H4909 014 04 - Local Ppo (2024)

FAQs

Is Anthem Blue the same as Medicare? ›

Anthem Blue Cross and Blue Shield is a Medicare Advantage plan with a Medicare contract. Anthem Blue Cross and Blue Shield is a D-SNP plan with a Medicare contract and a contract with the state Medicaid program. Enrollment in Anthem Blue Cross and Blue Shield depends on contract renewal.

A Preferred Provider Organization (PPO) Plan is a Medicare Advantage Plan that has a network of doctors, specialists, hospitals, and other health care providers you can use. Can I get my health care from any doctor, other health care provider, or hospital? Yes.

Original Medicare benefits through Part A, hospital insurance and Part B, medical insurance, do not need their primary care physician to provide a referral in order to see a specialist. Complications with coverage can occur if you see a specialist who is not Medicare-approved or opts out of accepting Medicare payments.

PPO stands for preferred provider organization. Just like an HMO, or health maintenance organization, a PPO plan offers a network of healthcare providers you can use for your medical care. These providers have agreed to provide care to the plan members at a certain rate.

HMOs don't offer coverage for care from out-of-network healthcare providers. The only exception is for true medical emergencies. With a PPO, you have the flexibility to visit providers outside of your network. However, visiting an out-of-network provider will include a higher fee and a separate deductible.

A local PPO plan has a small network of providers serving one or more counties, or partial counties. A regional PPO serves an entire region and has a large network of providers in order to better meet the needs of beneficiaries in rural areas.

If you joined a Medicare Advantage Plan during your Initial Enrollment Period, you can change to another Medicare Advantage Plan (with or without drug coverage) or go back to Original Medicare (with or without a drug plan) within the first 3 months you have Medicare Part A & Part B.

Summary: Medicare doesn't typically cover 100% of your medical costs. Like most health insurance, Medicare generally comes with out-of-pocket costs including copayments, coinsurance, and deductibles. As you'll learn in this article, Original Medicare (Part A and Part B)

Who automatically gets Part B Medicare? ›

If you are approaching age 65 and you already receive Social Security or Railroad Retirement benefits through early retirement, you will be automatically enrolled in Medicare Parts A (hospital insurance) and B (medical insurance) when you turn 65.

With an Anthem Medicare Advantage HMO plan, formerly MediBlue, you will have a strong network of doctors and hospitals you can trust for quality care.

Anthem Blue Cross is the trade name of In California: Blue Cross of California, Anthem Blue Cross Partnership Plan, Anthem BC Health Insurance Company and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association.

Since Anthem licenses with Blue Cross Blue Shield, it only offers its own health insurance brands in certain states, including California, New York, and a dozen more. If you don't live in a state with Anthem health insurance, you may want to search for your own regional Blue Cross Blue Shield regional company.

For Blue Shield Medicare Advantage Plans: Blue Shield of California is an HMO, HMO D-SNP, PPO and a PDP plan with a Medicare contract and a contract with the California State Medicaid Program.