Anthem Kidney Care (C-SNP) Plan Details for Greene County, GA
This page provides coverage and cost details for Anthem Blue Cross and Blue Shield’s H5422-015-0 Medicare SNP plan for 2025. Enrollment is subject to eligibility.
*CMS rated this Anthem Blue Cross and Blue Shield plan (H5422-015-0) 3.5 (Above Average) out of 5 stars.
This private health insurance option offers all of the same basic benefits as Original Medicare, but out-of-pocket costs are different. It may include additional benefits that Medicare Part A and Part B do not cover.
Individuals must meet all Chronic or Disabling Condition SNP qualification requirements to join this C-SNP plan.
Anthem Kidney Care Basic Plan Details
- Plan ID
- H5422-015-0
- Plan Type
- HMO-POS C-SNP
- Plan Year
- 2025
- Premium
- $0.00/mo
Plus your Medicare Part B premium. - Health Plan Deductible
- $0.00
- Out-of-Pocket Maximum
- 5,900.00 /yr (in-network)
- Part B Reduction
- $0.00/mo
- Drug Plan Benefit
- Enhanced
$0.00 deductible - Supplemental Benefits
- Vision, Hearing
- Availability
- Greene County, GA
- Insured By
- Anthem Blue Cross and Blue Shield
| Summary of Benefits |
|---|
Health Plan Out-of-Pocket Costs
The following table is a summary of the most common out-of-pocket costs you will incur if you join this Anthem Blue Cross and Blue Shield plan:
Doctor's Office Visits
- Primary
- $0 Copay
- Specialist
- $40 Copay
Prior Authorization Required
Emergency, Urgent, and Inpatient Hospital Coverage
- Emergency room care
- $125 Copay
- Urgent care
- $50 Copay
- Ground ambulance
- $220 Copay
- Inpatient hospital care
- $325.00 per day for days 1 through 5
$0.00 per day for days 6 and beyond - Skilled Nursing Facility
- $0.00 per day for days 1 through 20
$214.00 per day for days 21 and beyond
Foot Care
- Foot Exams and Treatments (Medicare-covered)
- $40 Copay
Prior Authorization Required - Routine Foot Care
- $0 Copay
Prior Authorization Required
Chiropractic Care
- Medicare-covered chiropractic
- $20 Copay
Prior Authorization Required - Routine chiropractic
- $20 Copay
Prior Authorization Required
Mental Health Services
- Outpatient individual therapy
- $40 Copay
- Outpatient group therapy
- $40 Copay
- Inpatient psychiatric hospital care
- $325.00 per day for days 1 through 5
$0.00 per day for days 6 and beyond
Rehabilitation Services
- Physical therapy and speech and language therapy
- $40 Copay
Prior Authorization Required - Occupational therapy
- $40 Copay
Prior Authorization Required
Medical Equipment and Supplies
- Diabetes supplies
- $0 Copay
- Durable medical equipment
- 20% Coinsurance
Prior Authorization Required - Prosthetics
- 20% Coinsurance
Diagnostics, Lab Services, and Imaging
- Diagnostic radiology services
- $325 Copay
Prior Authorization Required - Lab services
- $10 Copay
Prior Authorization Required - Outpatient x-rays
- $125 Copay
Prior Authorization Required - Diagnostic tests and procedures
- $175 Copay
Prior Authorization Required
Medicare Part B Drugs
- Chemotherapy
- 20% Coinsurance
- Other Part B drugs (Medicare-covered)
- 20% Coinsurance
Dental Services
- 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
- Maximum dental benefit
- $2,000.00 (Every year)
Hearing Aids and Services
- Fitting/evaluation
- Covered
Limits may apply - Hearing aids
- Covered
Limits may apply - Hearing exam
- Covered
Limits may apply
Vision Services
- Medicare-covered eye exam
- $ to $40 Copay
- Routine eye exam
- $0 Copay
1 Every year - Eyewear benefits
- None
Prescription Drug Costs & Benefits
Anthem Kidney Care includes enhanced benefit Medicare Part D. Enhanced benefits offer greater coverage than basic, typically providing lower cost-sharing, broader drug coverage, and additional benefits, such as covering drugs not included in the standard formulary. These plans usually have higher premiums due to the extra coverage and flexibility they provide, but they cover a larger percentage of overall drug costs.
As of 2023, approximately 75% of people on Medicare are enrolled in enhanced plans.
Prescription Drug Premium with Extra Help
Extra Help is a Social Security program that helps people with limited income and resources lower or cut Part D costs. The following table outlines premium assistance details with Extra Help.
| Low Income Premium Subsidy: | ${part_d_lips_amount} |
|---|---|
| Low Income Premium Subsidy CMS Pays: | $0.00 |
| Low Income Subsidy Premium: | $0.00 |
If you would like more information about the Extra Help program, you can refer to the Social Security Extra Help page.
Prescription Drug Deductible
The Medicare Part D annual deductible with this plan is $0.00. You must pay this amount at the pharmacy before Anthem Blue Cross and Blue Shield begins paying its share.
Prescription Drug Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, Anthem Kidney Care has out-of-pocket costs you must pay when you pick up your prescriptions.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $4.00 | $0.00 |
| Generic | $7.00 | $0.00 |
| Preferred Brand | 20.00% | 20.00% |
| Non-Preferred Drug | 25.00% | 25.00% |
| Specialty Tier | 33.00% | 33.00% |
| Select Care Drugs | $0.00 | $0.00 |
| *The Part D deductible does not apply. | ||
CMS 5-Star Rating Marks
Each year Medicare rates C-SNP plans, using a 5-star rating system, in nine major categories. These ratings are designed to help you understand the quality of care and service you can expect if you qualify and choose to join Anthem Kidney Care.
| 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 |
How to Qualify to Enroll in
Anthem Kidney Care
To be eligible to enroll in Anthem Kidney Care, you must meet these requirements:
- You are eligible for Medicare;
- You live in Greene County (the plan’s service area); and
- You have been diagnosed with one or more severe or disabling chronic conditions.
A disabling chronic condition (disease) is one that lasts one or more years and requires ongoing medical attention and/or limits activities of daily living. They include:
- Autoimmune disorders
- End-stage renal disease
- Cancer
- Cardiovascular disorders
- Hematologic disorders
- HIV/AIDS
- Chronic heart failure
- Chronic lung disorders
- Neurologic disorders
- Dementia
- Diabetes
- End-stage liver disease
- Neurologic disorders
- Stroke
- Mental health conditions
Additional C-SNP Plan Options
Here are some additional Medicare SNP plans that might be worth reviewing:
Contact Us About Anthem Blue Cross and Blue Shield
| Website: | Anthem Blue Cross and Blue Shield Plan Page (opens in new tab) |
|---|---|
| Providers: | Anthem Blue Cross and Blue Shield Providers Page (opens in new tab) |
| Formulary: | Anthem Blue Cross and Blue Shield Formulary Page (opens in new tab) |
| Pharmacy: | Anthem Blue Cross and Blue Shield Pharmacy Page (opens in new tab) |
| New Member Health Plan Help: | (833)668-2256 |
| New Member Health Plan TTY: | 711 |
| New Member Part D Help: | (833)668-2264 |
| New Member Part D TTY Users: | 711 |
If you qualify for Medicare benefits but have not yet enrolled or verified your enrollment status, you can do so on the Social Security Administration website. You can learn more about the Medicare Advantage program on www.medicare.gov.
Health Plan Compatibility
Medicare Advantage Special Need Plans are not compatible with most other forms of health insurance. If you have Medicare Part A and/or Medicare Part B and join a SNP plan, you will be disenrolled from Original Medicare. You cannot simultaneously enroll in an SNP plan and Medicare Supplement Insurance.
With a D-SNP, members retain their existing Medicaid plan and benefits. Veterans who have VA Health Benefits may also be able to receive care at their local VA hospital.
Citations & References
- Anthem Blue Cross and Blue Shield, https://shop.anthem.com/medicare, Last Accessed October 13, 2024
- Medicaid.gov, "Medicaid & CHIP in Georgia", Last Accessed October 1, 2024
- CMS.gov, Landscape Source Files, Last Accessed October 2, 2024
- CMS.gov, Medicare Part C & D Performance, Last Accessed October 2, 2024
- CMS.gov, Plan Benefits Package, Last Accessed October 5, 2024
Research Note: This content is based on independent analysis of CMS data by David Bynon, Medicare analyst and founder of MedicareWire.
For details on how this plan was analyzed and constructed using CMS data, see our Medicare Plan Research Methodology.
Disclaimer: MedicareWire does not endorse or rank Medicare plans. Plan information is provided for educational and research purposes only and may not reflect the most current data available from CMS or the plan provider.
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