Anthem Kidney Care (C-SNP) H8552 028 0 Plan Details
This page provides coverage and cost details for Anthem Blue Cross Life and Health Insurance Company’s H8552-028-0 Medicare SNP plan for 2025. Enrollment is subject to eligibilit
*CMS rated this Anthem Blue Cross Life and Health Insurance Company plan (H8552-028-0) 3 (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
- H8552-028-0
- Plan Type
- PPO C-SNP
- Plan Year
- 2025
- Premium
- $0.00/mo
Plus your Medicare Part B premium. - Health Plan Deductible
- $0.00
- Out-of-Pocket Maximum
- 8,300.00 /yr (in-network)
- Part B Reduction
- $0.00/mo
- Drug Plan Benefit
- Enhanced
$130.00 deductible - Supplemental Benefits
- Vision, Hearing
- Availability
- See List
- Insured By
- Anthem Blue Cross Life and Health Insurance Company
| 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 Life and Health Insurance Company plan:
Doctor's Office Visits
- Primary
- $0 Copay
- Specialist
- 20% Coinsurance
Prior Authorization Required
Emergency, Urgent, and Inpatient Hospital Coverage
- Emergency room care
- $90 Copay
- Urgent care
- $25 Copay
- Ground ambulance
- 20% Coinsurance
- Inpatient hospital care
- Coming Soon
- Skilled Nursing Facility
- Unknown
Foot Care
- Foot Exams and Treatments (Medicare-covered)
- 20% Coinsurance
Prior Authorization Required - Routine Foot Care
- $0 Copay
Prior Authorization Required
Chiropractic Care
- Medicare-covered chiropractic
- 20% Coinsurance
Prior Authorization Required - Routine chiropractic
- Not Covered
Mental Health Services
- Outpatient individual therapy
- 20% Coinsurance
- Outpatient group therapy
- 20% Coinsurance
- Inpatient psychiatric hospital care
- Coming Soon
Rehabilitation Services
- Physical therapy and speech and language therapy
- 20% Coinsurance
Prior Authorization Required - Occupational therapy
- 20% Coinsurance
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
- 20% Coinsurance
Prior Authorization Required - Lab services
- 20% Coinsurance
Prior Authorization Required - Outpatient x-rays
- 20% Coinsurance
Prior Authorization Required - Diagnostic tests and procedures
- 20% Coinsurance
Prior Authorization Required
Medicare Part B Drugs
- Chemotherapy
- 20% Coinsurance
- Other Part B drugs (Medicare-covered)
- 20% Coinsurance
Dental Services
- Medicare Covered Preventive Dental
- 20% Coinsurance
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
- 20% Coinsurance
- 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 $130.00. You must pay this amount at the pharmacy before Anthem Blue Cross Life and Health Insurance Company 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* | $0.00 | $0.00 |
| Generic* | $0.00 | $0.00 |
| Preferred Brand | 20.00% | 20.00% |
| Non-Preferred Drug | 25.00% | 25.00% |
| Specialty Tier | 31.00% | 31.00% |
| Select Care Drugs* | $0.00 | $0.00 |
| *The Part D deductible does not apply. | ||
CMS 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 | Not enough data available |
| 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 Fresno 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
Plan Availability
Anthem Kidney Care (H8552-028-0) is available in the following locations (click to open):
Additional C-SNP Plan Options
Here are some additional Medicare SNP plans that might be worth reviewing:
- H8552-028-0: Anthem Kidney Care ()
Contact Us About Anthem Blue Cross Life and Health Insurance Company
| Website: | Anthem Blue Cross Life and Health Insurance Company Plan Page (opens in new tab) |
|---|---|
| Providers: | Anthem Blue Cross Life and Health Insurance Company Providers Page (opens in new tab) |
| Formulary: | Anthem Blue Cross Life and Health Insurance Company Formulary Page (opens in new tab) |
| Pharmacy: | Anthem Blue Cross Life and Health Insurance Company Pharmacy Page (opens in new tab) |
| New Member Health Plan Help: | (833)668-2348 |
| New Member Health Plan TTY: | 711 |
| New Member Part D Help: | (833)668-2351 |
| 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 Needs Plans (SNPs) are generally incompatible with most other health insurance options. Enrolling in an SNP plan while having Medicare Part A and/or Medicare Part B will result in disenrollment from Original Medicare. Additionally, it is not possible to simultaneously hold a Medicare Supplement Insurance policy and be part of an SNP plan.
Members of a D-SNP maintain their current Medicaid plan and Medicaid benefits. Veterans with VA Health Benefits might have the option to receive care at a nearby VA hospital.
Citations & References
- Anthem Blue Cross Life and Health Insurance Company, https://shop.anthem.com/medicare/ca, Last Accessed October 13, 2024
- Medicaid.gov, "Medicaid & CHIP in California", 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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