- Entity
- plan:H5422-013-0
- Digest
- 2026-cms-snp-plan
- Source URL
- https://www.medicareplans.com/medicare-advantage/plan/H5422-013-0/
- Glossary Scope
- cms_landscape
- Fragment Scope
- semantic-digest
- Method
- https://webmem.com/protocol/serialization/html/
- fragment-H5422-013-0-performance
- CMS Plan ID
- All MA/MAPD and PDP plans have a CMS plan ID consisting of a contract ID, plan ID, and segment ID formatted like: H1234-001-0.
- Value
- H5422-013-0
- Derived
- true
- Contract Year
- The calendar year in which the plan's benefits, premiums, and rules are effective as defined by CMS.
- Value
- 2026
- Derived
- false
- Contract Category Type
- The CMS-assigned contract type for the plan, such as MA, MAPD, SNP, or PDP, which indicates the scope of services and population the contract is designed to serve.
- Value
- MA-PD
- Derived
- false
- Contract ID
- The unique contract ID assigned to a carrier by CMS. All plans have a contract ID.
- Value
- H5422
- Derived
- false
- Plan ID
- The unique plan ID within a CMS contract.
- Value
- 013
- Derived
- false
- Segment ID
- A segment ID is used to identify specific geographic market segments or subdivisions for variations in benefits, costs, and premiums.
- Value
- 0
- Derived
- false
- Parent Organization Name
- The legal parent company that owns the Medicare Advantage contract and is ultimately responsible for the plan’s administration.
- Value
- Elevance Health, Inc.
- Derived
- false
- Organization Marketing Name
- The publicly marketed name of the Medicare Advantage plan carrier as displayed to consumers, which may differ from the legal or corporate entity name.
- Value
- Anthem Blue Cross and Blue Shield
- Derived
- false
- Organization Type
- A descriptive label that classifies the Medicare plan contract type in plain language, such as Local HMO, Regional PPO, or SNP.
- Value
- Local CCP
- Derived
- true
- Plan Name
- The official name of the Medicare Advantage plan as listed in CMS source data.
- Value
- Anthem Extra Help (HMO-POS)
- Derived
- false
- Plan Type
- The type of Medicare plan, such as PDP, Regional PPO, HMO-POS, HMO D-SNP, which determines how the plan manages care and provider access.
- Value
- HMO-POS
- Derived
- false
- Special Needs Plan (SNP) Indicator
- Indicates whether the plan is a Special Needs Plan (SNP), designed to serve people with specific diseases, dual eligibility, or institutional needs.
- Value
- No
- Derived
- false
- SNP Type
- Specifies the type of Special Needs Plan, such as D-SNP for dual-eligible individuals, C-SNP for chronic conditions, or I-SNP for institutional care.
- Value
- Not Applicable
- Derived
- false
- Part D Coverage Indicator
- Indicates whether the Medicare Advantage plan includes Part D prescription drug coverage.
- Value
- Yes
- Derived
- false
- Drug Benefit Category
- Specifies whether the plan’s drug benefit is defined as basic, enhanced, or other CMS-classified categories.
- Value
- Enhanced
- Derived
- false
- Drug Benefit Type
- Specifies the delivery structure of the plan’s drug benefit, such as defined standard, actuarially equivalent, or enhanced alternative.
- Value
- Enhanced Alternative
- Derived
- false
- Voluntary De Minimis
- Indicates whether the plan participates in the voluntary de minimis policy, allowing small premium differences without disqualifying LIS benchmark eligibility.
- Value
- No
- Derived
- false
- Part D Basic Premium Benchmark
- The CMS-calculated benchmark for basic Part D premiums used to determine Low-Income Subsidy (LIS) eligibility thresholds.
- Value
- Not Applicable
- Derived
- false
- LIS Auto-Enrollment Eligible
- Indicates whether the plan is eligible for automatic enrollment of Low-Income Subsidy (LIS) beneficiaries by CMS.
- Value
- Not Applicable
- Derived
- false
- Drug Tiers with No Deductible
- Indicates which drug tiers are excluded from the plan’s Part D deductible, allowing members to access medications without paying the deductible first.
- Value
- Yes
- Derived
- false
- Part D Deductible
- The annual amount a member must pay out of pocket for Part D drugs before the plan begins to pay.
- Value
- 390.00
- Derived
- false
- Part D Basic Premium
- The portion of the plan's monthly premium that covers the standard Part D drug benefit.
- Value
- 25.40
- Derived
- false
- Part D Supplemental Premium
- The monthly premium amount for any supplemental drug coverage offered beyond the standard Part D benefit.
- Value
- 0.00
- Derived
- false
- Part D Total Premium
- The total monthly premium for the Part D plan, including both the basic and any supplemental components.
- Value
- 25.40
- Derived
- true
- Low Income Premium Subsidy (LIPS) Amount
- The amount of monthly premium subsidized by CMS for Low-Income Subsidy (LIS) eligible members enrolled in the plan.
- Value
- 25.42
- Derived
- false
- Part D LIPS (CMS Pays)
- The total amount CMS pays on behalf of LIS-eligible enrollees to cover premium costs under the Low-Income Subsidy program.
- Value
- 25.40
- Derived
- false
- Part D Low Income Beneficiary Premium Amount
- The amount that a Low-Income Subsidy (LIS) beneficiary is responsible for paying after CMS premium subsidies have been applied.
- Value
- 0.00
- Derived
- true
- Part D Out-of-Pocket (OOP) Threshold
- The total amount a member must spend on covered Part D drugs in a calendar year before entering the catastrophic coverage phase.
- Value
- 2100.00
- Derived
- false
- Part C Premium
- The monthly premium a member pays for Medicare Advantage (Part C) coverage, excluding prescription drug (Part D) premiums.
- Value
- $0.00
- Derived
- false
- Monthly Consolidated Premium (Part C + D)
- The total monthly premium a member pays for the Medicare Advantage plan, including both Part C and Part D coverage.
- Value
- $25.40
- Derived
- true
- In-Network Maximum Out-of-Pocket (MOOP) Amount
- The maximum amount a member will pay out of pocket for in-network Medicare-covered services during the plan year, after which the plan pays 100%.
- Value
- Derived
- false
- Record Checksum
- Checksum value associated with this published plan record.
- Value
- VXQ-731-H5422-013-0
- Derived
- true
- Entity
- contract:H5422
- Digest
- 2026-cms-part-c-and-d-performance
- Source URL
- https://www.medicareplans.com/medicare-advantage/plan/H5422-013-0/
- Glossary Scope
- cms_performance
- Fragment Scope
- semantic-digest
- Method
- https://webmem.com/protocol/serialization/html/
- fragment-H5422-013-0-landscape
- Overall Star Rating
- The overall CMS star rating for the plan, based on quality and performance across all measured domains.
- Value
- 3.5
- Unit
- stars
- Derived
- false
- Staying Healthy Measure
- Includes preventive screenings, vaccines, and wellness checks that help members stay healthy.
- Value
- 3
- Unit
- stars
- Derived
- false
- Managing Chronic Conditions Measure
- Evaluates how effectively the plan helps members manage chronic health conditions like diabetes, COPD, or hypertension.
- Value
- 3
- Unit
- stars
- Derived
- false
- Member Experience Measure (Health Plan)
- Captures what members say about their experience with the health plan.
- Value
- 4
- Unit
- stars
- Derived
- false
- Plan Complaints Measure
- Tracks member complaints and changes in the plan’s performance over time.
- Value
- 3
- Unit
- stars
- Derived
- false
- Health Plan Customer Service Measure
- Measures how well the plan handles member appeals and customer inquiries.
- Value
- 5
- Unit
- stars
- Derived
- false
- Drug Plan Customer Service Measure
- Rates the drug plan’s customer service and availability of foreign language and TTY services.
- Value
- 5
- Unit
- stars
- Derived
- false
- Drug Plan Complaints Measure
- Tracks complaints about the drug plan and trends in plan improvement.
- Value
- 3
- Unit
- stars
- Derived
- false
- Member Experience Measure (Drug Plan)
- Reflects satisfaction with the drug plan’s benefits and service.
- Value
- Not enough data available
- Unit
- stars
- Derived
- false
- Drug Safety and Pricing Accuracy Measure
- Assesses how accurately the drug plan prices medications and ensures safe usage.
- Value
- 3
- Unit
- stars
- Derived
- false
Anthem Extra Help (HMO-POS) Medicare Advantage Plan H5422-013 • 2026
This Medicare Advantage HMO-POS plan, identified by CMS Plan ID H5422-013, is offered by Anthem Blue Cross and Blue Shield for the 2026 plan year. The plan uses a Health Maintenance Organization with a Point of Service (HMO-POS) provider network and comes with Part D prescription drug coverage.
Anthem Extra Help Overview
Plan Overview for
H5422-013-0
|
|
|---|---|
| CMS Plan ID: |
H5422-013-0
|
| Plan Type: | HMO-POS |
| Plan Year: | 2026 |
| Monthly Premium: |
$25.40
Plus your Medicare Part B premium. |
| Medical Deductible: | $0.00 |
| Maximum Out-of-Pocket: | $5900.00 (In-Network) |
| Part B Give Back: | Not offered |
| Prescription Drug Coverage: | Enhanced, $390.00 deductible |
| Additional Benefits: | Dental, Vision, Hearing |
| Service Area: | See List |
| Enrollment (Nationwide): | 2,417 beneficiaries |
| Provided By: | Anthem Blue Cross and Blue Shield |
Plan Availability
Anthem Extra Help (H5422-013-0) is available in the following locations (click to open):
Plan Overview for Anthem Extra Help
This Medicare Advantage MAPD HMO-POS plan includes hospital, medical, and prescription drug coverage under Medicare Parts A and B. The monthly premium is $25.40, and the plan provides coverage through a network of participating providers, with limited access to out-of-network services in certain situations. The annual Part D deductible is $390.00.
Primary care visits have a $0 copay, specialist visits come with a $20 copay, urgent care services carry a $25 copay, and ambulance transportation is $255 copay. These costs apply toward the maximum out-of-pocket (MOOP) limit of $5900.00. After this limit is reached, in-network services are fully covered for the remainder of the year.
This plan is listed by CMS under Plan ID H5422-013. Cost-sharing details for key services are provided below.
Cost-Sharing Overview
Anthem Extra Help includes cost-sharing, which refers to out-of-pocket expenses for covered healthcare services. The table below outlines the most common in-network out-of-pocket costs associated with plan H5422-013.
Certain preventive services are covered 100% by Anthem Extra Help as a Part B benefit.
Prescription Drug Coverage
Anthem Extra Help includes a Medicare Part D prescription drug plan (PDP). Plan type and coverage level are defined by CMS and may vary between basic and enhanced benefit designs.
This plan includes an enhanced benefit Medicare Part D plan (PDP), providing coverage beyond the standard CMS-defined minimum.
Prescription Drug Plan Premium
The Part D prescription drug plan premium is included in the overall Medicare Special Needs Plan cost. Additional adjustments may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help, administered by Social Security. LIS benefits are separate from Medicare Special Needs Plan coverage.
| Basic Part D Premium: | $25.40 |
|---|---|
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $25.40 |
| Low-Income Premium Subsidy: | $25.42 |
| Low-Income Premium Subsidy Paid by CMS: | $25.40 |
| Low-Income Subsidy Premium: | $0.00 |
For more details, visit the Social Security Extra Help program .
Prescription Drug Plan Deductible
This plan has a $390.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Anthem Blue Cross and Blue Shield starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, Anthem Extra Help may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 copay | Coming soon |
| Generic | 25% coinsurance | Coming soon |
| Preferred Brand | 25% coinsurance | Coming soon |
| Non-Preferred Drug | 25% coinsurance | Coming soon |
| Specialty Tier | 28% coinsurance | Coming soon |
| Select Care Drugs | $0.00 copay | Coming soon |
| *Deductible does not apply. | ||
CMS Star Ratings
CMS evaluates Medicare Advantage (Part C) and Part D plans annually using a 5-star rating system. Ratings reflect performance in preventive care, chronic condition management, and member experience.
| CMS Measure | Star Rating |
|---|---|
| 2026 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 |
What is the monthly premium for Anthem Extra Help (HMO-POS)?
The plan’s monthly premium is $25.40 for 2026. The Part B premium is not included.
What is the MOOP for Anthem Extra Help in 2026?
The annual in-network MOOP is $5900.00 for 2026. After this limit is reached, covered in-network services are fully paid.
What is the CMS star rating for Anthem Extra Help?
The 2026 CMS star rating for Anthem Extra Help is ★3.5 out of 5.
What is the total enrollment for plan H5422-013?
The plan has 2,417 enrolled beneficiaries according to CMS.
Is there a Part D deductible for this plan?
The Part D deductible is $390.00.
Contact Information for Anthem Blue Cross and Blue Shield
| Contact Type | Details |
|---|---|
| Website: | Anthem Blue Cross and Blue Shield Plan Page |
| New Members: | 1-833-668-2261 |
| Existing Members: | 1-855-690-7797 |
| Plan Address: | 1351 William Howard Taft Road | CN14B-818 | Cincinnati, OH 45206 |
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at medicare.gov.
| Data Source | Publisher | Last Accessed |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | September 8, 2026 |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | September 8, 2026 |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | September 8, 2026 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | September 8, 2026 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| Anthem Blue Cross and Blue Shield (official source) | https://shop.anthem.com/medicare | October 13, 2025 |
| CMS.gov | Medicare Advantage Plan Fact Sheet | 25 May, 2025 |
| AARP.org | The Big Choice: Original Medicare vs. Medicare Advantage | 25 May, 2025 |
| Medicare.gov | Compare Original Medicare & Medicare Advantage | 25 May, 2025 |
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Data provenance documentation is maintained in alignment with the U.S. Core Data for Interoperability (USCDI) Provenance standard.
Page content independently curated and maintained by David W. Bynon, Editorial Steward, using a standardized, data-driven methodology for accurate, non-commercial Medicare plan interpretation and resolution.