Anthem Kidney Care (HMO-POS C-SNP)

Anthem Blue Cross and Blue Shield
Anthem Kidney Care (HMO-POS C-SNP) H5854-012 Plan Details
4 out of 5 stars

Anthem Kidney Care (HMO-POS C-SNP) is a HMO-POS Medicare Advantage (Medicare Part C) plan offered by Anthem Blue Cross and Blue Shield
Plan ID: H5854-012

Have Medicare questions?

Talk to a licensed agent today to find a plan that fits your needs.

$26.40
Monthly Premium

Anthem Kidney Care (HMO-POS C-SNP) is a HMO-POS Medicare Advantage (Medicare Part C) plan offered by Anthem Blue Cross and Blue Shield
Plan ID: H5854-012

Have Medicare questions?

Talk to a licensed agent today to find a plan that fits your needs.

Anthem Blue Cross and Blue Shield
Anthem Kidney Care (HMO-POS C-SNP) H5854-012 Plan Details
4 out of 5 stars

Anthem Kidney Care (HMO-POS C-SNP) is a HMO-POS Medicare Advantage (Medicare Part C) plan offered by Anthem Blue Cross and Blue Shield
Plan ID: H5854-012

Have Medicare questions?

Talk to a licensed agent today to find a plan that fits your needs.

$26.40
Monthly Premium

Connecticut Counties Served

Basic Costs and Coverage

Coverage Cost
Monthly Deductible $310
Out of Pocket Max In-Network: $8300
Out-of-Network: N/A
Initial Coverage Limit $5030
Catastrophic Coverage Limit $8,000
Primary Care Doctor Visit
In-Network:
$0.00 copay
Out-of-Network:
$0.00 copay
Specialty Doctor Visit
In-Network:
$0.00 copay - 20% coinsurance
Out-of-Network:
$0.00 copay - 20% coinsurance
Inpatient Hospital Care
In-Network:
Medicare-defined Cost Share
Out-of-Network:
Medicare-defined Cost Share
Urgent Care
Urgent Care: $25.00 copay
Emergency Room Visit
Emergency Care: $90.00 copay
Ambulance Transportation
Ground Ambulance: 20% coinsurance Per Trip
Air Ambulance: 20% coinsurance

Health Care Services and Medical Supplies

Anthem Kidney Care (HMO-POS C-SNP) covers additional benefits and services, some of which may not be covered by Original Medicare (Medicare Part A and Part B).

Coverage Cost
Chiropractic Services
In-Network:
Medicare Covered Chiropractic Services: 20% coinsurance
Out-of-Network:
Medicare Covered Chiropractic Services: 20% coinsurance
Diabetes Supplies, Training, Nutrition Therapy and Monitoring
In-Network:
Diabetic Supplies: $0.00 copay
Out-of-Network:
20% coinsurance
Durable Medical Eqipment (DME)
In-Network:
20% coinsurance
Diagnostic Tests, Lab and Radiology Services, and X-Rays
In-Network:
Lab Services: 20% coinsurance
X-Rays: 20% coinsurance
Therapeutic Radiological Services: 20% coinsurance
Outpatient Diagnostic Procedures/Tests: 20% coinsurance
Diagnostic Radiological Services: 20% coinsurance
Out-of-Network:
Lab Services: 20% coinsurance
X-Rays: 20% coinsurance
Therapeutic Radiological Services: 20% coinsurance
Outpatient Diagnostic Procedures/Tests: 20% coinsurance
Diagnostic Radiological Services: 20% coinsurance
Home Health Care
In-Network:
$0.00 copay
Mental Health Inpatient Care
In-Network:
Medicare-defined Cost Share
Out-of-Network:
Medicare-defined Cost Share
Mental Health Outpatient Care
In-Network:
Individual and Group Sessions: 20% coinsurance
Out-of-Network:
20% coinsurance
Outpatient Services / Surgery
In-Network:
Outpatient Hospital - Surgery: 20% coinsurance
Observation Services: 20% coinsurance
Ambulatory Surgical Center: 20% coinsurance
Out-of-Network:
Outpatient Hospital - Surgery: 20% coinsurance
Observation Services: 20% coinsurance
Ambulatory Surgical Center: 20% coinsurance
Outpatient Substance Abuse Care
In-Network:
Individual and Group Sessions: 20% coinsurance
Out-of-Network:
20% coinsurance
Over-the-counter (OTC) Items
This plan covers certain approved, non-prescription, over-the-counter drugs and health-related items, up to $100 every quarter. Unused OTC amounts do roll over to the next quarter. Unused OTC amounts do not roll over to the next calendar year.
Podiatry Services
In-Network:
Medicare Covered Podiatry Services: $0.00 copay - 20% coinsurance
Routine Foot Care: $0.00 copay
Unlimited routine foot care visits each year.
Out-of-Network:
Medicare Covered Podiatry Services: 20% coinsurance
Skilled Nursing Facility Care
In-Network:
Medicare-defined cost share

Dental Benefits

The following dental services are covered from in-network providers.

Coverage Cost
Dental Care
In-Network:
Preventive and Comprehensive Dental Combined Allowance
This plan covers up to $1,000 for covered preventive and comprehensive dental services every year.

Medicare Covered Dental: 20% coinsurance
Preventive Dental Services: $0.00 copay
Comprehensive Dental Services: $0.00 copay

Vision Benefits

The following vision services are covered from in-network providers.

Coverage Cost
Vision Benefits
In-Network:
Medicare Covered Eye Exam: 20% coinsurance
Routine Eye Exam: $0.00 copay
This plan covers 1 routine eye exam(s) every year.
Medicare Covered Eye Wear: 20% coinsurance
Routine Eye Wear: $0.00 copay
This plan covers up to $125.00 for eyeglasses or contact lenses every year.

Hearing Benefits

The following hearing services are covered from in-network providers.

Coverage Cost
Hearing Benefits
In-Network:
Medicare Covered Hearing Exam: 20% coinsurance
Routine Hearing Exam: $0.00 copay for routine hearing exam(s). $0.00 copay for hearing aids up to the maximum plan benefit amount.
This plan covers 1 routine hearing exam every year. $300.00 maximum plan benefit for over-the-counter hearing aids OR 1 routine hearing aid fitting evaluation and a $2,000.00 maximum plan benefit for prescribed hearing aids every year.

Preventive Services and Health/Wellness Education Programs

The following services are covered from in-network providers.

Coverage Cost
Preventive Services and Health/Wellness Education Programs
In-Network:
$0.00 copay for Medicare Covered Preventive Services
Out-of-Network:
20% coinsurance

Prescription Drug Costs and Coverage

The Anthem Kidney Care (HMO-POS C-SNP) plan offers the following prescription drug coverage, with an annual drug deductible of $310 (excludes Tiers 1 and 6) per year.

Coverage
Cost
Coverage & Cost
Annual Drug Deductible $310 (excludes Tiers 1 and 6)
Preferred Generic
  • Preferred cost-share retail $3.00
  • Standard retail $8.00
  • Standard mail order $0.00
Select Care Drugs
  • Preferred cost-share retail $0.00
  • Standard retail $0.00
  • Standard mail order $0.00
Annual Drug Deductible $310 (excludes Tiers 1 and 6)
Preferred Generic
  • Preferred cost-share retail $6.00
  • Standard retail $16.00
  • Standard mail order $0.00
Select Care Drugs
  • Preferred cost-share retail $0.00
  • Standard retail $0.00
  • Standard mail order $0.00
Annual Drug Deductible $310 (excludes Tiers 1 and 6)
Preferred Generic
  • Preferred cost-share retail $9.00
  • Standard retail $24.00
  • Standard mail order $0.00
Select Care Drugs
  • Preferred cost-share retail $0.00
  • Standard retail $0.00
  • Standard mail order $0.00