2024 Anthem Kidney Care C-SNP: H8552-028-0 for Stanislaus County, CA
What is Plan H8552-028-0 by Anthem Blue Cross Life and Health Insurance Co.?
Anthem Kidney Care, is a 2024 C-SNP Special Needs Plan, with a PPO provider network. This Anthem Blue Cross Life and Health Insurance Co. PPO plan is required to provide all of the same benefits as Original Medicare, and includes some additional benefits, but out-of-pocket costs may be different.
You must meet all qualification requirements to join this C-SNP plan.
Plan Basics | |
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Plan ID: | H8552-028-0 |
Plan Type: | PPO |
Plan Year: | 2024 |
Premium: | $37.10/mo Plus your Part B premium. |
Health Plan Deductible: | $0.00 |
Out-of-Pocket Maximum: | /yr |
Part B Reduction: | $0.00/mo |
Drug Plan Benefit: | Enhanced $130.00 deductible |
Rx Gap Coverage: | {gap} |
Supplemental Benefits: | Vision |
Availability: | Stanislaus County, CA |
Insured By: | Anthem Blue Cross Life and Health Insurance Co. |
Summary of Benefits |
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Health Plan Costs & Benefits
Anthem Kidney Care is a Preferred Provider Organization (PPO) plan. PPO plan members usually use in-network healthcare providers but can go out of network when necessary. However, visits to non-network providers could cost significantly more.
The following table is a summary of the most common out-of-pocket costs you will incur if you join this Anthem Blue Cross Life and Health Insurance Co. plan:
Healthcare Service | Member Cost |
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Doctor Visits (In-Network) | |
Primary: | $0 Copay |
Specialist: | 20% Coinsurance Authorization Required |
Wellness programs (e.g., fitness, nursing hotline): | |
Preventive care: | $0 Copay |
Foot Care (In-Network) | |
Foot exams and treatment (Medicare-covered): | 20% Coinsurance Authorization Required |
Routine foot care: | $0 Copay Authorization Required |
Chiropractic Care (In-Network) | |
Medicare-covered chiropractic care: | 20% Coinsurance Authorization Required |
Routine chiropractic care: | $0 |
Emergency Care / Urgent Care | |
Emergency room care: | $90 Copay |
Urgent care: | $25 Copay |
Ground ambulance: | 20% Coinsurance |
Inpatient hospital coverage: | Coming Soon |
Outpatient hospital coverage: | 20% Coinsurance Authorization Required |
Skilled Nursing Facility: | Unknown |
Optional supplemental benefits: | Not Covered |
Mental Health Services (In-Network) | |
Outpatient individual therapy visit with a psychiatrist: | 20% Coinsurance |
Outpatient group therapy visit with a psychiatrist: | 20% Coinsurance |
Inpatient hospital - psychiatric: | Coming Soon |
Outpatient group therapy visit: | 20% Coinsurance |
Outpatient individual therapy visit: | $0 |
Rehabilitation Services (In-Network) | |
Physical therapy and speech and language therapy visit: | 20% Coinsurance Authorization Required |
Occupational therapy visit: | 20% Coinsurance Authorization Required |
Medical Equipment / Supplies (In-Network) | |
Diabetes supplies: | $0 Copay |
Durable medical equipment (e.g., wheelchairs, oxygen): | 20% Coinsurance Authorization Required |
Prosthetics (e.g., braces, artificial limbs): | 20% Coinsurance |
Diagnostic Procedures / Lab Services / Imaging (In-Network) | |
Diagnostic radiology services (e.g., MRI): | 20% Coinsurance Authorization Required |
Lab services: | 20% Coinsurance Authorization Required |
Outpatient x-rays: | 20% Coinsurance Authorization Required |
Diagnostic tests and procedures: | 20% Coinsurance Authorization Required |
Medicare Part B Drugs (In-Network) | |
Chemotherapy: | 20% Coinsurance |
Other Part B drugs (Medicare-covered) | 20% Coinsurance |
Feel free to download our Anthem Kidney Care Summary of Benefits information.
Supplemental Health Plan Benefits (H8552-028-0)
The following is a summary of the supplemental benefits Anthem Blue Cross Life and Health Insurance Co. includes with this plan:
Supplemental Healthcare Service | Member Cost |
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Preventive Dental | |
Oral exam (In-Network) | Not Covered |
Fluoride treatment (In-Network) | Not Covered |
Dental x-ray(s) (In-Network) | Not Covered |
Cleaning (In-Network) | Not Covered |
Comprehensive Dental | |
Periodontics (In-Network) | Not Covered |
Non-routine services (In-Network) | Not Covered |
Diagnostic services (In-Network) | Not Covered |
Extractions (In-Network) | Not Covered |
Endodontics (In-Network) | Not Covered |
Restorative services (In-Network) | Not Covered |
Prosthodontics, other oral/maxillofacial surgery, other services (In-Network) | Not Covered |
Hearing | |
Fitting/evaluation (In-Network) | Not Covered |
Hearing aids (In-Network) | Not Covered |
Hearing exam (In-Network) | Not Covered |
Vision | Maximum vision benefit: | $300.00 Every year |
Eyeglasses (frames and lenses) (In-Network) | $0 Copay |
Routine eye exam (In-Network) | $0 Copay |
Contact lenses (In-Network) | $0 Copay |
Additional Supplemental Benefits
None specified.
Prescription Drug Plan Costs & Benefits
Anthem Kidney Care includes an enhanced benefit Medicare Part D plan (PDP). Enhanced plans have a higher actuarial value than basic plans. Actuarial value simply refers to the percentage of cost that's covered by the plan.
Prescription Drug Plan Premium
Although the prescription drug plan (Part D) premium is bundled with the total plan cost, some plans have supplemental costs and/or offer low-income subsidy (LIS) assistance. The following table outlines the prescription drug plan premium details of this plan.
Basic Part D Premium: | $37.10 |
Supplemental Part D Premium: | $0.00 |
Total Part D Premium: | $37.10 |
Part D Premium with Full LIS Assistance: | $0.00 |
For more information about the Low-Income Subsidy (aka, "Extra Help") program, refer to the Social Security Extra Help page.
Prescription Drug Plan Deductible
The Medicare Part D annual deductible with this plan is $130.00. This is the amount you must pay at the pharmacy before Anthem Blue Cross Life and Health Insurance Co. begins paying its share.
NOTE: The deductible does not apply to one or more drug tiers in this plan (see "Prescription Drug Plan Out-of-Pocket Costs" below).
Prescription Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, Anthem Kidney Care has out-of-pocket costs that you must pay when you pick up your prescriptions. The following table shows you those costs.
Drug Tier | Preferred | Standard |
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1 (Preferred Generic) | $1.00 copay (deductible does not apply) | $6.00 copay (deductible does not apply) |
2 (Generic) | $6.00 copay | $11.00 copay |
3 (Preferred Brand) | $42.00 copay | $47.00 copay |
4 (Non-Preferred Drug) | $95.00 copay | $100.00 copay |
5 (Specialty Tier) | 31% | 31% |
6 (Select Care Drugs) | $0.00 copay | $0.00 copay |
CMS Rating Marks
Each year CMS rates Medicare Special Needs Plans in nine broad categories based on a 5-star system. The table below shows the quality ratings for this Anthem Blue Cross Life and Health Insurance Co. plan.
CMS Measure | Star Rating |
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2024 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 | |
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 Stanislaus County (the plan’s service area); and
- You have been diagnosed with one or more severe or disabling chronic conditions.
A disabiling 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
This plan is for individuals with dialysis Services requiring dialysis (any mode of dialysis).
Additional C-SNP Plan Options
Here are some additional Medicare SNP plans that might be worth reviewing:
Contact Anthem Blue Cross Life and Health Insurance Co.
Plan Website: | https://shop.anthem.com/medicare/ca |
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Formulay Information: | https://shop.anthem.com/medicare/ca |
Pharmacy Information: | Anthem Blue Cross Life and Health Insurance Co. Pharmacy Page |
Prospective Members: | (855)768-1053 |
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.
Plans Offered
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, GlobalHealth, Health Care Service Corporation, Cigna Healthcare, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Scott and White Health Plan now part of Baylor Scott & White Health, UnitedHealthcare(R), and Wellcare.
Citations & References
- Anthem Blue Cross Life and Health Insurance Co., https://shop.anthem.com/medicare/ca, Last Accessed October 13, 2023
- Medicaid.gov, "Medicaid & CHIP in California", Last Accessed January 4, 2024
- CMS.gov, "Chronic Condition Special Needs Plans (C-SNPs)", Last Accessed January 20, 2023
- CMS.gov, Landscape Source Files, Last Accessed January 2, 2024
- CMS.gov, Medicare Part C & D Performance, Last Accessed January 2, 2024
- CMS.gov, Plan Benefits Package, Last Accessed January 3, 2024