Anthem Blue’s Local PPO Plan Terminates in 6 California Counties

Several beneficiaries from 6 California counties have been calling their local Health Insurance Counseling and Advocacy Program (HICAP) about their plan’s termination notice. These beneficiaries are enrolled in the Anthem Blue local PPO plan called Anthem Medicare Preferred Standard. They received a letter in late October letting them know that their plan is terminating as of December 31; it is not renewing their contract with Medicare for 2013. Yet this letter arrived 3 weeks past the October 2 deadline for plans to notify their enrollees of any non-renewal for next year. Furthermore, what makes this situation confusing for beneficiaries is that Anthem Blue is offering a new local PPO plan in 2013 with the exact same name (different plan ID number) but with much higher premiums and maximum out-of-pocket (MOOP) amounts.

If you know of affected beneficiaries in these counties (Sacramento, San Diego, San Francisco, San Mateo, Sonoma and Ventura), please help let them know that they need to actively choose their new coverage for the coming year. Because Anthem Blue’s 2012 local PPO is not renewing, plan members have a Special Election Period (SEP) to join a different Medicare Advantage plan (between December 8 and February 28) AND a guaranteed issue right to by a Medigap policy.

Below is a brief summary of their options:

Change to a different Medicare Advantage plan. Beneficiaries can make this change during the Annual Election Period (October 15 – December 7), or during their SEP (December 8 – February 28). Again, beneficiaries should be reminded that the new Anthem Blue local PPO is a different plan even though it has the same name. If a beneficiary wants the new Anthem Blue local PPO plan, they need to affirmatively enroll, understanding that the premium and maximum out-of-pocket (MOOP) amounts are higher. They will not be passively enrolled (or cross-walked) into the new Anthem Blue PPO.

Return to Original Medicare. Beneficiaries can go back to Original Medicare by enrolling in a stand-alone Part D plan during the Annual Election Period (AEP) or SEP. If they do nothing, they will be automatically enrolled in Original Medicare and not have prescription drug coverage as of January 1, 2013. Those who return to Original Medicare can also use their guaranteed issue right to buy a Medigap policy.

The chart below lists the 6 affected counties, the 2012 and 2013 plan numbers, and the 2012 and 2013 premium and MOOP amounts.

Beneficiaries with questions can contact their local Health Insurance Counseling and Advocacy Program (HICAP) at 1-800-434-0222.

County 2012 plan no. 2013 plan no. 2012 premium 2013 premium 2012 MOOP 2013 MOOP
Sacramento H8552-005 H8552-011 $131 $203 $3,400 $4,000
San Diego H8552-001 H8552-006 $0 $70 $3,400 $4,500
San Francisco H8552-002 H8552-008 $40 $85 $3,400 $3,800
San Mateo H8552-003 H8552-011 $106 $203 $3,400 $4,000
Sonoma H8552-002 H8552-009 $40 $105 $3,400 $4,400
Ventura H8552-001 H8552-007 $0 $41 $3,400 $4,500


Karen Joy Fletcher

Our blogger Karen Joy Fletcher is CHA’s Communications Director. With a Masters in Public Health from UC Berkeley, she is the online “public face” of the organization, provides technical expertise, writing and research on Medicare and other health care issues. She is responsible for digital content creation, management of CHA’s editorial calendar, and managing all aspects of CHA’s social media presence. She loves being a “communicator” and enjoys networking and collaborating with the passionate people and agencies in the health advocacy field. See her current articles.