Anthem Full Dual Advantage Aligned (HMO D-SNP)
Anthem Blue Cross · HMO D-SNP · 2026 coverage
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
- $9,250
- Drug deductible
- $615
- Tied for highest here
- Most you pay for covered drugs in a year
- $2,100
- Medicare star rating
- 3 of 5
This is a special needs plan. Only some people can join: Dual-Eligible.
In plain English
Compared with the 4 other plans in Santa Clara County that the same person could join.
What stands out
- No monthly premium
- Dental: plan pays up to $3,000 a year, most of 5 plans here
- Dental, vision and hearing extras included
Watch out for
- $40 for urgent care, highest of 4 plans here
- $615 drug deductible, tied for highest 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.Not counted, because the plan charges a percentage: Primary care visit, Lab tests.
- A busier year$40$0 in premiums + $40 for careHigher than most plans here4 checkups, 4 specialist visits, 4 lab tests, 1 X-ray and 1 urgent care visit.Not counted, because the plan charges a percentage: Primary care visit, Specialist visit, Lab tests, X-rays.
- A hard year$115$0 in premiums + $115 for careTied for lowest here6 checkups, 12 specialist visits, 6 lab tests, 2 scans, an ambulance ride, an ER visit and a 5-day hospital stay.Not counted, because the plan charges a percentage: Primary care visit, Specialist visit, Lab tests, MRI, CT and other scans, Ground ambulance, Hospital stay.
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 visit20%
- Specialist visit20%Referral neededPlan approval may be needed
- Urgent care$40Highest of 4 plans here
- Emergency room$115Not charged if you stay in the hospital within 24 hours
- Lab tests20%Referral neededPlan approval may be needed
More care: surgery, scans, mental health, therapy, home health and more
- Outpatient surgery center20%Referral neededPlan approval may be needed
- Outpatient hospital care20%
- X-rays20%Referral neededPlan approval may be needed
- MRI, CT and other scans20%Referral neededPlan approval may be needed
- Ground ambulance20%Plan approval may be needed
- Mental health therapy visit20%Referral neededPlan approval may be needed
- Psychiatrist visit20%Referral neededPlan approval may be needed
- Physical or speech therapy20%Referral neededPlan approval may be needed
- Occupational therapy20%Referral 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 rehab20%Plan approval may be needed
- Foot doctor (podiatrist)20%Referral neededPlan approval may be needed
- Chiropractor20%Referral 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 4 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 Full Dual Advantage Aligned (HMO D-SNP), plan number H4471-010-002, 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 | Network pharmacy |
|---|---|
| 1Preferred Generic | $0 |
| 2Generic | $0 |
| 3Preferred BrandAfter the deductible | 25% of the price |
| 4Non-Preferred DrugAfter the deductible | 25% of the price |
| 5Specialty TierAfter the deductible | 25% of the price |
For a 1-month supply. The $615 drug deductible applies only to the tiers marked. 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. Fillings, crowns and dentures: you pay $0.Cleanings and exams: plan pays up to $3,000 a year. Plan pays up to $3,000 a year for all dental.
- Vision IncludedYearly eye exam: $0. Glasses or contacts covered.Eyewear: plan pays up to $425 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 IncludedCovered for things like vitamins, pain relief and bandages.
- Fitness IncludedIncludes gym or fitness classes.
- Rides to care Included96 one-way rides to medical visits a year.
- Meals IncludedMeals for a short time, right after surgery or a hospital stay.
- Help at home IncludedIncludes an emergency call button and home and bathroom safety items.Ask the plan who can get it.
- Extra help for some members IncludedIf you have certain long-term health conditions: meals, food and produce and general support for living.The plan decides who qualifies.
- Other extras IncludedIncludes a nurse phone line or online visits and acupuncture.
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) 668-2238 · 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.