Anthem Minimum Value Plan
How it works
- This plan only covers services from in-network providers.
- If you meet the out-of-pocket maximum, the plan pays 100% of your eligible expenses for the rest of the year.
- There are some services with limited coverage as well as exclusions with this plan, including air ambulances, home health care, and certain durable medical equipment. Please review all exclusions found in the plan summary.
Key Features
Higher premiums than the Aetna Basic Plans but lower than the Anthem 6000.
You pay more out of each paycheck for this plan than the Aetna Basic Plans for a plan that covers more of your costs when you need care. There are some services with limited coverage as well as exclusions with this plan, including air ambulances, home health care, and certain durable medical equipment. Please review all exclusions found in the plan summary.
Copays for most in-network services.
You’re required to pay a copay for most services, except for hospitalization where other limitations apply.
Qualified in-network preventive care at no cost to you:
For example, you pay nothing out-of-pocket for in-network annual physicals, immunizations, routine cancer screenings, and more.
Important note for Massachusetts residents: The Anthem Minimum Value Plan (MVP) doesn’t meet the Massachusetts state requirements for residents to have Creditable Coverage for health care. If you live in Massachusetts, you may want to choose a different coverage option in order to avoid the Massachusetts penalty for not having Creditable Coverage.
Contact Info
Documents
Money-saving Tip
A Health Care Flexible Spending Account (FSA) lets you take advantage of tax-free savings when paying for care. But, be sure to plan your FSA contributions carefully: the money in your FSA does not carry over to the next plan year; you must “use it or lose it.”
Anthem Minimum Value (MVP)
| Anthem Minimum Value (MVP) | |
|---|---|
| In-Network | |
| Annual Deductible | |
| Individual | None |
| Family | |
| Out of Pocket Maximum | |
| Individual | $8,550 |
| Family | $15,000 |
| Coinsurance | None |
| Services | |
| Preventive Care | Covered at 100% |
| Office Visit - PCP | $25 copay |
| Office Visit - Specialist | $40 copay |
| X-ray | $50 copay (not covered if provided at a hospital as an outpatient service) |
| Laboratory | $50 copay (not covered if provided at a hospital as an outpatient service) |
| Diagnostic Complex Imaging | $400 copay (not covered if provided at a hospital as an outpatient service) |
| Inpatient Hospitalization | 40%; after $500 copay (15 day maximum per year) |
| Outpatient - Ambulatory Surgical Center | $500; 1 per year |
| Outpatient - Hospital | 40%; 1 per year |
| Urgent Care | $200 copay |
| Emergency Room | $400 copay (non-emergencies - not covered) |
| Ambulance | $200 copay; 2 per year |
| Physical Therapy | $40 copay (12 visits per calendar year) |
| Chiropractic | $25 copay (12 visits per calendar year) |
| Pharmacy Benefits (provided by Express Scripts) | |
| Pharmacy - Retail | |
| Generic | $15 |
| Preferred | $30 |
| Non-Preferred | $75 |
| Pharmacy - Mail Order | |
| Generic | $30 |
| Preferred | $60 |
| Non-Preferred | $150 |
| Specialty Drugs | |
| Not covered | |
Prescription Drug Benefits through Express Scripts (ESI)
When you enroll in an Anthem medical plan you automatically receive prescription drug benefits through Express Scripts (ESI). All plan prescription drug benefits are administered through ESI.
Express Scripts prescription drug tiers
The cost of your prescription drugs depends on the tier of the medication:
- Generic — Generic drugs contain the same active ingredients as their brand-name equivalents and meet the same federal standards for safety, but typically cost significantly less.
- Preferred brand (or formulary) — Preferred brand name prescription drugs are favored by a prescription plan based on drug effectiveness and cost.
- Non-Preferred brand (or Non-formulary) — Non-Preferred brand name prescription drugs are not on a prescription plan's favored list (or formulary) based on drug effectiveness and cost. Non-Preferred drugs still may be covered, but may require prior authorization and cost more.
Mail order
You must use the mail order program or your local CVS pharmacy for maintenance medications, or you will pay an even higher amount or the full cost of any prescription after you fill two times at a retail pharmacy. On the third fill, you must fill your prescription in a 90-day supply either at a CVS pharmacy or through the Express Scripts Pharmacy. You can avoid paying the higher cost by choosing the three-month refill option either through home delivery from the Express Scripts Pharmacy or from a CVS pharmacy. You will pay the same copayment for your three-month supply whether you fill through home delivery from the Express Scripts Pharmacy or from a CVS Pharmacy.
Why use mail order:
- Prescriptions are shipped to you for free — no waiting in line at the pharmacy.
- You save money with a reduced cost for a three-month supply.
- You can set up automatic refills.
Save Money
The cost of prescription drugs is rising faster than many other health care services and supplies. But, there's a way for you to save on your cost of prescriptions.
Ask your doctor about generic medications. Generic medications are generally just as effective as brand-name medications, but they cost between 30% and 75% less.