Anthem Medicare Advantage (HMO-POS) Medicare Advantage Plan H9525-013-1 • 2026 • Marshall County, KY

Anthem Medicare Advantage Overview

Coverage Overview for Anthem Medicare Advantage

This Medicare Advantage MAPD HMO-POS plan includes hospital, medical, and prescription drug coverage under Medicare Parts A and B. The monthly premium is $0.00, and the plan provides coverage through a network of participating providers, with limited access to out-of-network services in certain situations. The annual Part D deductible is $230.00.

Primary care visits have a $0 copay, specialist visits come with a $45 copay, urgent care services carry a $30 copay, and ambulance transportation is $260 copay. These costs apply toward the annual maximum out-of-pocket (MOOP) limit of $6300.00. After this limit is reached, in-network services are fully covered.

This plan is registered with CMS under Plan ID H9525-013-1. A summary of cost sharing is provided below.

Cost Sharing Expenses

Anthem Medicare Advantage has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The table below details the most common in-network out-of-pocket expenses for plan H9525-013-1.

Certain preventive services are covered 100% by Anthem Medicare Advantage as a Part B benefit.

Prescription Drug Coverage

Anthem Medicare Advantage includes a Medicare Part D prescription drug plan (PDP). Plan type and coverage level are defined by CMS and may vary between basic and enhanced benefit designs.

This plan includes an enhanced benefit Medicare Part D plan (PDP), providing coverage beyond the standard CMS-defined minimum.

Prescription Drug Plan Premium

The Part D prescription drug plan premium is included in the overall Medicare Special Needs Plan cost. Additional adjustments may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help, administered by Social Security. LIS benefits are separate from Medicare Special Needs Plan coverage.

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

Prescription Drug Plan Deductible

This plan has a $230.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Anthem Blue Cross and Blue Shield starts contributing towards your prescription costs.

Prescription Drug Plan Out-of-Pocket Costs

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

Medicare Plan Star Ratings

CMS evaluates Medicare Advantage (Part C) and Part D plans annually using a 5-star rating system. Ratings reflect performance in preventive care, chronic condition management, and member experience.