Medicare Plan Lookup Official CMS data · Contract Year 2026
CMS 2026 data

2026 Medicare plan code

H5854-012

Medicare Plan

Anthem Kidney Care (HMO-POS C-SNP) · Anthem Blue Cross and Blue Shield · HMOPOS · Select Counties in Connecticut

Full CMS plan ID: H5854-012-000

H5854-012-000 is the full CMS identifier for the H5854-012 Medicare plan. Common searches include H5854 012 and H5854012.

Historical 2026 record. Benefits and service areas shown apply to that year.

2026

Spaces or dashes work: H5216-435-002 · S2135 802

● CMS 2026 plan record

Anthem Kidney Care (HMO-POS C-SNP)

H5854-012-000 Select Counties in Connecticut HMOPOS Chronic or Disabling Condition

At-a-glance

Quick view

01

In-network

Inpatient hospital

inpatient coinsurance is selected but its percentage is missing

02

Emergency transport

Ambulance

Ground · in-network20% coinsurance
Air · in-network20% coinsurance

Ground ambulance: In-network: cost sharing varies by a CMS plan-defined group; Air ambulance: In-network: cost sharing varies by a CMS plan-defined group

03

Emergency services

Emergency room

$115 copay

04

Medical maximum

Maximum out-of-pocket

In-network$9,250
Combined in + out$13,900
05

Skilled care at home

Home health

In-network$0 copay
Out-of-networkNot separately reported
06

Monthly cost

Premium & giveback

Part C premium$0 / month
Consolidated C + D$0 / month

Plan details

All plan benefits

Medical care3 benefits

Primary care physician

Verify in plan documents
In-network$0 copay
Out-of-networkNot separately reported

Specialist

Verify in plan documents
In-network$0 copay + 20% coinsurance
Out-of-networkNot separately reported

Preventive care

Verify in plan documents
In-network$0 copay
Out-of-networkNot separately reported
Diagnostics & imaging4 benefits

Diagnostic procedures & tests

Verify in plan documents
In-network20% coinsurance
Out-of-networkNot separately reported

Laboratory services

Verify in plan documents
In-network20% coinsurance
Out-of-networkNot separately reported

X-rays & standard imaging

Verify in plan documents
In-network20% coinsurance
Out-of-networkNot separately reported

MRI, CT & PET imaging

Verify in plan documents
In-network20% coinsurance
Out-of-networkNot separately reported
Urgent & hospital care6 benefits

Urgent care

In-networkCost share not reported
Out-of-networkNot separately reported

Emergency room

In-network$115 copay
Out-of-networkNot separately reported

Ground ambulance

Verify in plan documents
In-network20% coinsurance
Out-of-networkNot separately reported

Air ambulance

Verify in plan documents
In-network20% coinsurance
Out-of-networkNot separately reported

Outpatient hospital

Verify in plan documents
In-network20% coinsurance
Out-of-networkNot separately reported

Outpatient surgery / ASC

Verify in plan documents
In-network20% coinsurance
Out-of-networkNot separately reported
Recovery & therapy5 benefits

Home health

Verify in plan documents
In-network$0 copay
Out-of-networkNot separately reported

Skilled nursing facility

In-networkCost share not reported
Out-of-networkNot separately reported

Cardiac & pulmonary rehabilitation

Verify in plan documents
In-network20% coinsurance
Out-of-networkNot separately reported

Occupational therapy

Verify in plan documents
In-network20% coinsurance
Out-of-networkNot separately reported

Physical & speech therapy

Verify in plan documents
In-network20% coinsurance
Out-of-networkNot separately reported
Behavioral health2 benefits

Mental health services

Verify in plan documents
In-network$55 copay
Out-of-networkNot separately reported

Substance use treatment

Verify in plan documents
In-network$55 copay
Out-of-networkNot separately reported
Specialty care2 benefits

Podiatry

In-network$0 copay
Out-of-networkNot separately reported

Chiropractic

Verify in plan documents
In-network20% coinsurance
Out-of-networkNot separately reported
Supplemental benefits7 benefits

Dental

Verify in plan documents
In-network20% coinsurance
Out-of-networkNot separately reported

Vision

In-network$0 copay
Out-of-networkNot separately reported

Hearing

In-network$0 copay
Out-of-networkNot separately reported

Transportation

In-network$0 copay
Out-of-networkNot separately reported

Fitness & wellness

Not reported in this CMS export

Not reported in this CMS export

Over-the-counter allowance

In-network$0 copay
Out-of-networkNot separately reported

Meals

In-network$0 copay
Out-of-networkNot separately reported
Plan costs & rulesCoverage overview

Premium & Part B giveback

$0 Part C premium / month · Part B giveback not separately reported

Maximum out-of-pocket (MOOP)

In-network$9,250
Combined in + out$13,900

Medical deductibles

In-networkNot reported
Out-of-networkNot reported

Network & referrals

HMOPOS · Referrals: Not required · Out-of-network coverage: Not reported

Prescription drugs6 tiers

Part D deductible

Not reported

Drug tier 1

$0 retail copay · 30-day supply

Drug tier 2

$7 retail copay · 30-day supply

Drug tier 3

25% retail coinsurance · 30-day supply

Drug tier 4

25% retail coinsurance · 30-day supply

Drug tier 5

29% retail coinsurance · 30-day supply

Drug tier 6

$0 retail copay · 30-day supply

Using this plan

Understand H5854-012-000

Plain-language context built from this plan’s 2026 CMS record. It is a guide to the reported benefits, not a personalized cost estimate.

Plan at a glance

A quick read on this plan

Anthem Kidney Care (HMO-POS C-SNP) is a 2026 HMOPOS offered by Anthem Blue Cross and Blue Shield in Select Counties in Connecticut. The plan record does not require referrals.

Common benefit costs

What you may pay

These are individual in-network benefit amounts. A real visit may involve more than one separately billed service.

Routine care

Primary care physician
$0 copay
Specialist
$0 copay + 20% coinsurance
Laboratory services
20% coinsurance

Separate visits or services; costs are not added together.

Tests & outpatient care

Diagnostic procedures & tests
20% coinsurance
MRI, CT & PET imaging
20% coinsurance
Outpatient hospital
20% coinsurance

The service setting and billing details can change what you pay.

Emergency & hospital care

Emergency room
$115 copay

Actual costs depend on the care received and plan rules.

Helpful context

Terms worth knowing

Maximum out-of-pocket (MOOP)

This is the most you generally pay during the plan year for covered Part A and Part B medical services under the applicable network limit. Premiums and prescription drug costs generally do not count toward it.

Availability

Who can enroll

Service area
Select Counties in Connecticut (CT)
Plan type
HMOPOS
Special Needs Plan
Chronic or Disabling Condition
Contract / plan
H5854-012
Coverage year
2026

This is a Chronic or Disabling Condition; enrollment requires the plan's specific eligibility criteria as well as residence in its service area. Confirm eligibility and the exact service area with the plan before enrolling.

Supplemental coverage

Extra benefits reported

Availability is summarized here; allowances, frequency limits, networks, and prior-authorization rules may apply.

Dental20% coinsurance
Vision$0 copay
Hearing$0 copay
Over-the-counter allowance$0 copay
Transportation$0 copay
Meals$0 copay

Plan-specific answers

Frequently asked questions

Where is H5854-012-000 available?

Anthem Kidney Care (HMO-POS C-SNP) is listed for Select Counties in Connecticut (CT). This is a Chronic or Disabling Condition; enrollment requires the plan's specific eligibility criteria as well as residence in its service area.

What is the in-network maximum out-of-pocket limit for H5854-012-000?

The 2026 CMS record lists an in-network medical maximum out-of-pocket limit of $9,250. Prescription drug spending generally does not count toward this medical limit.

What is the monthly plan premium for H5854-012-000?

The listed consolidated Part C and Part D premium is $0 per month. This does not replace the standard Medicare Part B premium.

What does an emergency room visit cost on H5854-012-000?

The plan record lists $115 copay.

Does H5854-012-000 report extra benefits?

Yes. CMS reports dental, vision, hearing, over-the-counter allowance, transportation, and other supplemental benefits. See the detailed benefit rows and official plan documents for limits and conditions.

Source trail

Official CMS, Contract Year 2026

Plan identity and benefits come from CMS PBP data. Premium and MOOP figures are cross-checked against the August 2026 Landscape release; county identity is sourced from segment-level Landscape rows and stable codes are enriched from the aligned MA contract service-area release where matched. Quick-reference values should be confirmed in 2026 official plan documents.

PBP benefits ↗ Landscape data ↗ County service area ↗

Plan context

Where H5854-012-000 fits

Full CMS plan ID
H5854-012-000
Contract
H5854
Base plan code
H5854-012
Segment
000
Carrier
Anthem Blue Cross and Blue Shield
Plan type
HMOPOS
Service area
Select Counties in Connecticut (CT)

County/service-area foundation

CMS service-area entries

Named county entries are tied to this exact contract, plan, and segment in CMS Landscape data. County codes are enriched from the aligned CMS contract service-area release where a match exists.

  • Fairfield, CT
  • Hartford, CT
  • Litchfield, CT
  • Middlesex, CT
  • New Haven, CT
  • Tolland, CT

Same CMS contract

H5854-018-000 Anthem Veteran (HMO-POS) Select counties in CT · HMOPOS H5854-013-000 Anthem Full Dual Advantage Select (HMO D-SNP) State of Connecticut · HMO H5854-019-001 Anthem Medicare Advantage (HMO) Hartford, Litchfield, Middlesex, Windham · HMO H5854-019-002 Anthem Medicare Advantage (HMO) Fairfield, New Haven · HMO H5854-020-000 Anthem Dual Advantage (HMO D-SNP) State of Connecticut · HMO H5854-801-000 Anthem Senior Advantage (HMO) Connecticut · HMO H5854-803-000 Anthem Senior Advantage (HMO) Connecticut · HMO H5854-806-000 Anthem Senior Advantage (HMO) Conneticut · HMO

About this code

What H5854-012-000 identifies

H5854-012-000 is a Contract Year 2026 Medicare plan segment code. Searches written as H5854-012, H5854 012, or the compact full CMS ID H5854012000 refer to this plan or its base plan code.

Medicare Plan Lookup uses official CMS data as a quick reference. Benefit details, eligibility, service-area rules, and cost sharing should be confirmed in the current Summary of Benefits or Evidence of Coverage.