Anthem Kidney Care (PPO C-SNP)
Medicare Special Need Plan H8552-028 • 2026
Anthem Kidney Care (PPO C-SNP) Medicare Special Need Plan H8552-028 • 2026
Anthem Kidney Care is a Medicare Chronic or Disabling Condition plan offered by Anthem Blue Cross Life and Health Insurance Company for the 2026 plan year. This Special Needs Plan (SNP) is designed for individuals who meet specific eligibility requirements. CMS Plan ID H8552-028 identifies this plan.
Anthem Kidney Care Overview
Plan Overview for H8552-028-0 | |
|---|---|
| CMS Plan ID: | H8552-028-0 |
| Plan Type: | PPO C-SNP |
| Plan Year: | 2026 |
| Monthly Premium: | $0.00 Plus your Medicare Part B premium. |
| Medical Deductible: | $0.00 |
| Maximum Out-of-Pocket: | $9250.00 (In-Network) |
| Part B Give Back: | Not offered |
| Prescription Drug Coverage: | Enhanced, $0.00 deductible |
| Additional Benefits: | Dental, Vision, Hearing |
| Service Area: | See List |
| Enrollment (Nationwide) | 1,058 beneficiaries |
| Provided By: | Anthem Blue Cross Life and Health Insurance Company |
Plan Availability
Anthem Kidney Care (H8552-028-0) is available in the following locations (click to open):
Plan Overview and Eligibility
- Anthem Kidney Care is a Medicare C-SNP plan for individuals with specific chronic or disabling conditions.
- This plan is for individuals requiring dialysis (any mode of dialysis).
- To enroll, you must have Medicare Part A and Part B and live in the plan’s service area (Fresno County).
- This plan uses a PPO provider network and includes Medicare Part D prescription drug coverage. There is no annual deductible. Cost sharing begins with your first prescription.
- Anthem Kidney Care provides the same core benefits as Original Medicare, with additional benefits for eligible members.
- Out-of-pocket costs differ from Original Medicare and may vary by service. See the cost and coverage tables below.
Anthem Kidney Care operates on a Preferred Provider Organization (PPO) network. Members may access care from in-network or out-of-network providers, with lower out-of-pocket costs when using in-network services. Referrals are generally not required for specialist visits. Emergency services and out-of-area dialysis are covered.
Covered Services and Cost Structure
This section outlines in-network costs for primary care and specialist office visits, along with related preventive services.
| Covered Service | In-Network Cost |
|---|---|
| Primary: | In-network: $0 copay | Out-of-network: $0 copay |
| Specialist: | In-network: $0 copay, 20% coinsurance | Out-of-network: $0 copay, 20% coinsurance |
This section outlines in-network costs for preventive and wellness services included in the plan.
| Covered Service | In-Network Cost |
|---|---|
| Annual wellness exam: | In-network: $0 copay |
| Telehealth benefit: | In-network: $0 copay |
| Routine chiropractic: | Not covered |
| Fitness benefits: | In-network: $0 copay | Out-of-network: $0 copay |
| Health education: | Not covered |
| Counseling services: | Not covered |
| Over-the-counter drug benefits: | In-network: $0 copay | Out-of-network: $0 copay |
| Health transportation (non-emergency): | In-network: $0 copay | Out-of-network: $0 copay |
This section outlines in-network costs for diagnostic services, lab tests, x-rays, and other imaging services.
| Covered Service | In-Network Cost |
|---|---|
| Diagnostic radiology services: | In-network: 20% coinsurance | Out-of-network: 20% coinsurance |
| Lab services: | In-network: 20% coinsurance | Out-of-network: 20% coinsurance |
| Outpatient x-rays: | In-network: 20% coinsurance | Out-of-network: 20% coinsurance |
| Diagnostic tests and procedures: | In-network: 20% coinsurance | Out-of-network: 20% coinsurance |
This section outlines in-network costs for emergency services, urgent care, ambulance transportation, inpatient hospital stays, and skilled nursing facility care.
| Covered Service | In-Network Cost |
|---|---|
| Emergency room care: | $115 copay |
| Worldwide emergency care: | Not covered |
| Urgent care: | $40 copay |
| Inpatient hospital care: | In-network: | Tier 1 | $0 per day for days 1-60 | $419 per day for days 61-90 | $838 per day for days 91-150 | Out-of-network: | $0 per day for days 1-60 | $419 per day for days 61-90 | $838 per day for days 91-150 |
| Skilled Nursing Facility: | In-network: | Tier 1 | $0 per day for days 1-20 | $209.5 per day for days 21-100 | Out-of-network: | $0 per day for days 1-20 | $209.5 per day for days 21-100 |
| Ground ambulance: | In-network: 20% coinsurance | Out-of-network: 20% coinsurance |
This section outlines in-network costs for mental health services, including outpatient therapy and inpatient psychiatric care.
| Covered Service | In-Network Cost |
|---|---|
| Outpatient individual therapy: | In-network: 20% coinsurance | Out-of-network: 20% coinsurance |
| Outpatient group therapy: | In-network: 20% coinsurance | Out-of-network: 20% coinsurance |
| Inpatient psychiatric hospital care: | In-network: | Tier 1 | $0 per day for days 1-60 | $419 per day for days 61-90 | $838 per day for days 91-150 | Out-of-network: | $0 per day for days 1-60 | $419 per day for days 61-90 | $838 per day for days 91-150 |
This section outlines in-network costs for rehabilitation services, including physical therapy, speech and language therapy, and occupational therapy.
| Covered Service | In-Network Cost |
|---|---|
| Physical therapy and speech and language therapy: | In-network: 20% coinsurance | Out-of-network: 20% coinsurance |
| Occupational therapy: | In-network: 20% coinsurance | Out-of-network: 20% coinsurance |
This section outlines in-network costs for medical equipment and supplies, including diabetes supplies, durable medical equipment, and prosthetics.
| Covered Service | In-Network Cost |
|---|---|
| Diabetes supplies: | In-network: $0 copay | Out-of-network: 20% coinsurance |
| Durable medical equipment: | In-network: 0%-20% coinsurance | Out-of-network: 20% coinsurance |
| Prosthetics: | In-network: 20% coinsurance | Out-of-network: 20% coinsurance |
This section outlines in-network cost sharing for chemotherapy and other Medicare Part B-covered drugs.
| Covered Service | In-Network Cost |
|---|---|
| Chemotherapy: | In-network: 0%-20% coinsurance | Out-of-network: 0%-20% coinsurance |
| Other Part B drugs (Medicare-covered): | In-network: 0%-20% coinsurance | Out-of-network: 0%-20% coinsurance |
This section outlines in-network cost sharing for dental services, including preventive care, exams, x-rays, cleanings, and comprehensive dental procedures.
| Covered Service | In-Network Cost |
|---|---|
| Oral exam: | In-network: $0 copay | Out-of-network: 20% coinsurance |
| Dental x-rays: | In-network: $0 copay | Out-of-network: 20% coinsurance |
| Cleaning: | In-network: $0 copay | Out-of-network: 20% coinsurance |
| Periodontics: | In-network: $0 copay | Out-of-network: 50% coinsurance |
| Endodontics: | In-network: $0 copay | Out-of-network: 50% coinsurance |
| Restorative services: | In-network: $0 copay | Out-of-network: 50% coinsurance |
| Implant services: | Not covered |
| Orthodontics: | Not covered |
| Oral/Maxillofacial surgery: | In-network: $0 copay | Out-of-network: 50% coinsurance |
This section outlines in-network cost sharing for vision services, including eye exams, eyeglasses, and contact lenses.
| Covered Service | In-Network Cost |
|---|---|
| Routine eye exam: | In-network: $0 copay | Out-of-network: $0 copay |
| Contact lenses: | In-network: $0 copay | Out-of-network: $0 copay |
| Eyeglass frames only: | In-network: $0 copay | Out-of-network: $0 copay |
| Eyeglass lenses only: | In-network: $0 copay | Out-of-network: $0 copay |
| Eyeglasses (frames & lenses): | In-network: $0 copay | Out-of-network: $0 copay |
| Upgrades: | Not covered |
This section outlines in-network cost sharing for hearing-related services, including exams, fittings, and hearing aids.
| Covered Service | In-Network Cost |
|---|---|
| Hearing exam: | In-network: $0 copay | Out-of-network: 20% coinsurance |
| Fitting/evaluation: | In-network: $0 copay | Out-of-network: 20% coinsurance |
| Prescription hearing aids: | In-network: $0 copay | Out-of-network: $0 copay |
| OTC hearing aids: | In-network: $0 copay | Out-of-network: $0 copay |
This section outlines in-network cost sharing for additional and special needs services that may be included in the plan.
| Covered Service | In-Network Cost |
|---|---|
| Adult day health services: | Not covered |
| Home-based palliative care: | Not covered |
| Personal emergency response system: | In-network: $0 copay | Out-of-network: $0 copay |
| Weight management programs: | Not covered |
| Wigs for chemotherapy-related hair loss: | Not covered |
| Alternative therapies: | Not covered |
| Massage therapy: | Not covered |
| Home/bathroom safety devices: | Not covered |
Prescription Drug Plan Costs & Benefits
Prescription Drug Plan Premium
The following table outlines the prescription drug plan premium details of this plan.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | $-52.80 |
| Supplemental Part D Premium: | $52.80 |
| Total Part D Premium: | $0.00 |
| Low Income Premium Subsidy: | $12.00 |
| Low Income Premium Subsidy CMS Pays: | $0.00 |
| Low Income Subsidy Premium: | $0.00 |
For more information about the Low Income Subsidy, refer to the Social Security Extra Help page.
Drug Plan Deductible
The prescription drug annual deductible with this plan is $0.00. This is the amount you must pay at the pharmacy before Anthem Blue Cross Life and Health Insurance Company begins paying its share.
Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and drug plan deductible, Anthem Kidney Care has costs that you must pay out-of-pocket when you pick up your prescriptions. The following table details those costs by formulary tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 copay | Coming soon |
| Generic | $0.00 copay | Coming soon |
| Preferred Brand | 15% coinsurance | Coming soon |
| Non-Preferred Drug | 25% coinsurance | Coming soon |
| Specialty Tier | 33% coinsurance | Coming soon |
| Select Care Drugs | $0.00 copay | Coming soon |
| *Deductible does not apply. | ||
CMS Star Ratings
CMS star ratings reflect how well a Medicare plan performs across key quality measures, such as managing chronic conditions, member satisfaction, and customer service. Ratings range from 1 to 5 stars and are updated each year by Medicare.
CMS Star Ratings for Plan H8552-028-0 – 2026
| CMS Measure | Star Rating (out of 5) |
|---|---|
| 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 |
Contact Information for Anthem Blue Cross Life and Health Insurance Company
| Contact Type | Details |
|---|---|
| Website: | Anthem Blue Cross Life and Health Insurance Company Plan Page |
| New Members: | 1-833-668-2348 |
| Existing Members: | 1-877-811-3107 |
| Plan Address: | P.O. Box 659404 | 3800 Buffalo Speedway, Suite 400 | San Antonio, TX 78265 |
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at medicare.gov.
- CMS.gov, Landscape Source Files — Last accessed May 2, 2026
- CMS.gov, Medicare Part C & D Performance — Last accessed May 2, 2026
- CMS.gov, Plan Benefits Package — Last accessed May 2, 2026
- CMS.gov, Monthly Enrollment by Contract/Plan/State/County — Last accessed May 2, 2026
Data sources and methodology documentation.
- Anthem Blue Cross Life and Health Insurance Company (official source), https://shop.anthem.com/medicare/ca — Last accessed April 30, 2026
- CMS.gov, "Chronic Condition Special Needs Plans (C-SNPs)" — Last accessed April 28, 2026
- CMS.gov, "Medicare Advantage Plan Fact Sheet" — Last accessed April 28, 2026
- Medicare.gov, "Joining a plan" — Last accessed April 28, 2026
MedicarePlans.com is an independent, non-government informational resource and is not affiliated with or endorsed by the U.S. Government or the federal Medicare program.
Data provenance is documented in accordance 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.