LAPRA offers you and your family three medical options:
All four plans provide coverage for preventive care, office visits, hospitalization, surgery and prescription drugs. The plans differ in co-payments, coinsurance, out-of-pocket costs, and provider choice.
If you and your eligible dependents are entitled to Medicare Part A and
enrolled in Medicare Part B, and you live in the defined service area, you can
choose the Anthem HMO Medicare Advantage with Prescription Drug Plan which
includes all of Original Medicare and Part D coverages, and provides additional
benefits for you. Below is an overview of the key benefits of the plan. For more
information, call LAPRA at 213-674-3701 or 888-252-7721 to request an Anthem
Blue Cross HMO Medicare Advantage with Prescription Drug Plan enrollment packet. reason.
The Anthem HMO Medicare Advantage Plan is available only to
individuals who live in the HMO Medicare Advantage geographic service area. To
remain a member of this plan, you must continue to reside in the HMO Medicare
Advantage geographic service area. The service area includes these counties in
California: Alameda, Contra Costa, Fresno, Kern, Kings, Los Angeles, Madera,
Orange, Placer, Riverside, Sacramento, San Benito, San Bernardino, San Diego,
San Francisco, Santa Clara, Solano, Sonoma, Stanislaus, Tulare, Ventura, Yolo.
Effective July 1, 2024
Benefit Feature |
Anthem
HMO Medicare Advantage with Prescription Drug Plan (Eligible Retirees & Dependents Only) |
|---|---|
| Providers | HMO Providers Only1 |
| Calendar Year Deductible | N/A |
| Calendar Year Out-of-Pocket Max (includes prescription drug co-pays) | Medidcal & Prescription Drug Charges: $0
out-of-pocket max2 |
| Office Visit | $0 co-pay for Medicare-approved services |
| Hospitalization | $0 co-pay for Medicare-approved hospital stays |
| Emergency Room | $0 co-pay for Medicare-covered emergency room visit |
| Urgent Care | $0 co-pay for Medicare-coverted unrgently needed
care visit |
| Routine Physical |
$0 co-pay for an annual physical exam |
| Diagnostic X-ray & Lab Tests | $0 co-pay for Medicare-covered X-ray visit and/or simple
diagnostic test $0 co-pay for Medicare-aproved complex diagnostic test and/or radiology visit |
| Body Scans |
Not Covered |
| Physical & Occupational Therapy and Chiropractic Services (additional services may be authorized) | $0 co-pay for Medicare-approved physicial,
occupational and speech language therapy visits (Chiropractic up to 40 visits per year) |
| Chiropractic Services | $ co-pay per visit |
| Acupuncture |
$ co-pay per visit |
|
Mental Health/Chemical Dependency |
$0 co-pay for each Medicare-covered outpatient visit $0 co-pay per admission |
1 Your primary care physician can refer you to a specialist when necessary and must approve all care you receive except in the event of an emergency.
2 The drug portion of the plan is Part D which carries a true out-of-pocket limit of $4,850. Once you meet that true out-of-pocket limit, you pay alower drug co-pay for the remainder of the year
When you enroll in the Anthem Blue Cross HMO Medicare Advantage with Prescription Drugs Plan, you automatically receive prescription drug coverage as shown in the table below.
To save money, request that your doctor write your prescriptions for “generic”
drugs whenever possible. Generic drugs are often the therapeutic equivalent of
their brand-name counterparts, but cost significantly less. Also, women's
generic prescription contraceptives are covered with a $0 co-pay to comply with
requirements of the Affordable Care Act.
Prescription Drugs1 |
Anthem
Blue Cross HMO Medicare Advantage with Prescription Drug Plan (Eligible Retirees & Dependents Only) |
|---|---|
Retail Pharmacy |
20% coinsurance ($150 max-co-pay) $5 co-pay)
|
Mail Order |
90-day supply
|
1 Co-pays shown for prescription drugs is your payment responsibility until the amount paid by you and the Coverage Gap Discount Program for covered Part D prescriptions reaches your True Out-of-Pocket limit of $4,850.
Click here for the 2024/25 retiree medical and dental premium rates. Your cost is the monthly premium rate minus the Pension Department subsidy, based on your retirement date, age and years of service.
The Anthem Blue Cross HMO Medicare Advantage rates reflect the options available to retirees meet the eligiblity requirements to participate in this plan. The Federal Medicare Agency, the Centers for Medicare and Medicaid Services (CMS), establishes eligibility requirements that impact members' cost and condition of enrollment. It is important to note that you must purchase and assign your Medicare benefits to Anthem Blue Cross or be reclassified into an unknown or unassigned category which will significantly affect your cost as indicated below.
This brief description of benefits is provided for your convenience and is subject to all terms, conditions, limitations and exclusions of the Anthem Blue Cross contract. Please refer to your plan’s Evidence of Coverage for details on your benefits.