Once your enrollment has been accepted by Anthem and CMS, you will now be enrolled in a Medicare Advantage Plan, which is a Medicare Part C (supplemental plan) combined with Part D prescription drug coverage. You will receive a new Anthem Medicare Advantage ID card in the mail. Please discard your old Anthem ID card. Please remember to update your providers and pharmacies with your new Anthem ID card. You do not need to show your Medicare red, white and blue card to providers (with the exception of routine clinical research studies and hospice services). Anthem will coordinate with Medicare and the provider on your behalf.
In addition to your standard benefits, the Medicare Advantage Plans also includes access to SilverSneakers, a copay-free fitness program designed for Medicare-eligible individuals, which offers physical activity, health education and social events. You will have access to SilverSneakers premier fitness center network, you’ll receive a complimentary basic membership with access to a variety of participating fitness centers throughout the country, with amenities such as:
- Fitness equipment, free weights and pools
- The signature SilverSneakers Fitness program classes, designed specifically for older adults and taught by certified instructors
To receive more information and find a participating location near you, please visit the SilverSneakers website.
Receiving Medical Care
The Medicare Advantage Plan works the same as the commercial PPO, except there are no deductibles or copays, and the same in and out-of-network benefits. You may continue to see the same in-network providers you were seeing before, with the addition of out-of-network providers for medically necessary services. Please note, for the medical services to be covered out-of-network, the out-of-network provider must be eligible to participate in Medicare. If the provider does not participate in Medicare, you may be responsible for a higher cost share of the services rendered. You may request a pre-visit coverage determination ahead of your visit by calling Customer Service.
On the Medicare Advantage Plan, there are certain procedures that will require pre-authorization prior to you receiving the services that may not have been required on the commercial plan. This pre-authorization determines medical necessity in advance of you receiving the services. This pre-authorization is a CMS requirement and ensures you will not be responsible for services that are considered medically necessary. Pre-authorizations are initiated by your treating physician. Please refer to the Evidence of Coverage (EOC) to see which services require pre-authorization.
Filling Prescriptions
Like the commercial plan, the Medicare Advantage Plan also utilizes Anthem Blue Cross and Express Scripts for its members. The Medicare Advantage Plan covers all Medicare Part D prescription drugs, in addition to additional drugs not covered by Part D, referred to as “Extra Covered Drugs.” This list of covered drugs is also known as a formulary. Generally, the lower the tier on the formulary, the less the drug will cost you.
The Medicare Advantage Plan will generally cover your drug so long as the prescription is written by a provider, the prescriber of the drug accepts Medicare, the drug is filled at an in-network pharmacy and is on the plan’s formulary. To find an in-network pharmacy, please call Customer Service.
The mail-order service allows members to receive up to a 90-day supply for most drugs. However, specialty drugs are limited to a 30-day only supply. Typically, a mail-order pharmacy fill will be delivered to you in no more than 14 days. If this is your first mail-order delivery, it is advisable to have at least a 30-day supply of medication on hand when a mail-order request is placed. To obtain a refill, please contact your pharmacy 21 days before the drugs you have on hand will run out to ensure the order is shipped to you in time.
To receive forms and information about filling your prescription by mail, please contact Customer Service.