Anthem Full Dual Advantage Aligned (HMO D-SNP)
Anthem Blue Cross
HMO D-SNPDual-EligibleSanta Clara CountyIncludes Part DPlan year 2026
$0/momonthly premium
$9,250most you pay in-network per year
3overall CMS star rating
—enrollment not published
Plan-level limits
Premium, deductibles, and the most you can pay out of pocket in a year.
In-network out-of-pocket maximum$9,250
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.
Doctor visits
Primary care visit
20%
Coinsurance — your share of the bill
Specialist visit
20%
Coinsurance — your share of the bill
Telehealth visit
$0
You pay nothing
Other health care professional
20%
Coinsurance — your share of the bill
Chiropractic care (Medicare-covered)
20%
Coinsurance — your share of the bill
Podiatry (Medicare-covered)
20%
Coinsurance — your share of the bill
Routine foot care
$0
You pay nothing
Emergency and urgent care
Emergency room visit
$115
Copay
Urgent care visit
$40
Copay
Emergency care outside the U.S.
$0
You pay nothing
Up to $100,000
Urgent care outside the U.S.
$0
You pay nothing
Emergency transportation outside the U.S.
$0
You pay nothing
Mental health and substance use
Individual therapy session
20%
Coinsurance — your share of the bill
Group therapy session
20%
Coinsurance — your share of the bill
Opioid treatment program
20%
Coinsurance — your share of the bill
Partial hospitalization program
$60
Copay
Prior authorization required
Therapy and rehabilitation
Occupational therapy
20%
Coinsurance — your share of the bill
Physical and speech therapy
20%
Coinsurance — your share of the bill
Cardiac rehabilitation
20%
Coinsurance — your share of the bill
Intensive cardiac rehabilitation
20%
Coinsurance — your share of the bill
Pulmonary rehabilitation
20%
Coinsurance — your share of the bill
Supervised exercise therapy for peripheral artery disease
20%
Coinsurance — your share of the bill
Tests, labs and imaging
Lab services
20%
Coinsurance — your share of the bill
Diagnostic tests
20%
Coinsurance — your share of the bill
X-rays
$20
Copay
Diagnostic radiology (MRI, CT, PET)
20%
Coinsurance — your share of the bill
Therapeutic radiology
20%
Coinsurance — your share of the bill
Outpatient hospital and surgery
Outpatient hospital services
20%
Coinsurance — your share of the bill
Ambulatory surgical center
20%
Coinsurance — your share of the bill
Observation services
20%
Coinsurance — your share of the bill
Blood services
$0
You pay nothing
Home health care
Home health visit
$0
You pay nothing
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
Vision
Eye exam (Medicare-covered)
20%
Coinsurance — your share of the bill
Routine eye exam
$0
You pay nothing
Eyewear after cataract surgery (Medicare-covered)
20%
Coinsurance — your share of the bill
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 $425 per year
Allowance
Hearing
Hearing exam (Medicare-covered)
20%
Coinsurance — your share of the bill
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
Meals
$0
You pay nothing
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.
No supplemental benefits are filed for this plan.
Not 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 CounselingFitness BenefitEnhanced Disease ManagementTelemonitoring ServicesRemote Access Technologies (including Web/Phone-based technologies and Nursing Hotline)Home and Bathroom Safety Devices and ModificationsCounseling Services
Prescription drugs (Part D)
$615 annual drug deductible · 5 formulary tiers · mail order available. Costs shown for a 30-day supply.
Before the deductible
| Tier | Preferred retail | Standard retail | Mail order | Insulin | Deductible |
|---|---|---|---|---|---|
| 1. Preferred Generic | — | No copay | — | — | Waived |
| 2. Generic | — | No copay | — | — | Waived |
Initial coverage
| Tier | Preferred retail | Standard retail | Mail order | Insulin | Deductible |
|---|---|---|---|---|---|
| 1. Preferred Generic | — | No copay | — | — | Waived |
| 2. Generic | — | No copay | — | — | Waived |
| 3. Preferred Brand | — | 25% coinsurance | — | — | Applies |
| 4. Non-Preferred Drug | — | 25% coinsurance | — | — | Applies |
| 5. Specialty Tier specialty | — | 25% coinsurance | — | — | Applies |
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 | — | Applies |
| 4. Non-Preferred Drug | No copay | No copay | No copay | — | Applies |
| 5. Specialty Tier specialty | No copay | No copay | No copay | — | Applies |
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)
3 out of 5Drug plan (Part D)
Staying healthy: screenings, tests and vaccines
- Breast cancer screening2
- Colorectal cancer screening2
Managing chronic (long-term) conditions
3- Readmissions3
- Kidney health4
- Blood pressure2
- Statin therapy3
- Pain assessment3
- Medication review3
- Diabetes eye exam3
- Transitions of care2
- Diabetes blood sugar3
- Osteoporosis management2
- Followup after emergency department visit1
- Medication reconciliation2
- Special needs plan SNP care management3
Member complaints and changes in the plan's performance
3- Complaints3
- Members leaving3
Health plan customer service
5- Call center5
- Timely decisions5
- Appeals decisions5
Drug plan customer service
5- Call center foreign language interpreter and TTY availability5
Drug plan complaints and changes
3- Complaints3
- Members leaving3
Drug safety and accuracy of drug pricing
3- Price accuracy5
- Statin diabetes4
- Medication therapy management comprehensive medication review completion4
- Medication adherence for diabetes medications3
- Medication adherence for hypertension RAS antagonists s2
- Medication adherence for cholesterol statins2
Service area and network
Service area not published.
Doctor directory
19,375 providers are named in Anthem Blue Cross’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
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.