Anthem Prime (HMO-POS)
Anthem Blue Cross Partnership Plan · HMO-POS · 2027 coverage
The big numbers
The plan premium is on top of your Part B premium.
- Monthly premium
- $0
- Most you pay in a year for covered care in network
- $3,000
- Drug deductible
- $250
- Higher than most plans here
- Medicare star rating
- No rating yet
In plain English
Compared with the 17 other plans in Madera County that the same person could join.
What stands out
- No monthly premium
- Dental, vision and hearing extras included
Watch out for
- $35 for urgent care, higher than most plans here
- $250 drug deductible, higher than most plans here
- You need a referral to see a specialist
What a year could cost
Premiums plus the plan’s copays for three example years. Medicines are not included.
- A light year$20$0 in premiums + $20 for careHigher than most plans here2 checkups and 2 lab tests.Uses the highest listed cost for: Lab tests.
- A busier year$125$0 in premiums + $125 for care4 checkups, 4 specialist visits, 4 lab tests, 1 X-ray and 1 urgent care visit.Uses the highest listed cost for: Lab tests, X-rays.
- A hard year$2,050$0 in premiums + $2,050 for care6 checkups, 12 specialist visits, 6 lab tests, 2 scans, an ambulance ride, an ER visit and a 5-day hospital stay.Uses the highest listed cost for: Lab tests, MRI, CT and other scans.
The visit counts are examples we chose to show how costs add up, not a prediction. Your costs depend on the care you get.
What you pay for care
Your cost each time, at doctors and hospitals in the plan’s network.
- Primary care visit$0
- Specialist visit$0Referral neededPlan approval may be needed
- Urgent care$35Higher than most plans here
- Emergency room$150Not charged if you stay in the hospital within 24 hours
- Hospital stay$225 a day for days 1 to 6, then $0 for days 7 to 90Plan approval may be needed
- Lab tests$0 to $10Depends on the serviceReferral neededPlan approval may be needed
More care: surgery, X-rays, scans, ambulance, nursing home
- Outpatient surgery center$0 to $200Depends on the serviceReferral neededPlan approval may be needed
- Outpatient hospital care$0 to $225Depends on the service
- X-rays$0 to $50Depends on the serviceReferral neededPlan approval may be needed
- MRI, CT and other scans$0 to $210Depends on the serviceReferral neededPlan approval may be needed
- Ground ambulance$295Plan approval may be needed
- Skilled nursing facility$0 for days 1 to 20, then $221 a day for days 21 to 100Plan approval may be needed
From the costs the plan filed with Medicare for 2027. A range like “$0 to $100” means the cost depends on the service or the place. “Lower than most” compares this plan with the 17 other plans in Madera County that the same person could join. Read the plan’s 2027 booklet (PDF)
What medicines cost
| Drug tier | Preferred pharmacy | Other network pharmacy |
|---|---|---|
| 1Preferred Generic | $0 | $0 |
| 2Generic | $0 | $0 |
| 3Preferred BrandAfter the deductible | 20% of the price | 25% of the price |
| 4Non-Preferred DrugAfter the deductible | 30% of the price | 30% of the price |
| 5Specialty TierAfter the deductible | 30% of the price | 30% of the price |
For a 1-month supply. The $250 drug deductible applies only to the tiers marked. Covered insulin costs at most $35 for a month’s supply. Your medicine’s tier is on the plan’s drug list; check it below.
Check my medicines
See if this plan covers each medicine you take in 2027, and what a month costs.
Type the name on the bottle. Add the strength to narrow it down.
Add each medicine once. We’ll show if this plan covers it, what a month costs, and any rules.
Extras
Help Original Medicare doesn’t give you.
- Dental IncludedCleanings and exams covered.
- Vision IncludedYearly eye exam: $0. Glasses or contacts covered.Eyewear: plan pays up to $50 a year.
- Hearing IncludedHearing test: $0. Hearing aids covered.Hearing aids: plan pays up to $1,500 a year, both ears.
- Over-the-counter items Not included
- Fitness Not included
- Rides to care Not included
What changed from 2026
- Most you pay in a year2026$2,9002027$3,000
- Drug deductible2026$02027$250
- Hospital stay2026$225 a day for days 1 to 5, then $0 for days 6 to 902027$225 a day for days 1 to 6, then $0 for days 7 to 90
- Ground ambulance2026$2502027$295
- Skilled nursing facility2026$0 for days 1 to 20, then $218 a day for days 21 to 1002027$0 for days 1 to 20, then $221 a day for days 21 to 100
- Vision2026Yearly eye exam: $0. Glasses or contacts covered. Eyewear: plan pays up to $150 a year2027Yearly eye exam: $0. Glasses or contacts covered. Eyewear: plan pays up to $50 a year
- Hearing2026Hearing test: $0. Hearing aids covered. Hearing aids: plan pays up to $2,000 a year, both ears2027Hearing test: $0. Hearing aids covered. Hearing aids: plan pays up to $1,500 a year, both ears
- Over-the-counter items2026Up to $42 every three months for things like vitamins, pain relief and bandages. Unused money does not carry over2027Not covered
Is my doctor in this plan?
Look up your doctors, then confirm with their office.
Call each doctor’s office and ask:
“Do you take Anthem Prime (HMO-POS), plan number H4161-006, for 2027?”