[California] California 2027 Medicare Advantage plan changes
Act
by Jan 1, 2027
Effective date
Jan 1, 2027
Identified
Oct 20, 2026
Summary
Anthem Blue Cross is making significant changes to its California Medicare Advantage plan portfolio effective January 1, 2027, including service area reductions for two HMO plans, non-renewal of five HMO plans, introduction of one new PPO plan, transition of one existing PPO plan to a new plan ID, and non-renewal of two PPO plans. Billing teams must verify plan eligibility, member ID changes, and updated benefit information for affected members in Sacramento, Yolo, San Joaquin, Alameda, Santa Clara, Fresno, Kern, Kings, Madera, Merced, Monterey, San Diego, San Luis Obispo, Stanislaus, Tulare, Ventura, Butte, Napa, Shasta, Solano, Sonoma, Sutter, Tehama, Yuba, Alpine, Amador, Calaveras, El Dorado, Inyo, Mono, and Tuolumne counties.
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01Billing team must (1) update billing system records to remove or flag the following non-renewing plans: H0544-064-000, H0544-095-000, H0544-098-000, H0544-108-000, H4161-010-000, H4704-001-000, and H4704-002-000; (2) implement service area reductions for H4161-004-000 (Sacramento/Yolo) and H4161-005-000 (San Joaquin/Alameda); (3) add new plan H4909-029-000 (Chronic Care Advantage PPO C-SNP) for Butte, Napa, Shasta, Solano, Sonoma, Sutter, Tehama, Yuba counties; (4) update plan ID transition from H8552-028-000 to H4909-030-000 for Kidney Care PPO C-SNP across all listed counties; (5) verify member ID card information for identification and group number changes that may affect claim submissions; and (6) check https://Availity.com or contact Anthem Provider Services to confirm current member eligibility and updated benefit details including medical/Part D benefits, copays, coinsurance, deductibles, formulary coverage, pharmacy networks, premiums, and out-of-pocket maximums.
If missed: Failure to update plan records and eligibility verification may result in claim denials or processing errors for affected members.
Original notice
[California] California 2027 Medicare Advantage plan changes
providernews.anthem.com · Always check the source before changing claims.
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