- Emergency room care $250 copay/visit. Deductible does not apply. Same as in-network plus excess over allowed amount. Copay waived if admitted. Emergency medical transportation No charge No charge None. Urgent care $15 copay/visit. Deductible does not apply. 20% coinsurance None.
- Services that are not medically necessary; The difference between the actual charge and the maximum allowed amount, plus any deductible and/or copayments/coinsurance. Anthem has processes to review claims before and after payment to detect fraud, waste, abuse and other inappropriate activity.
- A: A deductible is an annual flat-dollar amount that you meet before your Anthem plan begins to pay onmedical expenses. Co-insurance is a fixed precentage cost-sharing arrangement for certain services you receive after the deductible has been met. Co-pays are flat dollar amounts that you pay for certain servicesat the time you receive care.
- A copay is the amount you pay each time you go to the doctor or get prescriptions. In HIP, members who are American Indian/Alaska Native, pregnant or who have hit the 5% cost-sharing limit do not have copays. HIP Basic members have these copays: Doctor/outpatient visits: $4 Inpatient services: $75 Preferred drugs: $4 Nonpreferred drugs: $8.
Extra benefits
Anthem Copay Waiver
We also offer our members special benefits and services:- Free eyeglasses or a $50 credit for contacts for adults age 21 and older
- Free sports physicals for youth ages 5 to 18
- Free smartphone with texts and data, as well as up to 1,000 free monthly minutes to call your family, friends, and doctors
- Fresh fruits and vegetables program
- WW® (formerly called Weight Watchers) membership pays for joining fee and 13 weeks of classes
- Home-delivered, medically-tailored meals for those with chronic
health problems - Anthem Medicaid’s Prenatal program with:
- Free crib or car seat when you go to your PCP or OB/GYN at least six times while you are pregnant
- Free gift card when you complete prenatal and postpartum checkups
on time - Mail-order diapers when you complete one postpartum visit
- Free health support and coaching
- Baby shower gift (one free stroller organizer)
- Breastfeeding Support kit offers new moms with an infant support nursing pillow and cover, washable nursing pads, and nursing tip sheets
- Safe sleep kit for new moms with infants under the age of 1. The kit includes a swaddle sleep sack, pacifier, and infant sleep fact sheets
- Books for Babies provides a $50 Barnes & Noble gift card for parents or caregivers with children up to age 2 to encourage reading
- Boys & Girls Club membership for youth ages 6 to 18
- Family activity coupon book for households with children 12 and under
- Caregiver tool kit
- Anthem Medicaid gives you the chance to join our Resource Navigation program, which helps you with seeking schooling, job skills, and work opportunities! Members actively taking part in this program will receive:
- Transportation assistance: we will give rides to buy groceries, as well as seek employment and training opportunities
- GED test vouchers: we will provide vouchers that allow you to take your GED test for free at an approved testing center
- Criminal record expungement: we will help with court and application fees tied to criminal record expungement (as allowed by statute)
- Jump Start program gives online skills assessment and job search tool
- No-cost laptop for those who are graduating high school with a 3.0 grade point average or higher
- Free gift cards for receiving HbA1c diabetic screenings each year
- Free 24/7 NurseLine to speak to a nurse about your health questions or concerns 24 hours a day, seven days a week, 365 days a year
- Mail order over-the-counter products
- Medicine safety kit
- Choose Healthy program offers over 1,000 resources like videos, articles, and self-care tools
- Healthy Families program helps families make healthier food choices and improve activity levels
- Online well-being program for those 13 years and up; helps mental health and wellness through lessons, games, and goal setting
- Healthy-lifestyle aids like digital scales, hearing aid batteries, and
lumbar pillows - Community Resource Link helps you find programs, benefits, and services near you
- Free disease management programs to help you manage difficult health conditions like asthma, diabetes and COPD
- Smoking distraction kits
- Substance Use Disorder Recovery Support program provides peer support and counselor advice
Anthem Copay Plan
The Department for Medicaid Services now requires Medicaid members to pay copays for certain services.Preventive services DO NOT HAVE COPAYS. Preventive services include screenings, checkups, and patient counseling to prevent illnesses, disease, or other health problems.
HMO 3200 Rx Copay 15% (5JQX) Anthem Silver Mountain Enhanced HMO 2000 30% (5JQV) Anthem Bronze Pathway Essentials HMO 8550 (5L9C) Anthem Bronze Pathway Essentials HMO 7000 for HSA (5L9B) Anthem Bronze Pathway Essentials HMO 6000 (5L9A) Anthem Bronze Pathway Essentials HMO 5650 Rx Copay (5L99) Anthem Bronze Pathway HMO 8550 (5JRP) Plan name.