MedicareCommons™

Neutral. Transparent. Retrieval-first.

array(20) { ["plan_name"]=> string(20) "Anthem Veteran (PPO)" ["plan_id"]=> string(9) "H4909-023" ["org_name"]=> string(33) "Anthem Blue Cross and Blue Shield" ["plan_type"]=> string(9) "Local PPO" ["region"]=> string(8) "Kentucky" ["moop"]=> string(12) "Data missing" ["deductible"]=> string(12) "Data missing" ["inpatient_hospital"]=> string(88) "$295.00 (days 1–7), $0.00 (days 8–90)
Prior Authorization Required" ["snf"]=> string(91) "$0.00 (days 1–20), $214.00 (days 21–100)
Prior Authorization Required" ["pcp"]=> string(11) "$0.00 Copay" ["specialist"]=> string(59) "$15.00 Copay
Prior Authorization Required" ["urgent_care"]=> string(59) "$45.00 Copay
Prior Authorization Required" ["er"]=> string(68) "$0.00 - $295.00 Copay
Prior Authorization Required" ["ambulance_ground"]=> string(60) "$290.00 Copay
Prior Authorization Required" ["ambulance_air"]=> string(60) "$290.00 Copay
Prior Authorization Required" ["dental"]=> string(45) "$2,000.00 max
$2,000.00 max" ["vision"]=> string(48) "$0.00 Copay
$200.00/yr eyewear" ["hearing"]=> string(11) "Not Covered" ["rx"]=> array(2) { ["deductible"]=> string(11) "Not Covered" ["tiers"]=> array(0) { } } ["data_status"]=> string(2) "ok" }
🩺 Doctor’s Office Visits
Service 2026 2025
PrimaryComing soon$0.00 Copay
SpecialistComing soon$15.00 Copay
Prior Authorization Required
🏥 Emergency, Urgent, and Inpatient Hospital Coverage
Service 2026 2025
Emergency room careComing soon$0.00 - $295.00 Copay
Prior Authorization Required
Urgent careComing soon$45.00 Copay
Prior Authorization Required
Ground ambulanceComing soon$290.00 Copay
Prior Authorization Required
Inpatient hospital careComing soon$295.00 (days 1–7), $0.00 (days 8–90)
Prior Authorization Required
Skilled Nursing FacilityComing soon$0.00 (days 1–20), $214.00 (days 21–100)
Prior Authorization Required
🦶 Foot Care
Service 2026 2025
Foot Exams and Treatments (Medicare-covered)Coming soon20% Coinsurance
Routine Foot CareComing soon0% - 20% Coinsurance
Prior Authorization Required
💆 Chiropractic Care
Service 2026 2025
Medicare-covered chiropracticComing soon0% - 20% Coinsurance
Prior Authorization Required
Routine chiropracticComing soon20% Coinsurance
Prior Authorization Required
🧠 Mental Health Services
Service 2026 2025
Outpatient individual therapyComing soon$15.00 Copay
Prior Authorization Required
Outpatient group therapyComing soon$20.00 Copay
Prior Authorization Required
Inpatient psychiatric hospital careComing soon$295.00 (days 1–7), $0.00 (days 8–90)
Prior Authorization Required
🏋️ Rehabilitation Services
Service 2026 2025
Physical therapy and speech/language therapyComing soon$45.00 Copay
Prior Authorization Required
Occupational therapyComing soon$45.00 Copay
Prior Authorization Required
🧰 Medical Equipment and Supplies
Service 2026 2025
Diabetes suppliesComing soon$0.00 Copay
Prior Authorization Required
Durable medical equipmentComing soon$0.00 Copay
Prior Authorization Required
ProstheticsComing soon$0.00 - $20.00 Copay
Prior Authorization Required
🔬 Diagnostics, Lab Services, and Imaging
Service 2026 2025
Diagnostic radiology servicesComing soon$45.00 Copay
Prior Authorization Required
Lab servicesComing soon$45.00 Copay
Prior Authorization Required
Outpatient x-raysComing soon$0.00 Copay
Diagnostic tests and proceduresComing soon$45.00 Copay
Prior Authorization Required
💉 Medicare Part B Drugs
Service 2026 2025
ChemotherapyComing soon$0.00 Copay
Other Part B drugs (Medicare-covered)Coming soon$0.00 Copay

Supplemental Benefits

🦷 Dental Services
Service 2026 2025
Medicare Covered Preventive DentalComing soon$2,000.00 max
$2,000.00 max
Oral examComing soon$0.00 Copay
Dental x-raysComing soon$0.00 Copay
CleaningComing soon$0.00 Copay
PeriodonticsComing soon$0.00 Copay
EndodonticsComing soon$0.00 Copay
Restorative ServicesComing soon$0.00 Copay
Dental MaximumComing soon$2000.00 max
👂 Hearing Aids and Services
Service 2026 2025
Fitting/evaluationComing soon$0.00 Copay
Hearing aidsComing soon$0.00 Copay
Hearing examComing soon$59.00 max
$59.00 max
Prior Authorization Required
Hearing MaximumComing soon$59.00 max
👓 Vision Services
Service 2026 2025
Medicare-covered eye examComing soon$69.00 max
$69.00 max
Prior Authorization Required
Routine eye examComing soon$0.00 Copay
Eyewear benefitsComing soon$0.00 Copay
Vision Eyewear MaximumComing soon$200.00/yr eyewear
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Part D Plan Premium

The Part D prescription drug plan premium is included in your overall Medicare Advantage plan cost. However, additional expenses or subsidies may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help. LIS, provided by Social Security, helps those with limited income and resources to lower or eliminate Part D costs. LIS benefits are not part of Medicare Advantage coverage.

{name} Prescription Drug Plan Premium Details
Basic Part D Premium: ${part_d_basic_premium}
Supplemental Part D Premium: ${part_d_supplemental_premium}
Total Part D Premium: ${part_d_total_premium}
Low-Income Premium Subsidy: ${part_d_lips_amount}
Low-Income Premium Subsidy Paid by CMS: ${part_d_lips_cms_pays}
Low-Income Subsidy Premium: ${part_d_lis_premium}

For more details, visit the Social Security Extra Help program.

Prescription Drug Plan Deductible

This plan has a ${deductible} annual Part D deductible. You'll pay this deductible at the pharmacy before {carrier} starts contributing towards your prescription costs.

Prescription Drug Plan Out-of-Pocket Costs

Beyond premiums and deductibles, {name} may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.

{name} Pharmacy Out-of-Pocket Costs by Drug Tier
Drug Tier Retail Mail Order
*Deductible does not apply.