Anthem Prime (HMO-POS)
Anthem Blue Cross Partnership Plan · HMO-POS · 2026 coverage
This plan ends after 2026
Ends December 31. Choose a new plan by December 7, or by the last day of February. You may also have a right to buy a Medigap policy.
The big numbers
The plan premium is on top of your Part B premium.
- Monthly premium
- $0
- Most you pay in a year for covered care in network
- $800
- Lower than most plans here
- Drug deductible
- $0
- Most you pay for covered drugs in a year
- $2,100
- Medicare star rating
- 3 of 5
In plain English
Compared with the 25 other plans in Santa Clara County that the same person could join.
What stands out
- No monthly premium
- At most $800 a year for covered care, lower than most plans here
- $0 for a 5-day hospital stay, tied for lowest here
- No drug deductible
Watch out for
- $150 for the emergency room, tied for highest here
- $25 for urgent care, higher than most plans here
- You need a referral to see a specialist
What a year could cost
Premiums plus the plan’s copays for three example years. Medicines are not included.
- A light year$0$0 in premiums + $0 for care2 checkups and 2 lab tests.
- A busier year$25$0 in premiums + $25 for care4 checkups, 4 specialist visits, 4 lab tests, 1 X-ray and 1 urgent care visit.
- A hard year$450$0 in premiums + $450 for careLower than most plans here6 checkups, 12 specialist visits, 6 lab tests, 2 scans, an ambulance ride, an ER visit and a 5-day hospital stay.Uses the highest listed cost for: MRI, CT and other scans.
The visit counts are examples we chose to show how costs add up, not a prediction. Your costs depend on the care you get.
What you pay for care
Your cost each time, at doctors and hospitals in the plan’s network.
- Primary care visit$0
- Specialist visit$0Referral neededPlan approval may be needed
- Urgent care$25Higher than most plans here
- Emergency room$150Tied for highest hereNot charged if you stay in the hospital within 24 hours
- Hospital stay$0 per stayTied for lowest herePlan approval may be needed
- Lab tests$0Referral neededPlan approval may be needed
More care: surgery, scans, mental health, therapy, home health and more
- Outpatient surgery center$0Tied for lowest hereReferral neededPlan approval may be needed
- Outpatient hospital care$0Tied for lowest here
- X-rays$0Referral neededPlan approval may be needed
- MRI, CT and other scans$0 to $50Depends on the serviceReferral neededPlan approval may be needed
- Ground ambulance$200Plan approval may be needed
- Skilled nursing facility$0 for days 1 to 20, then $218 a day for days 21 to 100Plan approval may be needed
- Mental health therapy visit$25Higher than most plans hereReferral neededPlan approval may be needed
- Psychiatrist visit$25Referral neededPlan approval may be needed
- Physical or speech therapy$0Referral neededPlan approval may be needed
- Occupational therapy$0Referral neededPlan approval may be needed
- Home health care$0Referral neededPlan approval may be needed
- Medical equipment, like a walker or oxygen0% to 20%Depends on the servicePlan approval may be needed
- Kidney dialysis20%
- Chemotherapy and radiation drugs0% to 20%Depends on the servicePlan approval may be needed
- Other drugs given at a clinic0% to 20%Depends on the servicePlan approval may be needed
- Heart rehab$0Plan approval may be needed
- Foot doctor (podiatrist)$0Referral neededPlan approval may be needed
- Chiropractor$0Referral neededPlan approval may be needed
From the costs the plan filed with Medicare for 2026. A range like “$0 to $100” means the cost depends on the service or the place. “Lower than most” compares this plan with the 25 other plans in Santa Clara County that the same person could join. Read the plan’s 2026 booklet (PDF)
Is my doctor in this plan?
Look up your doctors, then confirm with their office.
Add your doctors once. We’ll check them against each plan you look at.
Before you choose, call each doctor’s office and ask:
“Do you take Anthem Prime (HMO-POS), plan number H4161-010, for 2026?”
What medicines cost
The most you pay for covered drugs in 2026 is $2,100. After that, covered drugs cost $0 for the rest of the year.
| Drug tier | Preferred pharmacy | Other network pharmacy |
|---|---|---|
| 1Preferred Generic | $0 | $0 |
| 2Generic | $0 | $0 |
| 3Preferred Brand | $42 | $47 |
| 4Non-Preferred Drug | 25% of the price | 25% of the price |
| 5Specialty Tier | 33% of the price | 33% of the price |
For a 1-month supply. Covered insulin costs at most $35 for a month’s supply. Your medicine’s tier is on the plan’s drug list; check it below.
Check my medicines
See if this plan covers each medicine you take in 2026, and what a month costs.
Type the name on the bottle. Add the strength to narrow it down.
Add each medicine once. We’ll show if this plan covers it, what a month costs, and any rules.
Extras
Help Original Medicare doesn’t give you.
- Dental IncludedCleanings and exams: $0. Some bigger dental work included, more with an optional add-on you can buy.Cleanings and exams: plan pays up to $500 a year. Plan pays up to $500 a year for all dental.
- Vision IncludedYearly eye exam: $0. Glasses or contacts covered.Eyewear: plan pays up to $300 a year.
- Hearing IncludedHearing test: $0. Hearing aids covered.Hearing aids: plan pays up to $3,000 a year, both ears.
- Over-the-counter items IncludedUp to $38 every three months for things like vitamins, pain relief and bandages.Unused money does not carry over.
- Fitness Not included
- Rides to care Included36 one-way rides to medical visits a year.
- Other extras IncludedIncludes a nurse phone line or online visits and acupuncture.
Add-ons you can buy
Optional. Each costs extra every month, on top of the plan premium.
- Preventive Dental Package$12 a month · Adds dental and other extras
- Enhanced Dental and Vision Package$39 a month · Adds dental, eye care and glasses and other extras
- Dental and Vision Package$31 a month · Adds dental, eye care and glasses and other extras
Help paying for this plan
Programs that can lower your Medicare costs if your income is limited.
Extra Help with drug costs
The drug part of this plan’s premium is already $0, so Extra Help would not lower the premium.
Extra Help also lowers what you pay for each medicine.
See who can get Extra HelpHelp with your Part B premium
A Medicare Savings Program can pay your Part B premium, and for some people more of their Medicare costs.
See who can get a Medicare Savings ProgramContact the plan
- Call about joining(833) 668-2201 · TTY 711
- Plan websiteshop.anthem.com/medicare
- List of covered drugswww.shop.anthem.com/medicare
- Full 2026 rulesRead the plan’s booklet (PDF)
From the details the plan filed with Medicare for 2026. To check whether a doctor takes this plan, call the doctor’s office, not the plan.