Fitness Benefit
Activity Tracker; Physical Fitness
No copay · up to $25 Every monthMandatory
IncludedAnthem Prime (HMO-POS)
Anthem Blue Cross Partnership Plan
HMO-POSSanta Clara CountyIncludes Part DPlan year 2026
$0/momonthly premium
$800most you pay in-network per year
3overall CMS star rating
5,625members enrolled, January 2026
Plan-level limits
Premium, deductibles, and the most you can pay out of pocket in a year.
In-network out-of-pocket maximum$800
Plan premium, per month$0
What a year on this plan would likely cost
What you pay for care
In-network costs for every service in this plan's CMS benefit filing. A copay is a fixed dollar amount; coinsurance is a percentage of the bill.
Hospital stays
Skilled nursing facility stay
Days 1–20$0 per day
Days 21–100$218 per day
Doctor visits
Primary care visit
$0
You pay nothing
Specialist visit
$0
You pay nothing
Telehealth visit
$0
You pay nothing
Other health care professional
$0
You pay nothing
Chiropractic care (Medicare-covered)
$0
You pay nothing
Routine chiropractic care
$0
You pay nothing
Podiatry (Medicare-covered)
$0
You pay nothing
Routine foot care
$0
You pay nothing
Emergency and urgent care
Emergency room visit
$150
Copay
Urgent care visit
$25
Copay
Emergency care outside the U.S.
$150
Copay
Up to $100,000
Urgent care outside the U.S.
$150
Copay
Emergency transportation outside the U.S.
$150
Copay
Mental health and substance use
Individual therapy session
$25
Copay
Group therapy session
$25
Copay
Opioid treatment program
$25
Copay
Partial hospitalization program
$0
You pay nothing
Prior authorization required
Therapy and rehabilitation
Occupational therapy
$0
You pay nothing
Physical and speech therapy
$0
You pay nothing
Cardiac rehabilitation
$0
You pay nothing
Intensive cardiac rehabilitation
$0
You pay nothing
Pulmonary rehabilitation
$0
You pay nothing
Supervised exercise therapy for peripheral artery disease
$0
You pay nothing
Tests, labs and imaging
Lab services
$0
You pay nothing
Diagnostic tests
$0
You pay nothing
Diagnostic procedures
$0
You pay nothing
Diagnostic radiology (MRI, CT, PET)
$0–$50
Copay, depends on the service
Therapeutic radiology
20%
Coinsurance — your share of the bill
Outpatient hospital and surgery
Outpatient hospital services
$0
You pay nothing
Ambulatory surgical center
$0
You pay nothing
Observation services
$0
You pay nothing
Blood services
$0
You pay nothing
Home health care
Home health visit
$0
You pay nothing
Ambulance
Ground ambulance
$0–$150
Copay, depends on the service
Air ambulance
$150
Copay
Medical equipment and supplies
Durable medical equipment
0–20%
Coinsurance, depends on the service
Medical supplies
20%
Coinsurance — your share of the bill
Prosthetic devices
20%
Coinsurance — your share of the bill
Dialysis
Dialysis
20%
Coinsurance — your share of the bill
Part B drugs
Part B drugs
0–20%
Coinsurance, depends on the service
Chemotherapy drugs
0–20%
Coinsurance, depends on the service
Part B insulin
$35
Copay
Preventive and wellness
Barium enema
$0
You pay nothing
Bathroom safety devices
$0
You pay nothing
Diabetes screening
$0
You pay nothing
Digital rectal exam
$0
You pay nothing
Electrocardiogram (EKG)
$0
You pay nothing
Fitness (health club membership)
$0
You pay nothing
Glaucoma screening
$0
You pay nothing
Nursing hotline
$0
You pay nothing
Web / phone access
$0
You pay nothing
Vision
Eye exam (Medicare-covered)
$0
You pay nothing
Routine eye exam
$0
You pay nothing
Eyewear after cataract surgery (Medicare-covered)
$0
You pay nothing
Eyeglasses (lenses and frames)
$0
You pay nothing
Eyeglass lenses
$0
You pay nothing
Eyeglass frames
$0
You pay nothing
Contact lenses
$0
You pay nothing
Eyewear allowance
Up to $300 per year
Allowance
Hearing
Hearing exam (Medicare-covered)
$0
You pay nothing
Routine hearing exam
$0
You pay nothing
Hearing aid fitting and evaluation
$0
You pay nothing
Prescription hearing aids
$0
You pay nothing
Up to $3,000 per year, both ears combined
Over-the-counter hearing aids
$0
You pay nothing
Up to $300 per year
Extra benefits
Over-the-counter items
$0
You pay nothing
Up to $38 every three months
Acupuncture
$0
You pay nothing
Medicare Community Resource Support
$0
You pay nothing
Extra benefits beyond Original Medicare
Supplemental benefits this plan filed with CMS, with the cap and period exactly as filed.
Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline)
Nursing Hotline; Web/Phone-based technologies
No copayMandatory
IncludedHome and Bathroom Safety Devices and Modifications
No copay · up to $500 Every yearMandatory
IncludedNot offered by this plan
Health EducationIn-Home Safety AssessmentPersonal Emergency Response System (PERS)Medical Nutrition Therapy (MNT)Post discharge In-Home Medication ReconciliationRe-admission PreventionWigs for Hair Loss Related to ChemotherapyWeight Management ProgramsAlternative TherapiesTherapeutic MassageAdult Day Health ServicesNutritional/Dietary BenefitHome-Based Palliative CareIn-Home Support ServicesSupport for Caregivers of EnrolleesAdditional Sessions of Smoking and Tobacco Cessation CounselingEnhanced Disease ManagementTelemonitoring ServicesCounseling Services
Dental
$750 every year allowance, shared by preventive and comprehensive services. No dental deductible.
Preventive
Oral examsNo copay
CleaningsNo copay
X-raysNo copay
Fluoride treatmentNo copay
Other diagnostic servicesNo copay
Other preventive servicesNo copay
Comprehensive
Restorative (fillings)No copay, prior authorization
Endodontics (root canals)No copay, prior authorization
Periodontics (gum treatment)No copay, prior authorization
Oral surgeryNo copay, prior authorization
Fixed prosthodontics (crowns, bridges)No copay, prior authorization
Removable prosthodontics (dentures)No copay, prior authorization
Adjunctive general servicesNo copay, prior authorization
Medicare-covered dental services: $0 copay.
Prescription drugs (Part D)
$0 annual drug deductible · 5 formulary tiers · mail order available. Costs shown for a 30-day supply.
Initial coverage
| Tier | Preferred retail | Standard retail | Mail order | Insulin | Deductible |
|---|---|---|---|---|---|
| 1. Preferred Generic | No copay | No copay | — | — | Waived |
| 2. Generic | No copay | No copay | — | — | Waived |
| 3. Preferred Brand | $42 copay | $47 copay | — | $35 | Waived |
| 4. Non-Preferred Drug | 25% coinsurance | 25% coinsurance | — | $35 | Waived |
| 5. Specialty Tier specialty | 33% coinsurance | 33% coinsurance | — | — | Waived |
Catastrophic (after the out-of-pocket threshold)
| Tier | Preferred retail | Standard retail | Mail order | Insulin | Deductible |
|---|---|---|---|---|---|
| 1. Preferred Generic | No copay | No copay | No copay | — | Waived |
| 2. Generic | No copay | No copay | No copay | — | Waived |
| 3. Preferred Brand | No copay | No copay | No copay | $35 | Waived |
| 4. Non-Preferred Drug | No copay | No copay | No copay | $35 | Waived |
| 5. Specialty Tier specialty | No copay | No copay | No copay | — | Waived |
Out-of-pocket threshold for the catastrophic phase: $2,100.
Is my medicine on this plan’s list?
Pharmacies near you in this plan's network
From the plan's filed Part D pharmacy network, matched to geocoded pharmacy locations. Preferred pharmacies come first: they carry the lower copay column in the tier table above. The ZIP you enter stays in this browser.
CMS star ratings
Star ratings are set by CMS for the whole contract, so every plan under this contract shares them.
3 out of 5Overall rating
3 out of 5Health services (Part C)
2.5 out of 5Drug plan (Part D)
Staying healthy: screenings, tests and vaccines
3- Annual flu vaccine3
- Breast cancer screening3
- Colorectal cancer screening4
- Monitoring physical activity3
Managing chronic (long-term) conditions
3- Readmissions3
- Kidney health4
- Blood pressure2
- Reducing falls4
- Statin therapy3
- Diabetes eye exam3
- Transitions of care3
- Diabetes blood sugar3
- Osteoporosis management3
- Followup after emergency department visit1
- Medication reconciliation3
Member experience with the health plan
2- Customer service3
- Healthcare quality1
- Health plan rating1
- Getting needed care1
Member complaints and changes in the plan's performance
3- Complaints3
- Members leaving2
- Quality improvement4
Health plan customer service
4- Call center5
- Timely decisions3
- Appeals decisions5
Drug plan customer service
5- Call center foreign language interpreter and TTY availability5
Drug plan complaints and changes
2- Complaints3
- Members leaving2
- Quality improvement1
Member experience with the drug plan
2- Drug plan rating2
- Prescription drugs2
Drug safety and accuracy of drug pricing
4- Price accuracy5
- Statin diabetes4
- Medication therapy management comprehensive medication review completion4
- Medication adherence for diabetes medications3
- Medication adherence for hypertension RAS antagonists s3
- Medication adherence for cholesterol statins3
Why members leave this contract
Service area and network
Sold in 1 California county.
Santa Clara
Doctor directory
18,139 providers are named in Anthem Blue Cross Partnership Plan’s directory for this plan, dated Sep 8, 2026.
A doctor named there is listed. A doctor missing from it is unknown, never out of network: carrier directories are partial and change monthly. Open the carrier directory
Contract with Medicare sinceJan 1, 2023
Medicare Advantage regionCalifornia
Ask about this plan
A question box grounded in this plan's filed benefits, drug list, and pharmacy network. It reads the same records shown on this page and says so when something is not filed.
Answers come from this plan’s filed benefits, drug list, and pharmacy network. They are not enrollment advice; the Evidence of Coverage is the final word.