Anthem Veteran Select (HMO)
H8432 - 036 - 0
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Anthem Veteran Select (HMO) is a Medicare Advantage (Part C) Plan by Empire BlueCross BlueShield.
This page features plan details for 2024 Anthem Veteran Select (HMO) H8432 – 036 – 0 available in Select Counties in New York.
IMPORTANT: This page has been updated with plan and premium data for 2024.
Locations
Anthem Veteran Select (HMO) is offered in the following locations.
Plan Overview
Anthem Veteran Select (HMO) offers the following coverage and cost-sharing.
| Insurer: | Empire BlueCross BlueShield |
| Health Plan Deductible: | |
| MOOP: | $6,700.00 |
| Drugs Covered: | No |
Ready to sign up for Anthem Veteran Select (HMO) ?
Premium Breakdown
Anthem Veteran Select (HMO) has a monthly premium of $0.00. This amount includes your Part C premium but does not include your Part B premium.| Part B | Part C | Part B Give Back | Total |
|---|---|---|---|
| $174.70 | $0.00 | $0.00 | $174.70 |
- Your Part B premium may differ based on factors including late enrollment, income, and disability status.
Additional Benefits
Anthem Veteran Select (HMO) also provides the following benefits.
| $0 |
| In-network | No |
| $6,700 In-network |
| Yes |
| In-network | No |
| $0-300 copay per visit (Authorization is required.) (Referral is required.) |
| Primary | $10 copay per visit (Not applicable.) (Not applicable.) |
| Specialist | $30 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 | $0-50 copay (Authorization is required.) (Referral is required.) |
| Lab services | $0 copay (Authorization is required.) (Referral is required.) |
| Diagnostic radiology services (e.g., MRI) | $50-100 copay (Authorization is required.) (Referral is required.) |
| Outpatient x-rays | $20-50 copay (Authorization is required.) (Referral is required.) |
| Hearing exam | $30 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 | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Cleaning | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Fluoride treatment | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Dental x-ray(s) | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Non-routine services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Diagnostic services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Restorative services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Endodontics | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Periodontics | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Extractions | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Prosthodontics, other oral/maxillofacial surgery, other services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| 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.) |
| $260 copay (Not applicable.) (Not applicable.) |
| Not covered (Not applicable.) (Not applicable.) |
| Foot exams and treatment | $30 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.) |
| $350 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 | $415 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 Select (HMO) ?
Table of Contents
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