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PW_E226847
 
2018 Medicare Advantage Summary of Benefits (SOB) and Evidence of Coverage (EOC) for Individual Medicare Advantage Products. If the product you are searching for is not on the list below, then please call the number on the back of the member’s ID card for EOC and SOB information. 
 
Colorado  

Anthem MediBlue Plus (HMO) 
     
Larimer, Pueblo, Weld, El Paso 
EOC  
SOB  
Denver, Boulder, Broomfield, Arapahoe, Douglas, Adams 
EOC  
SOB  
Anthem MediBlue Access (PPO) 
EOC  
SOB  
Anthem MediBlue Dual Advantage (HMO SNP) 
EOC  
SOB  
MedicareRx Standard (PDP) 
EOC  
SOB  
MedicareRx Plus (PDP) 
EOC  
SOB  
MedicareRx Premier (PDP) 
EOC  
SOB  
 
Connecticut  

Anthem MediBlue Plus (HMO) 
     
Middlesex, Litchfield, Windham, New Haven, Fairfield 
EOC  
SOB  
Hartford 
EOC  
SOB  
Anthem MediBlue Select (HMO) 
     
Middlesex, Litchfield, Windham, New Haven, Fairfield 
EOC  
SOB  
Hartford 
EOC  
SOB  
Anthem MediBlue Dual Advantage (HMO SNP) 
EOC  
SOB  
 
Indiana  

Anthem MediBlue Plus (HMO) 
     
Gibson, Huntington, Parke, Clinton, Posey, Sullivan, Vanderburgh, Vigo, Allen, Miami, Steuben, Adams, Clay, Dearborn, Howard, Tipton, Whitley, Noble, Ripley, De Kalb, Wabash, Warrick, Wells 
EOC  
SOB  
Marshall, Lake, Elkhart, Kosciusko, Lagrange, St. Joseph, La Porte, Porter, Starke 
EOC  
SOB  
Brown, Putnam, Montgomery, Shelby, Decatur, Hendricks, Tippecanoe, Madison, Marion, Clark, Hamilton, Bartholomew, Boone, Floyd, Henry, Johnson, Hancock, Jefferson 
EOC  
SOB  
Anthem MediBlue Access (PPO) 
EOC  
SOB  
Anthem MediBlue Access Basic (Regional PPO) 
EOC  
SOB  
Anthem MediBlue Dual Advantage (HMO SNP) 
EOC  
SOB  
MedicareRx Standard 
EOC  
SOB  
MedicareRx Plus 
EOC  
SOB  
MedicareRx Premier 
EOC  
SOB  
 
Kentucky  

Anthem MediBlue Plus (HMO) 
EOC  
SOB  
Anthem MediBlue Access (PPO) 
     
Campbell, Elliott, Nicholas, Owen, Scott, Bourbon, McCracken, Pendleton, Fayette, Madison, Carroll, Bath, Grant, Boone, Edmonson, Franklin, Gallatin, Jessamine, Kenton, Metcalfe, Montgomery, Warren, Clark, Woodford, Anderson, Bracken, Estill, Harrison, Livingston, Mason 
EOC  
SOB  
Breckinridge, Meade, Nelson, Oldham, Hardin, Henry, Webster, Bullitt, Shelby, Larue, McLean, Daviess, Jefferson, Trimble, Henderson, Spencer 
EOC  
SOB  
Anthem MediBlue Access Basic (Regional PPO) 
EOC  
SOB  
Anthem MediBlue Dual Advantage (HMO SNP) 
EOC  
SOB  
MedicareRx Standard 
EOC  
SOB  
MedicareRx Plus 
EOC  
SOB  
MedicareRx Premier 
EOC  
SOB  
 
Maine  

Anthem MediBlue Choice (HMO-POS) 
     
Cumberland, Kennebec, Knox, Androscoggin, York 
EOC  
SOB  
Penobscot 
EOC  
SOB  
Anthem MediBlue Choice (HMO) 
     
Cumberland, Kennebec, Knox, Androscoggin, York 
EOC  
SOB  
Penobscot 
EOC  
SOB  
Anthem MediBlue Access (PPO) 
EOC  
SOB  
Anthem MediBlue Dual Advantage (HMO SNP) 
EOC  
SOB  
MedicareRx Standard 
EOC  
SOB  
MedicareRx Plus 
EOC  
SOB  
MedicareRx Premier 
EOC  
SOB  
 
Missouri  

Anthem MediBlue Plus (HMO) 
EOC  
SOB  
Anthem MediBlue Access (PPO) 
EOC  
SOB  
Anthem MediBlue Dual Advantage (HMO SNP) 
EOC 
SOB 
MedicareRx Value 
EOC  
SOB  
MedicareRx Plus 
EOC  
SOB  
MedicareRx Premier 
EOC  
SOB  
 
New Hampshire  

Anthem MediBlue Coordination Plus (HMO) 
EOC  
SOB  
Anthem MediBlue Plus (HMO) 
     
Rockingham, Hillsborough 
EOC  
SOB  
Merrimack, Cheshire, Strafford 
EOC  
SOB  
Anthem MediBlue Access (PPO) 
EOC  
SOB  
MedicareRx Standard 
EOC  
SOB  
MedicareRx Plus 
EOC  
SOB  
MedicareRx Premier 
EOC  
SOB  
 
Ohio  

Anthem MediBlue Essential (HMO) 
     
Darke, Lake, Ottawa, Ross, Wayne, Fulton, Geauga, Highland, Seneca, Adams, Hancock, Marion, Clark, Cuyahoga, Lawrence, Morrow, Mercer, Ashland, Ashtabula, Auglaize, Champaign, Clinton, Franklin, Licking, Medina, Richland, Sandusky, Washington, Williams, Allen, Clermont, Crawford, Pickaway, Van Wert, Warren, Defiance, Erie, Fairfield, Fayette, Huron, Jefferson, Lorain, Madison, Scioto 
EOC  
SOB  
Miami, Portage, Stark, Summit, Belmont, Brown, Columbiana, Muskingum, Delaware, Preble, Tuscarawas, Wood, Trumbull, Butler, Mahoning, Carroll, Lucas, Montgomery, Shelby, Union, Greene, Hamilton 
EOC  
SOB  
Anthem MediBlue Plus (HMO) 
EOC  
SOB  
Anthem MediBlue Prime Select (HMO) 
EOC  
SOB  
Anthem MediBlue Access (PPO) 
     
Adams, Darke, Huron, Morrow, Allen, Butler, Crawford, Marion, Mercer, Van Wert, Defiance, Fairfield, Highland, Jefferson, Seneca, Wood, Clinton, Pickaway, Tuscarawas, Ashtabula, Auglaize, Champaign, Ottawa, Scioto, Washington, Williams, Franklin, Fulton, Richland, Clark, Fayette, Hamilton, Hancock, Ross, Erie, Lawrence, Union 
EOC  
SOB  
Sandusky, Miami, Trumbull, Lorain, Cuyahoga, Muskingum 
EOC  
SOB  
Carroll, Stark, Columbiana 
EOC  
SOB  
Summit, Montgomery, Delaware, Geauga, Lake, Preble, Greene 
EOC  
SOB  
Belmont 
EOC  
SOB  
Ashland, Wayne, Brown, Clermont, Mahoning, Madison, Portage, Medina, Shelby, Licking, Warren, Lucas 
EOC  
SOB  
Anthem MediBlue Access Basic (Regional PPO) 
EOC  
SOB  
Anthem MediBlue Access Core (Regional PPO) 
EOC  
SOB  
 
Anthem MediBlue Access Plus (PPO) 
     
Belmont 
EOC  
SOB  
Stark, Carroll, Columbiana 
EOC  
SOB  
Muskingum, Lorain, Miami, Cuyahoga, Sandusky, Trumbull  
EOC  
SOB  
Delaware, Geauga, Lake, Preble, Greene, Montgomery, Summit 
EOC  
SOB  
Anthem MediBlue Dual Advantage (HMO SNP) 
EOC  
SOB  
MedicareRx Standard 
EOC  
SOB  
MedicareRx Plus 
EOC  
SOB  
MedicareRx Premier 
EOC  
SOB  
 
Virginia  

Anthem MediBlue Plus (HMO) 
     
Chesapeake City, Hampton City, Norfolk City, Suffolk City, James City, Newport News City, Virginia Beach City, Portsmouth City 
EOC  
SOB  
Fairfax, Loudoun, Alexandria City, Arlington, Prince William 
EOC  
SOB  
Anthem MediBlue Access (PPO) 
EOC  
SOB  
Anthem MediBlue Dual Advantage (HMO SNP) 
     
Henrico, Hampton City, Loudoun, Portsmouth City, Spotsylvania, Suffolk City, Fairfax, Fairfax City, Alexandria City, Arlington, Chesapeake City, Goochland, James City, Norfolk City, Prince William, Richmond City, Newport News City, Roanoke City, Virginia Beach City, Chesterfield, Roanoke 
EOC  
SOB  
Alleghany, Bath, Falls Church City, Floyd, Franklin, Franklin City, King and Queen, Lancaster, Lunenburg, Northumberland, Orange, York, Brunswick, Culpeper, Dinwiddie, King William, Madison, Buena Vista City, Cumberland, Fredericksburg City, Caroline, Greene, Greensville, Petersburg City, Buckingham, Emporia City, Fluvanna, Giles, Hopewell City, Mathews, Mecklenburg, Nelson, Stafford, Williamsburg City, Craig, Hanover, Manassas City, Surry, Amelia, Botetourt, Colonial Heights City, Fauquier, Middlesex, Northampton, Powhatan, Prince George, Rockbridge, Charles City, Covington City, Essex, Highland, Isle of Wight, Lexington City, Poquoson City, Southampton, Sussex, Gloucester, King George, Louisa, New Kent, Nottoway, Patrick, Richmond 
EOC  
SOB  
MedicareRx Standard 
EOC  
SOB  
MedicareRx Plus 
EOC  
SOB  
MedicareRx Premier 
EOC  
SOB  
 
Wisconsin  

Anthem MediBlue Plus (HMO) 
     
Langlade, Marinette, Marathon, Milwaukee, Taylor, Lincoln, Jefferson, Kenosha, Portage, Waukesha 
EOC  
SOB  
Brown, Calumet, Fond du Lac, Oconto, Outagamie, Kewaunee, Winnebago, Manitowoc 
EOC  
SOB  
Anthem MediBlue Access (PPO) 
     
Manitowoc, Brown, Jefferson, Rock, Calumet, Milwaukee, Outagamie, Ozaukee, Green Lake, Taylor, Winnebago, Shawano, Walworth, Kewaunee, Lincoln, Langlade, Washington, Waukesha, Fond du Lac, Kenosha, Sheboygan, Dodge, Marinette, Waupaca 
EOC  
SOB  
Waushara, Marathon, Oconto, Portage 
EOC  
SOB  
Anthem MediBlue Access Core (PPO) 
EOC  
SOB  
 
Anthem MediBlue Dual Advantage (HMO SNP) 
EOC  
SOB  
MedicareRx Standard 
EOC  
SOB  
MedicareRx Plus 
EOC  
SOB  
MedicareRx Premier 
EOC  
SOB  
 
 

©2005-2019 copyright of Anthem Insurance Companies, Inc.

Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. HMO plans are administered by Anthem Health Plans of New Hampshire, Inc. and underwritten by Matthew Thornton Health Plan, Inc. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin (BCBSWI), underwrites or administers PPO and indemnity policies and underwrites the out of network benefits in POS policies offered by Compcare Health Services Insurance Corporation (Compcare) or Wisconsin Collaborative Insurance Corporation (WCIC). Compcare underwrites or administers HMO or POS policies; WCIC underwrites or administers Well Priority HMO or POS policies. Independent licensees of the Blue Cross and Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Use of the Anthem Web sites constitutes your agreement with our Terms of Use