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Anthem MediBlue Dual Advantage (D-SNP HMO) A 2023 Clark County, Nevada Medicare Advantage Special Needs Plan

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Anthem MediBlue Dual Advantage, by Anthem Blue Cross and Blue Shield, is a 2023 Medicare Advantage Special Needs Plan (HMO D-SNP) available in Clark County, Nevada. Delivery of healthcare services and costs are significantly different than in Original Medicare, and the plan offers additional benefits that are not included with Medicare Part AMedicare Part A is hospital coverage for Medicare beneficiaries. It covers inpatient care in hospitals and skilled nursing facilities. It also covers limited home healthcare services and hospice care. and Part B.

This page contains editorial content that is not endorsed or approved by Anthem Blue Cross and Blue Shield[2]. This is not a solicitation of insurance.

Key Takeaways

1. This is a Medicare Special Needs Plan, with a HMO provider network, exclusively for people with Medicare and MedicaidMedicaid is a public health insurance program that provides health care coverage to low-income families and individuals in the United States. benefits (dual-eligibleDual-eligible beneficiaries are those who receive both Medicare and Medicaid benefits. It includes beneficiaries enrolled in Medicare Part A and/or Part B while receiving full Medicaid and/or financial assistance through a Medicare Savings Program....).
2. This is a zero-dollar D-SNP cost-sharing plan. Members have no copays when they use Medicare-approved healthcare services.
3. To qualify, you must live in Clark County and have both Medicare Part A and Part B. Plus, you must qualify for full Medicaid.
4. Anthem MediBlue Dual Advantage includes a Medicare Part DMedicare Part D plans are an option Medicare beneficiaries can use to get prescription drug coverage. Part D plans provide cost-sharing on covered medications in four different phases: deductible, initial coverage, coverage gap, and catastrophic. Each... prescription drug plan.
5. The annual Part D deductible is $505.00. You pay this amount before cost-sharing begins.
6. If you qualify for the Social Security "Extra Help" program you can get financial assistance to help pay your Medicare Part D monthly premium, annual deductible, and prescription copaymentsA copayment, also known as a copay, is a set dollar amount you are required to pay for a medical service..
7. Anthem MediBlue Dual Advantage provides the same coverage benefits as Medicare Part A and Part B (Original Medicare) and includes some extra benefits not covered by Original Medicare.
8. If you are not qualifed to enroll, one of the traditional MedicareOriginal Medicare is private fee-for-service health insurance for people on Medicare. It has two parts. Part A is hospital coverage. Part B is medical coverage.Medicare Advantage plansMedicare Advantage (MA), also known as Medicare Part C, are health plans from private insurance companies that are available to people eligible for Original Medicare (Medicare Part A and Medicare Part B). available in Clark County, Nevada might be your best option.

If you qualify for Medicare but don't know where to begin, we have licensed agents[1] at 1-855-728-0510 (TTY 711) who can answer your questions and help you get enrolled. There's no obligation.

Health Plan Costs & Benefits

Anthem MediBlue Dual Advantage is a Health Maintenance Organization (HMO) plan. HMO plan members usually receive health care services through the plan’s local network of providers. Referrals are almost always required to see a specialist and other providers. However, Anthem MediBlue Dual Advantage does allow out-of-network care for emergencies and out-of-area dialysis.

PremiumsA premium is an amount that an insurance policyholder must pay for coverage. Premiums are typically paid on a monthly basis. In the federal Medicare program, there are four different types of premiums. , deductiblesA deductible is an amount a beneficiary must pay for their health care expenses before the health insurance policy begins to pay its share., and copays vary widely from plan to plan. It is very important to compare costs and apply them to your personal financial and healthcare needs.

Monthly Premium

Anthem MediBlue Dual Advantage's total monthly premium in Clark County is $14.40. This includes your prescription coverage, as well. Plus, you must continue to pay your monthly Medicare Part B premiumThe Medicare Part B premium is the monthly charge paid by beneficiaries for their outpatient medical care, services, and supplies. A beneficiary's premium may be uplifted by an IRMAA surcharge if their income is above....

Annual Deductible

Anthem MediBlue Dual Advantage's annual health plan deductible is $0.00. This does not include the deductible for the prescription drug plan (if any), which is detailed below.

Maximum Out-of-Pocket Limit

The Maximum Out-of-Pocket (MOOP) with this Anthem Blue Cross and Blue Shield plan is $7,550 in-network. Unlike Original Medicare, Medicare Advantage plans must set an annual Maximum Out-of-Pocket (MOOP) limit on inpatient and outpatient healthcare services. Once you reach this amount of spending on your copayments, all of your Medicare Part A and Part B services will be covered at no additional charge for the remainder of the year. MOOP does not include monthly premiums, prescriptions, or other extra benefits.

Health Plan Out-of-Pocket Costs

The following table is a summary of the most common out-of-pocket costsOut-of-Pocket Costs for Medicare are the remaining costs that are not covered by the beneficiary's health insurance plan. These costs can come from the beneficiary's monthly premiums, deductibles, coinsurance, and copayments. you will incur if you join this Anthem Blue Cross and Blue Shield plan:

Feel free to download our Anthem MediBlue Dual Advantage Summary of Benefits information.

Do you have questions about the costs with this plan? Call 1-855-728-0510 (TTY 711) to learn more about this Medicare Advantage plan (H4346-025-0) and other plans on this site.

Prescription Drug Plan Costs & Benefits

Anthem MediBlue Dual Advantage includes an enhanced benefit Medicare Part D plan (PDP). Enhanced plans have a higher actuarial value than basic plans. Actuarial value simply refers to the percentage of cost that's covered by the plan.

Enhanced plans generally have higher monthly premiums than basic benefit plans but offer more benefits. For example, many enhanced PDPs do not have an annual deductible, may offer additional coverage during the coverage gap (aka, "donut hole"), and may have a broader list of supported drugs, known as a formularyA formulary is a list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. Medications not on a plan's formulary are generally not covered.. Some enhanced PDPs even cover excluded drugs. It's important to remember that benefits vary from plan to plan.

Prescription Drug Plan Premium

Although the prescription drug plan (Part D) premium is bundled with the total plan cost, some plans have supplemental costs and/or offer low-income subsidySocial Security's Low-Income Subsidy (LIS) program helps Medicare beneficiaries pay for their Medicare Part D prescription drugs by paying some of the costs. Also known as "Extra Help", beneficiaries who qualify for LIS receive premium... (LIS) assistance. The following table outlines the prescription drug plan premium details of this plan.

For more information about the Low-Income Subsidy (aka, "Extra Help") program, refer to the Social Security Extra Help page.

Prescription Drug Plan Deductible

The Medicare Part D annual deductible with this plan is $505.00. This is the amount you must pay at the pharmacy before Anthem Blue Cross and Blue Shield begins paying its share.

Prescription Drug Plan Out-of-Pocket Costs

In addition to the plan's monthly premium and deductible, Anthem MediBlue Dual Advantage has copayments (a fixed dollar amount) and/or coinsurances (a percentage amount) that you must pay when you pick up your prescriptions. The following table shows you those costs.

Our Review & 2023 CMS Rating Marks

Each year the Centers for Medicare & Medicaid ServicesThe Centers for Medicare & Medicaid Services (CMS) is the U.S. Federal agency that runs the Medicare, Medicaid, and Children’s Health Insurance Programs. (CMS) rates Medicare Advantage D-SNP's in nine broad categories. MedicareWireMedicareWire is a Medicare insurance consulting agency. We founded MedicareWire after seeing and hearing how confusing and frustrating it is to find, understand, and choose a plan. Our services are free to the consumer. does not recommend joining a plan with an overall rating of less than 3.0. (3 stars)

You have options, and this one is below average. From MedicareWire's perspective, Anthem MediBlue Dual Advantage does an average job keeping Clark County members healthy through preventive care measures, including screenings, tests, and vaccines. This plan is good at managing its member's chronic (long-term) health conditions. Sadly, the overall member experience with this Anthem Blue Cross and Blue Shield D-SNP plan is poor. When it comes to complaints and changes in performance, this plan is below average. The plan shines at customer service with an overall excellent mark on this important metric.

How to Qualify to Enroll in Anthem MediBlue Dual Advantage

To qualify for enrollment in Anthem MediBlue Dual Advantage in Clark County, you must be eligible for both Medicare and Medicaid. To be eligible for Medicare, you must be age 65 or older, or have Social Security Disability Insurance for 24 months. To be eligible for Medicaid, your income and assets must be at or below Nevada's state thresholds.

Before enrolling in Anthem MediBlue Dual Advantage, or any other dual-eligible SNP, be sure to ask the following questions:

• What costs should I expect to pay out-of-pocket (premiums, deductibles, copayments)?
• Will I be able to use my doctors? Are they in the plan's network?
• Are the plan's in-network providers and facilities in convenient locations?
• Does the plan provide coverage for services I receive from out-of-network providers?
• Do I need a referral to see a specialist?
• Are my medications on the Part D plan's formulary? What if I can't afford my medications?
• What special accommodations does the plan make for persons with disabilities?
• Does the plan offer free meal delivery after a stay in the hospital?
• What help is offered for caregivers? Is adult day care covered?
• Does the plan offer a prepaid card for over the counter medications and covered groceries?

Call 1-855-728-0510 (TTY 711) to learn more about this Medicare Advantage plan and other plans on this site. You may also Enroll Online using our safe and secure online enrollment website or take advantage of the following plan resources:

If you qualify for Medicare but have not yet enrolled or verified your enrollment status, you can do so on the Social Security Administration website. You can learn more about the Medicare Advantage program on www.medicare.gov.

Citations & References

• Anthem Blue Cross and Blue Shield, https://shop.anthem.com/medicare, Last Accessed October 13, 2022
• Medicaid.gov, "Medicaid & CHIP in Nevada", Last Accessed October 15, 2022
• CMS.gov, "Dual Eligible Special Needs Plans (D-SNPs)", Last Accessed May 21, 2022
• CMS.gov, Landscape Source Files, Last Accessed October 26, 2021
• CMS.gov, Medicare Part C & D Performance, Last Accessed October 6, 2021
• CMS.gov, Plan Benefits Package, Last Accessed October 4, 2021

The Medicare Special Needs Plans in Clark County, Nevada for 2023 information on this page was last updated on November 5, 2022.