What Is Medicare Plan H5422-013 and How Does It Work?

Key Takeaways

• H5422-013 is a Medicare Advantage plan identifier for Anthem Extra Help (HMO-POS) in select Georgia counties, not a medical code. Always verify current premiums, benefits, and provider networks through official sources like Medicare.gov and Anthem before enrolling.
• HMO-POS plans require using in-network providers to control costs, may need referrals for specialists, and may require prior authorization for certain services. A strong primary care relationship helps navigate these requirements and improves health outcomes.
• The plan name 'Extra Help' does not automatically qualify you for federal Part D Low-Income Subsidy; eligibility is determined separately by Social Security based on income and resources. Always review the drug formulary and verify your actual drug costs.
• Before enrolling, confirm your preferred doctors participate in the network by calling clinics directly, as provider directories can be outdated. Check the 2026 Summary of Benefits and Evidence of Coverage to understand copays, the $5,900 out-of-pocket maximum, and covered preventive services.
• Plan availability is limited to select Georgia counties and changes by location. Use Medicare.gov Plan Finder with your ZIP code or call 1-800-MEDICARE to confirm if H5422-013 is available in your area and which local providers are in-network.
• Common enrollment mistakes include assuming doctors are in-network without verification, skipping the drug formulary review, and ignoring yearly out-of-pocket limits. Build a trusted primary care team relationship for the best long-term health management regardless of plan choice.

If you have seen the code H5422-013 on a Medicare mailer, an insurance card, or a plan comparison site, you are probably wondering what it means. It is not a diagnosis or a medical procedure code. H5422-013 is a Medicare Advantage plan identifier. In 2026 listings, it is tied to Anthem Extra Help (HMO-POS), a plan offered by Anthem Blue Cross and Blue Shield in select Georgia counties.

This matters for your primary care and wellness. The plan you choose shapes which doctors you can see, what you pay, and how easily you can get preventive care. This guide explains what H5422-013 is, what the details mean in plain terms, and how to confirm your benefits. It also shows how to build a strong relationship with a primary care team, whatever plan you carry.

What Does H5422-013 Mean?

Every Medicare Advantage plan has a CMS-style identifier. The first part, H5422, points to the insurance contract. The second part, 013, points to the specific plan under that contract. You may also see it written as H5422-013-000 or H5422-013-0. The last segment marks a plan segment, so check the exact code on your own plan documents.

Here is a quick summary of what 2026 listings report about this plan:

These figures come from third-party listings. Premiums, benefits, and ratings can change. Always confirm them in the official 2026 plan documents before you decide.

Is H5422-013 a Medical Code?

No. This is a common point of confusion. People often search for codes like this after seeing them on paperwork. A medical billing code describes a service or diagnosis. H5422-013 describes a health insurance plan.

Think of it as a plan's license plate. It helps Medicare, insurers, and clinics identify the exact plan you have. When you call a clinic to ask whether it takes your insurance, giving the plan name and ID number helps staff check your coverage faster.

What Does HMO-POS Mean for Your Doctor Visits?

HMO-POS stands for Health Maintenance Organization with a Point-of-Service option. In simple terms, the plan mostly works through a network of doctors and hospitals. Staying in network usually keeps your costs lower.

The point-of-service feature may allow some covered services outside the network. But rules vary by service and plan. Costs, referral needs, and approval steps depend on the plan terms.

Key HMO-POS Basics

• Network matters: Using in-network providers is the safest way to control costs.
• Referrals may apply: Some specialist visits may need a referral from your primary care doctor.
• Out-of-network rules differ: Coverage and cost sharing depend on the type of service.
• Prior authorization: Some tests, drugs, or procedures may need plan approval first.

Because of these rules, your primary care doctor often acts as your health guide. A strong primary care relationship can help you move through referrals and approvals with less stress. You can learn more about how a Medicare HMO supports better primary care in our related guide.

Which Insurance Company Offers H5422-013?

Listings identify Anthem Blue Cross and Blue Shield as the carrier. The plan includes Medicare Part A and Part B benefits, plus Part D prescription drug coverage. That is why it is called an MA-PD plan.

Remember that you still pay the Medicare Part B premium unless you qualify for help paying it. The plan premium is an added cost on top of that. Third-party listings report $25.40 per month for the plan itself, but verify the current amount with Anthem or Medicare.gov.

Does "Extra Help" Mean You Get Low-Income Drug Subsidies?

Not automatically. The name "Extra Help" can be misleading. It does not mean every member qualifies for the federal Part D Low-Income Subsidy, also known as Extra Help.

That federal program is separate. Eligibility is decided by Social Security based on income and resources. If you think you may qualify, apply through Social Security or check with Medicare. Once approved, your drug costs under the plan may drop.

Do not assume the plan name alone lowers your drug costs. Review the formulary, which is the plan's drug list. Also check for tiers, copays, and prior authorization rules.

Is H5422-013 Available in Your County?

This plan is listed for select Georgia counties. Medicare Advantage plans are tied to where you live. Moving to a new county or state can change your options.

To check availability:

1. Visit Medicare.gov and use the plan finder with your ZIP code.
2. Look for Anthem Extra Help (HMO-POS) in your results.
3. Call Anthem or 1-800-MEDICARE to confirm your county is covered.
4. Ask whether your current doctors are in the network.

Even if the plan is offered in your county, a specific clinic or doctor may not participate. The plan name alone does not prove a provider is in network.

Does H5422-013 Cover Primary Care and Preventive Services?

Medicare Advantage plans must cover everything Original Medicare covers. That includes many preventive services, such as an annual wellness visit and certain cancer screenings. But your costs, such as copays, depend on your plan.

To see what applies to you, read two official documents:

• Summary of Benefits: A short overview of copays, premiums, and covered services.
• Evidence of Coverage: The full legal document that explains your rights and plan rules.

Look for primary care visit copays, preventive care coverage, network rules, and your yearly out-of-pocket limit. Also check what counts toward that $5,900 in-network maximum reported in listings. Third-party summaries can be incomplete, so rely on official sources.

If you want to understand what these visits typically include, read about what happens during an annual wellness visit.

How to Find a Primary Care Doctor in Your Plan's Network

Finding the right doctor takes a little homework. Here is a simple process:

1. Use the plan's provider directory. Search by specialty and location on the Anthem website.
2. Call the clinic directly. Ask if they accept your exact plan, not just the insurance company.
3. Confirm they are accepting new patients. Our guide on finding doctors accepting new patients can help.
4. Ask about referral and approval steps. Understand how the office handles them.
5. Check practical details. Think about hours, location, same-day visits, and telehealth.

Provider directories can be out of date. A phone call before your first visit can save you from surprise bills.

What About Prescription Drug Coverage?

H5422-013 is described as including Part D drug coverage. Before you enroll or stay in the plan, review the formulary. Ask your doctor to check whether your regular medicines are listed.

Keep these points in mind:

• Drugs are placed in tiers, and each tier has a different cost.
• Some drugs may need prior authorization or step therapy.
• Pharmacy networks may affect your price.
• Your yearly drug costs may change as you move through coverage stages.

Good medication management also helps. Our article on prescription management tips for better health in 2026 offers practical steps to stay organized.

How to Check Your 2026 Premiums, Copays, and Benefits

Do not rely only on third-party websites. Use these official steps:

1. Log in to your Anthem member account or request plan documents by phone.
2. Read the 2026 Summary of Benefits and Evidence of Coverage.
3. Use the Medicare.gov Plan Finder to compare costs and star ratings.
4. Check the current CMS star rating. Ratings change by year.
5. Write down questions and call the plan or a licensed Medicare counselor.

You can also contact your State Health Insurance Assistance Program (SHIP) for free, unbiased Medicare counseling.

Why Your Primary Care Relationship Matters More Than the Plan Code

A plan code tells you what coverage you hold. It does not tell you how well you will be cared for. The best outcomes usually come from a primary care team that knows your history and focuses on prevention.

A strong primary care practice can:

• Track chronic conditions like high blood pressure and diabetes.
• Order screenings and vaccines at the right time.
• Coordinate care with specialists.
• Review your medications for safety.
• Help you build healthy habits over time.

InCare takes this whole-person approach in Tampa and Riverview, Florida. The clinic combines state-of-the-art technology with personalized primary care, urgent care, cancer screening, and wellness services. Patients can also use virtual visits for added convenience. If you live in Florida, you can read more about Medicare Advantage plans and primary care or learn what Medicare covers for seniors in primary care. See what patients say in InCare reviews on Google.

One important note: H5422-013 is listed for Georgia counties. If you are a Florida resident, this specific plan would not apply to you. Florida Medicare plans have different identifiers. A team member at InCare can help you understand which plans the clinic accepts.

Common Mistakes to Avoid With Medicare Advantage Plans

• Assuming your doctor is in network. Always verify before you schedule.
• Skipping the formulary check. Your drugs may cost more than expected.
• Ignoring the out-of-pocket maximum. Know your worst-case yearly cost.
• Relying on outdated listings. Plans change each year.
• Waiting too long for preventive care. Early screening catches problems sooner.

For more on this topic, see our guide to the traits of the best Medicare provider for primary care.

Stay Connected for Health Tips

Follow InCare for wellness updates and clinic news on Facebook, Instagram, and TikTok.

Final Thoughts

H5422-013 is a Medicare Advantage plan identifier linked to Anthem Extra Help (HMO-POS) in select Georgia counties. It is not a medical code. Your costs, network, and benefits depend on your location and the official plan documents. Verify details with Medicare.gov or Anthem before you act on any third-party summary.

Whatever plan you hold, a trusted primary care team makes the biggest difference in your health. If you live in the Tampa or Riverview area, book your visit with InCare today, or contact our team with questions about insurance and new patient appointments. You can also explore our primary care services to see how InCare can support your long-term health.

FAQs

Q: What is Medicare plan H5422-013?

A: H5422-013 is a Medicare Advantage plan identifier. In 2026 listings, it is associated with Anthem Extra Help (HMO-POS), offered by Anthem Blue Cross and Blue Shield in select Georgia counties. It combines Medicare Part A, Part B, and Part D drug coverage.

Q: Can I see an out-of-network doctor with an HMO-POS plan?

A: Possibly, for some covered services. The point-of-service feature may allow limited out-of-network care, but costs, referrals, and approval rules depend on the service and plan terms. Check your Evidence of Coverage or call the plan before you schedule.

Q: Does the name "Extra Help" mean I automatically qualify for the Part D Low-Income Subsidy?

A: No. The plan name does not guarantee federal Extra Help eligibility. Social Security decides eligibility based on income and resources, so verify your subsidy status separately and confirm your resulting drug costs.

Q: How do I check H5422-013 premiums, copays, and benefits for 2026?

A: Review the official 2026 Summary of Benefits and Evidence of Coverage from Anthem, and use the Plan Finder on Medicare.gov. Third-party listings can be incomplete or outdated, so official sources are the most reliable.

Q: Is H5422-013 available in my county?

A: Listings show the plan in select Georgia counties only. Enter your ZIP code in the Medicare.gov Plan Finder or call Anthem to confirm availability and ask whether your preferred doctors are in the network.

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