Anthem Veteran (HMO) is a Medicare Advantage (Part C) Plan by Empire BlueCross BlueShield.
This page features plan details for 2024 Anthem Veteran (HMO) H8432 – 037 – 2 available in Saratoga County.
IMPORTANT: This page has been updated with plan and premium data for 2024.
Anthem Veteran (HMO) is offered in the following locations.
Anthem Veteran (HMO) offers the following coverage and cost-sharing.
Insurer: | Empire BlueCross BlueShield |
Health Plan Deductible: | |
MOOP: | $6,500.00 |
Drugs Covered: | No |
Ready to sign up for Anthem Veteran (HMO) ?
Part B | Part C | Part B Give Back | Total |
---|---|---|---|
$174.70 | $0.00 | $0.00 | $174.70 |
Anthem Veteran (HMO) also provides the following benefits.
$0 |
In-network | No |
$6,500 In-network |
Yes |
In-network | No |
$0 copay or 30% coinsurance per visit (Authorization is required.) (Referral is required.) |
Primary | $0 copay (Not applicable.) (Not applicable.) |
Specialist | $50 copay per visit (Authorization is required.) (Referral is required.) |
$0 copay (Authorization is not required.) (Referral is not required.) |
Emergency | $90 copay per visit (always covered) (Not applicable.) (Not applicable.) |
Urgent care | $55 copay per visit (always covered) (Not applicable.) (Not applicable.) |
Diagnostic tests and procedures | $0-150 copay (Authorization is required.) (Referral is required.) |
Lab services | $0 copay (Authorization is required.) (Referral is required.) |
Diagnostic radiology services (e.g., MRI) | $200-250 copay (Authorization is required.) (Referral is required.) |
Outpatient x-rays | $60-100 copay (Authorization is required.) (Referral is required.) |
Hearing exam | $50 copay (Authorization is required.) (Referral is required.) |
Fitting/evaluation | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Hearing aids – inner ear | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Hearing aids – outer ear | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Hearing aids – over the ear | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Oral exam | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Cleaning | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Fluoride treatment | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Dental x-ray(s) | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Non-routine services | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
Diagnostic services | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
Restorative services | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
Endodontics | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
Periodontics | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
Extractions | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
Prosthodontics, other oral/maxillofacial surgery, other services | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
Routine eye exam | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Other | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Contact lenses | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Eyeglasses (frames and lenses) | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Eyeglass frames | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Eyeglass lenses | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Upgrades | Not covered (Not applicable.) (Not applicable.) |
Occupational therapy visit | $40 copay (Authorization is required.) (Referral is required.) |
Physical therapy and speech and language therapy visit | $40 copay (Authorization is required.) (Referral is required.) |
$265 copay (Not applicable.) (Not applicable.) |
Not covered (Not applicable.) (Not applicable.) |
Foot exams and treatment | $50 copay (Authorization is required.) (Referral is required.) |
Routine foot care | Not covered (Not applicable.) (Not applicable.) |
Durable medical equipment (e.g., wheelchairs, oxygen) | 0-20% coinsurance per item (Authorization is required.) (Not applicable.) |
Prosthetics (e.g., braces, artificial limbs) | 20% coinsurance per item (Authorization is required.) (Not applicable.) |
Diabetes supplies | $0 copay (Authorization is not required.) (Not applicable.) |
Covered (Authorization is not required.) (Referral is not required.) |
Chemotherapy | 0-20% coinsurance (Authorization is required.) (Not applicable.) |
Other Part B drugs | 0-20% coinsurance (Authorization is required.) (Not applicable.) |
Part B Insulin drugs | $35 copay (Authorization is required.) (Not applicable.) |
$400 per day for days 1 through 5 $0 per day for days 6 through 90 (Authorization is required.) (Referral is not required.) |
Inpatient hospital – psychiatric | $465 per day for days 1 through 4 $0 per day for days 5 through 90 (Authorization is required.) (Referral is not required.) |
Outpatient group therapy visit with a psychiatrist | $40 copay (Authorization is required.) (Referral is required.) |
Outpatient individual therapy visit with a psychiatrist | $40 copay (Authorization is required.) (Referral is required.) |
Outpatient group therapy visit | $40 copay (Authorization is required.) (Referral is required.) |
Outpatient individual therapy visit | $40 copay (Authorization is required.) (Referral is required.) |
$0 per day for days 1 through 20 $196 per day for days 21 through 100 (Authorization is required.) (Referral is not required.) |
Monthly Premium | $16.00 |
Deductible | nan |
Monthly Premium | $26.00 |
Deductible | nan |
Monthly Premium | $47.00 |
Deductible | nan |
Ready to sign up for Anthem Veteran (HMO) ?
SMID: MULTIPLAN_HCIHNDOGMED01_M
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