Anthem Extra Help (HMO-POS) 2025 Plan Details for Toombs County, Georgia Residents
Anthem Extra Help (HMO-POS) 2025 Plan Details for Toombs County, Georgia Residents
When selecting a Medicare Advantage plan in Toombs County for 2025, it's important to compare all your options. Anthem Extra Help (HMO-POS) is among the plans you can review side-by-side with others, ensuring you find the coverage that suits your needs. You can easily enroll online or reach out to a licensed agent for personalized guidance.
As of May 31, 2025, plan enrollments topped 2,564 members, with 13 in Toombs County, Georgia.
Anthem Extra Help Overview
| Plan ID H5422-013-0 Overview | |
|---|---|
| Health Plan ID: | H5422-013-0 |
| Medicare Advantage Plan Type: | HMO-POS |
| Plan Year: | 2025 |
| Monthly Premium: | $38.60 Plus your Medicare Part B premium. |
| Health Plan Deductible: | $0.00 |
| Annual Out-of-Pocket Maximum: | $5,900.00 (In-Network) |
| Part B Give Back: | $0.00/mo |
| Part D Drug Plan Benefit: | Enhanced, $590.00 deductible |
| Additional Benefits: | Dental, Vision, Hearing |
| Availability: | Toombs County, GA |
| Insured By: | Anthem Blue Cross and Blue Shield |
Explore the Benefits of Anthem Extra Help
Looking for flexibility without giving up full coverage? This Medicare Advantage MAPD HMO-POS plan includes hospital, medical, and prescription drug benefits — all for a monthly premium of $38.60. It offers the full range of Medicare Part A and Part B services, plus drug coverage to help manage routine prescriptions. The annual Part D deductible is $590.00. With this plan, you can receive care from both in-network and out-of-network providers, though you’ll typically save more by staying in-network.
Primary care visits have a $0 copay, specialist visits come with a $15 copay, urgent care services carry a $25 copay, and ambulance transportation is $255 copay. These costs apply toward the plan’s annual maximum out-of-pocket (MOOP) limit of $5,900.00 . Once you reach that limit, in-network care is fully covered — offering financial protection and peace of mind.
Registered with CMS under plan ID H5422-013-0, Anthem Extra Help is a strong pick for those who want flexibility with cost predictability baked in. You’ll find a summary of cost sharing below. Still have questions? Check the FAQ section.
| We're Here to Help You Enroll |
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Out-of-Pocket Costs
Anthem Extra Help includes cost-sharing, which refers to the out-of-pocket expenses you'll incur when accessing approved healthcare services. The table below outlines the most common in-network out-of-pocket costs for plan H5422-013-0.
Find out the costs for visiting your primary care doctor and specialists, as well as coverage for wellness and preventive programs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Primary: | $0 Copay |
| Specialist: | $15 Copay Prior Authorization Required |
Review the costs for emergency services, urgent care, ambulance services, inpatient hospital stays, and skilled nursing facility care.
| Service | Enrollee Cost |
|---|---|
| Emergency room care: | $125 Copay |
| Urgent care: | $25 Copay |
| Ground ambulance: | $255 Copay |
| Inpatient hospital care: | $295.00 per day for days 1 through 7 $0.00 per day for days 8 and beyond |
| Skilled Nursing Facility: | $0.00 per day for days 1 through 20 $214.00 per day for days 21 and beyond |
This section covers Medicare-approved foot care services, including exams and routine foot care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Foot Exams and Treatments (Medicare-covered): | $15 Copay Prior Authorization Required |
| Routine Foot Care: | $0 Copay Prior Authorization Required |
Understand the coverage for Medicare-approved chiropractic services and routine chiropractic care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Medicare-covered chiropractic: | $20 Copay Prior Authorization Required |
| Routine chiropractic: | Not Covered |
This section explains the costs for mental health services, including individual and group therapy, and inpatient care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Outpatient individual therapy: | $15 Copay |
| Outpatient group therapy: | $15 Copay |
| Inpatient psychiatric hospital care: | $295.00 per day for days 1 through 7 $0.00 per day for days 8 and beyond |
See the cost details for rehabilitation services, including physical therapy, speech therapy, and occupational therapy.
| Service | Enrollee Cost (in-network) |
|---|---|
| Physical therapy and speech and language therapy: | $15 Copay Prior Authorization Required |
| Occupational therapy: | $15 Copay Prior Authorization Required |
Learn about the costs associated with medical equipment and supplies, including diabetes supplies, durable medical equipment, and prosthetics.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diabetes supplies: | $0 Copay |
| Durable medical equipment: | 20% Coinsurance Prior Authorization Required |
| Prosthetics: | 20% Coinsurance |
This section outlines the costs for diagnostic services, lab tests, x-rays, and other imaging services.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diagnostic radiology services: | $295 Copay Prior Authorization Required |
| Lab services: | $15 Copay Prior Authorization Required |
| Outpatient x-rays: | $125 Copay Prior Authorization Required |
| Diagnostic tests and procedures: | $175 Copay Prior Authorization Required |
Review the cost-sharing details for chemotherapy and other Medicare Part B-covered drugs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Chemotherapy: | 20% Coinsurance |
| Other Part B drugs (Medicare-covered): | 20% Coinsurance |
This section details the dental services covered under your plan including, Medicare-covered preventive dental, oral exams, x-rays, dental cleanings, and comprehensive dental.
| Service | Member Cost (in-network) |
|---|---|
| Medicare Covered Preventive Dental | $0 Copay Prior Authorization Required |
| Oral exam | $0 Copay |
| Dental x-rays | $0 Copay |
| Cleaning | $0 Copay |
| Periodontics | Not Covered |
| Endodontics | Not Covered |
| Restorative Services | Not Covered |
This section outlines the coverage for hearing-related services, including exams, fittings, and hearing aids.
| Service | Member Cost (in-network) |
|---|---|
| Fitting/evaluation | $0 Copay Prior Authorization Required |
| Hearing aids | Covered Limits may apply |
| Hearing exam | $0 Copay Prior Authorization Required |
Learn about the costs for vision-related services, including eye exams, eyeglasses, and contact lenses.
| Service | Member Cost (in-network) |
|---|---|
| Medicare-covered eye exam (in-network) | $0 to $15 Copay |
| Routine eye exam (in-network) | $0 Copay 1 Every year |
| Eyewear benefits | Eyeglasses: Yes Contact Lenses: Yes Eyeglass Lenses: Yes Eyeglass Frames: Yes Eyewear Upgrades: Yes |
Maximum eyewear benefit: | $250.00 Every year |
Certain preventive services are covered 100% by Anthem Extra Help as a Part B benefit.
Part D Prescription Drug Costs & Benefits
Anthem Extra Help includes an enhanced benefit Medicare Part D plan (PDP), which offers greater coverage than basic plans. An enhanced benefit plan has a higher actuarial value, meaning it covers a larger percentage of your healthcare costs.
Part D Plan Premium
The Part D prescription drug plan premium is included in your overall Medicare Advantage plan cost. However, additional expenses or subsidies may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help. LIS, provided by Social Security, helps those with limited income and resources to lower or eliminate Part D costs. LIS benefits are not part of Medicare Advantage coverage.
| Basic Part D Premium: | $38.60 |
|---|---|
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $38.60 |
| Low-Income Premium Subsidy: | ${part_d_lips_amount} |
| Low-Income Premium Subsidy Paid by CMS: | $38.60 |
| Low-Income Subsidy Premium: | $0.00 |
For more details, visit the Social Security Extra Help program.
Prescription Drug Plan Deductible
This plan has a $590.00 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 Extra Help 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 | $0.00 |
| Generic | 25.00% | 25.00% |
| Preferred Brand | 25.00% | 25.00% |
| Non-Preferred Drug | 25.00% | 25.00% |
| Specialty Tier | 25.00% | 25.00% |
| Select Care Drugs* | $0.00 | $0.00 |
| *Deductible does not apply. | ||
CMS 5-Star Rating Overview
Each year, the Centers for Medicare & Medicaid Services (CMS) evaluates health and drug plans using a comprehensive 5-star rating system. These ratings offer valuable insights into the quality of care, member satisfaction, and overall plan performance.
When selecting a Medicare Advantage plan, looking at the star ratings can help you gauge how well a plan might meet your healthcare needs, making it easier to choose a plan with confidence.
| CMS Measure | Star Rating |
|---|---|
| 2025 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 | Not enough data available |
| Drug Safety and Accuracy of Drug Pricing |
If you are new to Medicare or Medicare Advantage plans, the following information will help you understand the enrollment process and restrictions.
Eligibility Requirements for Anthem Extra Help
To enroll in Anthem Extra Help , you must meet the following criteria:
- Be eligible for Medicare Part A and Part B.
- Reside in the plan’s service area.
If you meet these requirements, you are eligible to enroll in Anthem Extra Help and benefit from its comprehensive coverage options.
Enrollment Periods for Anthem Extra Help
Knowing when you can enroll in Anthem Extra Help is essential. Here are the main enrollment periods:
- Initial Enrollment Period (IEP): Your IEP starts three months before your 65th birthday and ends three months after, giving you a seven-month window to enroll in Medicare.
- Annual Enrollment Period (AEP): The AEP, from October 15 to December 7, allows you to make changes to your Medicare Advantage plan if you are currently enrolled in a Medicare Advantage plan.
- Medicare Advantage Open Enrollment Period (MA OEP): Running from January 1 to March 31, the MA OEP lets you switch plans or return to Original Medicare if you are currently enrolled in a Medicare Advantage plan.
- Special Enrollment Periods (SEPs): Life events such as moving or losing coverage may qualify you for a SEP, enabling you to enroll or make changes outside the usual periods.
If you're uncertain about the right time to enroll, Call HealthCompare (our trusted enrollment partner) at 1-833-748-3201 (TTY 711) for guidance from a licensed insurance agent.
How to Sign Up for Anthem Extra Help
Joining Anthem Extra Help is straightforward. Here are the steps you can take:
- Online: Use our online enrollment partner's Secure Online Enrollment Form to sign up.
- By Phone: Reach out to HealthCompare (our trusted enrollment partner) at 1-833-748-3201 (TTY 711). A licensed insurance agent will help you with the enrollment process and answer any questions you might have.
- Through Medicare.gov: Enroll directly through the official Medicare website. Visit Medicare.gov, log in or create an account, and follow the steps to join Anthem Extra Help .
- Direct Enrollment: You can also choose to enroll directly with Anthem Extra Help . The contact information can be found below in the "Contact" section.
Make sure you enroll during the appropriate period to activate your coverage as soon as possible.
Here are some of the most frequently asked questions people have about plan ID H5422-013-0:
How much does H5422-013-0 cost per month?
Members pay their Part B premium and the plan's of $38.60 per month to be in this 2025 plan.
What is the annual out-of-pocket maximum on this plan?
Your costs top out at $5,900.00 (for in-network services) in 2025; after that the plan pays 100% of covered services.
How much do I pay before drug coverage starts?
You’ll pay the first $590.00 in drug costs before coinsurance kicks in.
What’s the CMS star score for Anthem Extra Help ?
The latest CMS score is ★3.5 out of 5 stars; anything 4 or higher earns quality bonuses.
How many people are enrolled in this plan?
As of last month, about 2,564 beneficiaries are enrolled.
Contact 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)668-2261 |
| New Member Health Plan TTY: | 711 |
| New Member Part D Help: | (833)668-2269 |
| New Member Part D TTY Users: | 711 |
If you're eligible for Medicare but haven't enrolled or need to verify your enrollment status, visit the Social Security Administration website. For more information about Medicare Advantage, visit medicare.gov.
- Anthem Blue Cross and Blue Shield, https://shop.anthem.com/medicare, Last Accessed June 1, 2025
- CMS.gov, "Medicare Advantage Plan Fact Sheet", Last Accessed 25 May, 2025
- Medicare.gov, "Joining a plan", Last Accessed 25 May, 2025
- Medicare.gov, "Your coverage options", Last Accessed 25 May, 2025
- CMS.gov, Landscape Source Files, Last Accessed October 15, 2024
- CMS.gov, Medicare Part C & D Performance, Last Accessed October 15, 2024
- CMS.gov, Plan Benefits Package, Last Accessed October 15, 2024
- CMS.gov, Monthly Enrollment by Contract/Plan/State/County, Last Accessed June 6, 2025
Medicare Advantage and Part D plans and benefits offered by: Aetna Medicare, Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Baylor Scott & White Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, GlobalHealth, Health Care Service Corporation, Healthy Blue, HealthSun, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.