Anthem Wisconsin
Plan Overviews
Starting in 2018, Anthem will reduce their ACA plans on the exchange
Beginning on January 1, 2018, they will offer just one “off exchange” individual health plan in Menominee County only. This doesn’t impact Anthem’s employer-based, Medicare Advantage, Dental, Vision or Medicaid plans, nor does it impact individuals or families whose plans are “grandfathered” or “grandmothered” (grandfathered plans must have been purchased prior to March 23, 2010, and grandmothered plans must have been purchased by December 2013).
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| Anthem Bronze Blue Priority WI 30% for HSA (2ESM) | Anthem Bronze Blue Priority WI 5450 (2ETB) | Anthem Bronze Blue Priority WI 40% for HSA (2ET8) | Anthem Bronze Blue Priority WI 0% for HSA (2ESJ) | |
| Network Name | Blue Priority-WI | Blue Priority-WI | Blue Priority-WI | Blue Priority – WI |
| Plan includes out-of-network coverage? | No | No | No | No |
| Individual Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim. | $5,150 | $5,450 | $5,500 | $6,550 |
| Individual Out-of-Pocket MaximumAn out-of-pocket maximum is the most you'll have to pay during a policy period (usually a year) for health care services | $6,550 | $7,150 | $6,550 | $6,550 |
| CoinsuranceWhat % you pay after your deductible has been met and before your out of pocket max | 30% | 30% | 40% | 0% |
| Preventative Care | No additional cost | No additional cost | No additional cost | No additional cost |
| Office Visit: PCP | Deductible, then 30% coinsurance | Deductible, then 30% coinsurance | Deductible, then 40% coinsurance | Deductible, then 0% coinsurance |
| Office Visit: Specialist | Deductible, then 30% coinsurance | Deductible, then 30% coinsurance | Deductible, then 40% coinsurance | Deductible, then 0% coinsurance |
| Outpatient diagnostic tests | Deductible, then 30% coinsurance | Deductible, then 30% coinsurance | Deductible, then 40% coinsurance | Deductible, then 0% coinsurance |
| Outpatient advanced diagnostic tests | Deductible, then $500 copay and 50% coinsurance | Deductible, then $500 copay and 50% coinsurance | Deductible, then 50% coinsurance | Deductible, then 0% coinsurance |
| Urgent Care | Deductible, then $150 copay and 30% coinsurance | Deductible, then $150 copay and 30% coinsurance | Deductible, then $150 copay and 40% coinsurance | Deductible, then 0% coinsurance |
| Emergency Room | Deductible, then $500 copay and 30% coinsurance | Deductible, then $500 copay and 30% coinsurance | Deductible, then $500 copay and 40% coinsurance | Deductible, then 0% coinsurance |
| Hospital: Inpatient Admission | Deductible, then $1,000 copay and 30% coinsurance | Deductible then $1,000 copay | Deductible, then $1,000 copay and 50% coinsurance | Deductible, then 0% coinsurance |
| Hosptial: Outpatient surgery hospital facility | Deductible, then 30% coinsurance | Deductible, then 30% coinsurance | Deductible, then 40% coinsurance | Deductible, then 0% coinsurance |
| Pharmacy deductible | Level 1 / Level 2 pharmacy
Tier 1, 2, 3, 4: Medical deductible applies |
Level 1 / Level 2 Pharmacy
Tier 1, 2, 3, 4: Medical deductible applies |
Level 1 / Level 2 Pharmacy
Tier 1, 2, 3, 4: Medical deductible applies |
Level 1 / Level 2 Pharmacy
Tier 1, 2, 3, 4: Medical deductible applies |
| Retail pharmacy tier 1: level 1 / level 2 | 30% coinsurance / 40% coinsurance | 30% coinsurance / 40% coinsurance | 40% coinsurance / 50% coinsurance | 0% coinsurance / 0% coinsurance |
| Retail pharmacy tier 2: level 1 / level 2 | 30% coinsurance / 50% coinsurance | 30% coinsurance / 50% coinsurance | 40% coinsurance / 50% coinsurance | 0% coinsurance / 0% coinsurance |
| Retail pharmacy tier 3: level 1 / level 2 | 40% coinsurance / 50% coinsurance | 40% coinsurance / 50% coinsurance | 40% coinsurance / 50% coinsurance | 0% coinsurance / 0% coinsurance |
| Retail pharmacy tier 4: level 1 / level 2 | 40% coinsurance / 50% coinsurance | 40% coinsurance / 50% coinsurance | 40% coinsurance / 50% coinsurance | 0% coinsurance / 0% coinsurance |
| Physical and occupational therapy | Deductible, then 30% coinsurance | Deductible, then 30% coinsurance | Deductible, then 40% coinsurance | Deductible, then 0% coinsurance |
| Speech therapy | Deductible, then 30% coinsurance | Deductible, then 30% coinsurance | Deductible, then 40% coinsurance | Deductible, then 0% coinsurance |
| Office Visit: chiropractic | Deductible, then 30% coinsurance | Deductible, then 30% coinsurance | Deductible, then 40% coinsurance | Deductible, then 0% coinsurance |
| Anthem Silver Blue Priority WI 1850 (2ETL) | Anthem Silver Blue Priority WI 2500 (2ESW) | Anthem Silver Blue Priority WI for HSA (2ET2) | Anthem Silver Blue Priority WI 3200 (2ESA) | Anthem Silver Blue Priority WI 3750 (2ESQ) | Anthem Silver Blue Priority WI 4000 (2ETE) | Anthem Silver Blue Priority WI 5300 (2ES4) | |
| Network Name | Blue Priority-WI | Blue Priority-WI | Blue Priority-WI | Blue Priority – WI | Blue Priority-WI | Blue Priority-WI | Blue Priority-WI |
| Plan includes out-of-network coverage? | No | No | No | No | No | No | No |
| Individual Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim. | $1,850 | $2,500 | $3,000 | $3,200 | $3,750 | $4,000 | $5,300 |
| Individual Out-of-Pocket MaximumAn out-of-pocket maximum is the most you'll have to pay during a policy period (usually a year) for health care services | $7,150 | $7,150 | $5,000 | $6,650 | $5,500 | $5,000 | $6,650 |
| CoinsuranceWhat % you pay after your deductible has been met and before your out of pocket max | 20% | 10% | 10% | 50% | 10% | 25% | 25% |
| Preventative Care | No additional cost | No additional cost | No additional cost | No additional cost | No additional cost | No additional cost | No additional cost |
| Office Visit: PCP | $40 copay per visit for the first 3 visits, then deductible and 20% coinsurance | $40 copay per visit for the first 3 visits, then deductible and 10% coinsurance | Deductible, then 10% coinsurance | $20 copay | $45 copay | $20 copay | $35 copay |
| Office Visit: Specialist | Deductible, then 0% coinsurance | Deductible, then 20% coinsurance | Deductible, then 10% coinsurance | Deductible, then 50% coinsurance | Deductible, then 10% coinsurance | Deductible, then 25% coinsurance | Deductible, then 25% coinsurance |
| Outpatient diagnostic tests | Deductible, then 20% coinsurance | Deductible, then 10% coinsurance | Deductible, then 10% coinsurance | Deductible, then 50% coinsurance | Deductible, then 10% coinsurance | Deductible, then 25% coinsurance | Deductible, then 25% coinsurance |
| Outpatient advanced diagnostic tests | Deductible, then $500 copay and 50% coinsurance | Deductible, then $500 copay and 50% coinsurance | Deductible, then $500 copay and 50% coinsurance | Deductible, then $500 copay and 50% coinsurance | Deductible, then $500 copay and 50% coinsurance | Deductible, then 50% coinsurance | Deductible, then $500 copay and 50% coinsurance |
| Urgent Care | Deductible, then $150 copay and 20% coinsurance | Deductible, then $150 copay and 10% coinsurance | Deductible, then $150 copay and 10% coinsurance | Deductible, then $150 copay and 50% coinsurance | Deductible, then $150 copay and 10% coinsurance | $150 copay | Deductible, then $150 copay and 25% coinsurance |
| Emergency Room | Deductible, then $500 copay and 20% coinsurance | Deductible then $500 copay and 10% coinsurance | Deductible, then $500 copay and 10% coinsurance | Deductible, then $500 copay and 50% coinsurance | Deductible, then $500 copay and 10% coinsurance | Deductible, then $500 copay and 25% coinsurance | Deductible, then $500 copay and 25% coinsurance |
| Hospital: Inpatient Admission | Deductible, then $750 copay and 50% coinsurance | Deductilbe, then $750 copay and 50% coinsurance | Deductible, then $750 copay and 50% coinsurance | Deductible, then $750 copay and 50% coinsurance | Deductible, then $750 copay and 50% coinsurance | Deductible, then $750 copay and 50% coinsurance | Deductible, then $750 copay and 50% coinsurance |
| Hosptial: Outpatient surgery hospital facility | Deductible, then 20% coinsurance | Deductible, then 10% coinsurance | Deductible, then 10% coinsurance | Deductible, then 50% coinsurance | Deductible, then 10% coinsurance | Deductible, then 25% coinsurance | Deductible, then 25% coinsurance |
| Pharmacy deductible | Level 1 / Level 2 pharmacy
Tier 1, 2: No deductible Tier 3, 4: Medical deductible applies |
Level 1 / Level 2 pharmacy
Tier 1, 2: No deductible Tier 3, 4: Medical deductible applies |
Level 1 / Level 2 Pharmacy
Tier 1, 2, 3, 4: Medical deductible applies |
Level 1 / Level 2 pharmacy
Tier 1, 2: No deductible Tier 3, 4: Medical deductible applies |
Level 1 / Level 2 pharmacy
Tier 1, 2: No deductible Tier 3, 4: Medical deductible applies |
Level 1 / Level 2 pharmacy
Tier 1: No deductible Tier 2, 3, 4: $1,000 Combined pharmacy deductible |
Level 1 / Level 2 pharmacy
Tier 1, 2: No deductible Tier 3, 4: Medical deductible applies |
| Retail pharmacy tier 1: level 1 / level 2 | $10 copay/$20 copay | $10 copay/$20 copay | 10% coinsurance / 20% coinsurance | $10 copay/$20 copay | $10 copay/$20 copay | $10 copay/$20 copay | $10 copay/$20 copay |
| Retail pharmacy tier 2: level 1 / level 2 | $50 copay/$60 copay | $40 copay/$50 copay | 10% coinsurance / 30% coinsurance | $40 copay/$50 copay | $40 copay/$60 copay | $40 copay/$50 copay | $40 copay/$50 copay |
| Retail pharmacy tier 3: level 1 / level 2 | 40% coinsurance / 50% coinsurance | 40% coinsurance / 50% coinsurance | 40% coinsurance / 50% coinsurance | 50% coinsurance / 50% coinsurance | 40% coinsurance / 50% coinsurance | 40% coinsurance / 50% coinsurance | 40% coinsurance / 50% coinsurance |
| Retail pharmacy tier 4: level 1 / level 2 | 40% coinsurance / 50% coinsurance | 40% coinsurance / 50% coinsurance | 40% coinsurance / 50% coinsurance | 50% coinsurance / 50% coinsurance | 40% coinsurance / 50% coinsurance | 40% coinsurance / 50% coinsurance | 40% coinsurance / 50% coinsurance |
| Physical and occupational therapy | Deductible, then 20% coinsurance | Deductible, then 10% coinsurance | Deductible, then 10% coinsurance | Deductible, then 50% coinsurance | Deductible, then 10% coinsurance | Deductible, then 25% coinsurance | Deductible, then 25% coinsurance |
| Speech therapy | Deductible, then 20% coinsurance | Deductible, then 10% coinsurance | Deductible, then 10% coinsurance | Deductible, then 50% coinsurance | Deductible, then 10% coinsurance | Deductible, then 25% coinsurance | Deductible, then 25% coinsurance |
| Office Visit: chiropractic | $40 copay per visit for the first 3 visits, then deductible and 20% coinsurance | $40 copay per visit for the first 3 visits, then deductible and 10% coinsurance | Deductible, then 10% coinsurance | $20 copay | $45 copay | $20 copay | $35 copay |
| Anthem Catastrophic Blue Priority WI 7150 (2ESG) | |
| Network Name | Blue Priority-WI |
| Plan includes out-of-network coverage? | No |
| Individual Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim. | $7,150 |
| Individual Out-of-Pocket MaximumAn out-of-pocket maximum is the most you'll have to pay during a policy period (usually a year) for health care services | $7,150 |
| CoinsuranceWhat % you pay after your deductible has been met and before your out of pocket max | 0% |
| Preventative Care | No additional cost |
| Office Visit: PCP | $40 copay per visit for the first 3 visits, then deductible and 0% coinsurance |
| Office Visit: Specialist | Deductible, then 0% coinsurance |
| Outpatient diagnostic tests | Deductible, then 0% coinsurance |
| Outpatient advanced diagnostic tests | Deductible, then 0% coinsurance |
| Urgent Care | Deductible, then 0% coinsurance |
| Emergency Room | Deductible, then 0% coinsurance |
| Hospital: Inpatient Admission | Deductible, then 0% coinsurance |
| Hosptial: Outpatient surgery hospital facility | Deductible, then 0% coinsurance |
| Pharmacy deductible | Level 1 / Level 2 pharmacy
Tier 1, 2, 3, 4: Medical deductible applies |
| Retail pharmacy tier 1: level 1 / level 2 | 0% coinsurance / 0% coinsurance |
| Retail pharmacy tier 2: level 1 / level 2 | 0% coinsurance / 0% coinsurance |
| Retail pharmacy tier 3: level 1 / level 2 | 0% coinsurance / 0% coinsurance |
| Retail pharmacy tier 4: level 1 / level 2 | 0% coinsurance / 0% coinsurance |
| Physical and occupational therapy | Deductible, then 0% coinsurance |
| Speech therapy | Deductible, then 0% coinsurance |
| Office Visit: chiropractic | $40 copay per visit for the first 3 visits, then deductible and 0% coinsurance |
When you begin shopping for a Marketplace health plan, you’ll see plan options with different metal tiers such as Gold, Silver and Bronze plans. But the only difference between these plans is how much premium you’ll pay each month and how much you’ll pay for certain medical services. A Bronze plan typically gives you lower monthly premium payments, but potentially higher out-of-pocket costs – if you end up needing a lot of care. And a Gold plan may have higher monthly premiums, but that helps you limit your out-of-pocket costs later. If you’re looking for a balance on your monthly premium payments and your out-of-pocket costs, Silver plans provide just that. And, Silver plans are the only plans with additional out-of-pocket payment reductions (cost sharing reductions)! This helps lower the costs of your copays, deductibles and coinsurance. So, if you are eligible for a subsidy and cost sharing, Silver plans offer the highest value.
Dental Plans
| Benefit Frequency | Cost Share | |
|---|---|---|
| Eye Exam | Once every 12 months | $20 copay |
| Standard plastic (CR39) lenses | Once every 24 months | |
| Single Vision | $20 copay | |
| Bifocal | $20 copay | |
| Trifocal | $20 copay | |
| Contact lenses: | Once every 24 months | |
| Elective (conventional and disposable) | $80 allowance | |
| Non-elective | Covered in full | |
| Frames | Once every 24 months | $130 allowance |
FAQ
Q: I have an Anthem individual ACA health plan — when do I have to find new coverage?
A: Nothing is changing with your Anthem ACA health plan in 2017. Later this year, you’ll have to shop for a new plan for 2018. You’ll do this during the open enrollment period starting November 1. Affected members will receive an official notice that their plan is ending, along with information on options for next year. We’ll help you connect with the right people to find a new plan.
Q: I didn’t switch to an ACA plan, my individual health plan is grandfathered/grandmothered. Does this affect me?
A: No, this change affects Anthem’s ACA individual health plans only.
Q: Is Anthem also discontinuing individual dental and vision plans in Wisconsin?
A: No, this change affects Anthem’s individual ACA health plans only. We’ll continue to offer dental and vision plans in Wisconsin.
Q: I get health benefits from my employer. Does this affect me?
A: No, this change affects Anthem’s individual ACA health plans only. Plans sponsored by employers are not impacted.
Q: I have an Anthem Medicare plan. Does this affect me?
A: No, this change affects Anthem’s individual ACA health plans only. Anthem’s Medicare plans are not impacted.
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Contact Us
New Enrollments:
Phone: (312) 726-6565
Email: [email protected]