Anthem Medicare Advantage (HMO-POS) Medicare Advantage Plan H9525-006 • 2027 • Green Lake County, WI
- Monthly Premium
- $38.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $4300.00In-network
- Part B Giveback
- Not offered
- Prescription Coverage
- Enhanced, $240.00 deductible
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- Green Lake County, WI
- Local Enrollment
- 56 beneficiaries in Green Lake County
Anthem Medicare Advantage (HMO-POS) Introduction
Anthem Medicare Advantage is a Medicare Advantage HMO-POS plan offered by Anthem Blue Cross and Blue Shield. It uses a Health Maintenance Organization with a Point of Service (HMO-POS) provider network and comes with prescription drug coverage. For the 2027 plan year it has a $38.00 monthly premium, $0.00 medical deductible, and $4300.00 in-network maximum out-of-pocket. CMS Plan ID H9525-006 identifies this plan. The 2027 Part D prescription drug deductible is $240.00.
You must live in Green Lake County, Wisconsin to enroll in this plan. CMS reports 56 beneficiaries enrolled in this plan in Green Lake County. For assistance with this plan, new members can call (833)668-2385 (TTY 711).
Compare Similar Plans in Green Lake County
No other HMO-POS plans are available in Green Lake County, Wisconsin using the same plan-type comparison criteria.
Plan Benefits
Anthem Medicare Advantage includes cost-sharing, which refers to out-of-pocket expenses for covered healthcare services. The tables below outline the most common in-network out-of-pocket costs associated with plan H9525-006.
You can also compare 2027 costs and coverage with last year, side-by-side: Plan H9525-006-0 Cost Compare.
Office Visits
- Primary care
- In-network: $0 copay
- Specialist
- In-network: $40 copay
Preventive and Wellness Services
- Annual wellness exam
- In-network: $0 copay
- Telehealth benefit
- In-network: $0 copay
- Routine chiropractic
- Not covered
- Fitness benefits
- Coming soon
- Health education
- Not covered
- Counseling services
- Not covered
- Over-the-counter drug benefits
- Not covered
- Health transportation (non-emergency)
- Coming soon
Diagnostic, Lab, and Imaging Services
- Diagnostic radiology services
- In-network: $50-$195 copay
- Lab services
- In-network: $0-$15 copay
- Outpatient x-rays
- In-network: $80-$100 copay
- Diagnostic tests and procedures
- In-network: $0-$95 copay
Emergency and Urgent Care Services
- Emergency room care
- $150 copay
- Worldwide emergency care
- Coming soon
- Urgent care
- $45 copay
- Inpatient hospital care
- In-network:
Tier 1
$325 per day for days 1-6
$0 per day for days 7-90
$0 per stay - Skilled Nursing Facility
- In-network:
Tier 1
$0 per day for days 1-20
$221 per day for days 21-100 - Ground ambulance
- In-network: $325 copay
Mental Health Services
- Outpatient individual therapy
- In-network: $40 copay
- Outpatient group therapy
- In-network: $40 copay
- Inpatient psychiatric hospital care
- In-network:
Tier 1
$325 per day for days 1-6
$0 per day for days 7-90
$0 per stay
Rehabilitation Services
- Physical therapy and speech and language therapy
- In-network: $40 copay
- Occupational therapy
- In-network: $40 copay
Medical Equipment and Supplies
- Diabetes supplies
- In-network: $0 copay
- Durable medical equipment
- In-network: 20% coinsurance
- Prosthetics
- In-network: 20% coinsurance
Medicare Part B Drugs
- Chemotherapy
- In-network: 0%-20% coinsurance
- Other Part B drugs (Medicare-covered)
- In-network: 0%-20% coinsurance
Dental Services
- Oral exam
- In-network: $0 copay
Out-of-network: 20%-50% coinsurance - Dental x-rays
- In-network: $0 copay
Out-of-network: 20%-50% coinsurance - Cleaning
- In-network: $0 copay
Out-of-network: 20%-50% coinsurance - Periodontics
- In-network: 25% coinsurance
Out-of-network: 20%-50% coinsurance - Endodontics
- In-network: 25% coinsurance
Out-of-network: 20%-50% coinsurance - Restorative services
- In-network: 25% coinsurance
Out-of-network: 20%-50% coinsurance - Implant services
- Not covered
- Orthodontics
- Not covered
- Oral/Maxillofacial surgery
- In-network: 25% coinsurance
Out-of-network: 20%-50% coinsurance
Vision Services
- Routine eye exam
- In-network: $0 copay
- Contact lenses
- In-network: $0 copay
- Eyeglass frames only
- In-network: $0 copay
- Eyeglass lenses only
- In-network: $0 copay
- Eyeglasses (frames & lenses)
- In-network: $0 copay
- Upgrades
- Not covered
Hearing Services
- Hearing exam
- In-network: $0 copay
- Fitting/evaluation
- In-network: $0 copay
- Prescription hearing aids
- In-network: $0 copay
You can choose for this plan to cover
either
your prescription or over-the-counter hearing aids each year, but
not
both. - OTC hearing aids
- In-network: $0 copay
You can choose for this plan to cover
either
your prescription or over-the-counter hearing aids each year, but
not
both.
Additional and Special Needs Services
- Adult day health services
- Not covered
- Home-based palliative care
- Not covered
- Personal emergency response system
- Coming soon
- Weight management programs
- Not covered
- Wigs for chemotherapy-related hair loss
- Coming soon
- Alternative therapies
- Not covered
- Massage therapy
- Not covered
- Home/bathroom safety devices
- Not covered
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 Advantage 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.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | ($9.50) |
| Supplemental Part D Premium: | $$9.50 |
| Total Part D Premium: | $0.00 |
| Low-Income Premium Subsidy: | $6.27 |
| Low-Income Premium Subsidy Paid by CMS: | $0.00 |
| Low-Income Subsidy Premium: | $0.00 |
For more details, visit the Social Security Extra Help program .
Prescription Drug Plan Deductible
This plan has a $240.00 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.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 copay | Coming soon |
| Generic | $0.00 copay | Coming soon |
| Preferred Brand | 25% coinsurance | Coming soon |
| Non-Preferred Drug | 28% coinsurance | Coming soon |
| Specialty Tier | 30% coinsurance | Coming soon |
| *Deductible does not apply. | ||
CMS 5-Star Performance Ratings (Contract ID: H9525)
Medicare Advantage (Part C) and Part D plans are rated each year by CMS on a 5-star scale. Ratings summarize plan performance across clinical care and member experience measures.
| CMS Measure | Star Rating |
|---|---|
| 2027 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
Contact Information for Anthem Blue Cross and Blue Shield
- Website
- Anthem Blue Cross and Blue Shield Plan Page
- Providers
- Anthem Blue Cross and Blue Shield Providers Page
- Formulary
- Anthem Blue Cross and Blue Shield Formulary Page
- Pharmacy
- Anthem Blue Cross and Blue Shield Pharmacy Page
- New Member Health Plan Help
- (833)668-2385
- New Member Health Plan TTY
- 711
- New Member Part D Help
- (833)668-2389
- New Member Part D TTY Users
- 711
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.
Medicare Plan Data Sources and Methodology
| Data Source | Publisher | Last Accessed |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | October 5, 2026 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| Anthem Blue Cross and Blue Shield (official source) | http://shop.anthem.com/medicare | October 4, 2026 |
| Medicare.gov | Compare types of Medicare Advantage Plans | 25 May, 2025 |
| NCOA.org | 5 Steps to Choosing the Right Medicare Plan for You | 25 May, 2025 |
| Medicare.gov | Compare Original Medicare & Medicare Advantage | 25 May, 2025 |
MedicarePlans.com is an independent informational resource and is not affiliated with or endorsed by the U.S. Government or the federal Medicare program.
Provenance documentation for this data is maintained under the U.S. Core Data for Interoperability (USCDI) Provenance standard.
Page content independently curated and maintained by David W. Bynon, Editorial Steward, using a standardized, data-driven methodology for accurate, non-commercial Medicare plan interpretation and resolution.