBlue Select

This plan another $0 premium plan with $0 copays for primary care and specialists. Tier 1 drugs start at a $0. The premium for Part D is $0 with a $275 deductible. For in-network coverage, there is a max out-of-pocket limit of $6700. Select plans are Dual Eligible Special Needs Plans. To be eligible for these plans, you must meet certain medical qualification or also be eligible for Medicaid along with Medicare.


MediBlue Extra

This plan has a monthly premium but $0 copays for primary care and specialist visits. For prescription drug coverage you will have a $415 deductible applying to all drug tiers except tier one. Inpatient hospital care have a copay fo $95 for the first 4 days. The policy has includes dental, vision, and hearing.


MediBlue Coordination Plus 

This plan has the same prescription drug coverage as the Extra plan. It also includes dental, vision, and hearing coverage. For your primary and specialist coverage there will be a 20% coinsurance cost for each visit.


Eligibility for MediBlue plans

To join a MediBlue there are certain qualifications.

  • Eligible for Medicare Part B
  • Eligible for Medicare Part A

An HMO like Anthem MediBlue is a great option for people who like predictability in their healthcare with a standard list of physicians and networks to choose from. If you prefer one provider managing your healthcare, an HMO might be a great option for you.



Is Anthem Blue MediBlue PPO or HMO? 

MediBlue does have PPO plans. One advantage of the HMO over the PPO is the cost. HMO plans tend to be have much lower premiums thant PPOs. Under an HMO you do have fewer doctor options and will be limited to the Anthem network to receive coverage.

PPO plans will give you access to more providers and you will not need a referral from your primary care physician to see a specialist. 

Even though MediBlue plans come bundled with prescription drug coverage, Anthem also offer standalone Prescription Drug Plans. This is a great option if you choose to have a Medicare Supplement policy which does not include prescription drug coverage.

Anthem offers three types of Prescription Drug Plans (PDP), including:


MediBlue Rx Enhanced Part D Plan

This plan has the lowest premiums of the Anthem PDPs, with savings on prescriptions at preferred pharmacies.


MediBlue Rx Plus Part D Plan 

The plus plan has the largest drug list of all the Anthem PDPs. These plans have no deductibles and provide savings at preferred pharmacies.


MediBlue Rx Standard Part D Plan 

The standard plan provides savings on prescriptions at preferred pharmacies and a high level of coverage with higher monthly premiums, low out-of-pocket costs, and more comprehensive drug coverage. 


Set Appointment

This appointment is meant to alleviate any concerns and there is no-cost or obligation to make a change.


Anthem is an excellent company. They continually receive high marks among financial service and customer service. 

Depending on your geography plans may vary. Some geographies have limited medical networks and do not have Medicare Advantage plans because of this limitation.

At Medicare Nationwide we are able to offer a wide variety of Medicare products including Advantage plans and Supplements. We are able to quote multiple companies and plans to provide the best possible pricing at coverage you need.

When you speak to one of our agents, let us know your budget along with your medical history which will help us give you multiple options to choose from.

Prefer to chat by phone? Give us a call at 1-888-559-0103.