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Anthem I Carelon Medicare Advantage 2 (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem I Carelon Medicare Advantage 2 (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Anthem I Carelon Medicare Advantage 2 (HMO-POS) in 2025, please refer to our full plan details page.
Anthem I Carelon Medicare Advantage 2 (HMO-POS) is a HMO-POS plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Los Angeles and Orange Counties. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Anthem I Carelon Medicare Advantage 2 (HMO-POS) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Anthem I Carelon Medicare Advantage 2 (HMO-POS).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Anthem I Carelon Medicare Advantage 2 (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $1000.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Anthem I Carelon Medicare Advantage 2 (HMO-POS) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay either a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs, there is no copay. For standard generic drugs, you'll pay 20-25% coinsurance. For preferred brand drugs, you'll pay 25% coinsurance. For non-preferred drugs, you'll pay 33% coinsurance. Specialty tier drugs have no copay. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered Part D drugs.
Additional Benefits
The Anthem I Carelon Medicare Advantage 2 (HMO-POS) plan offers a variety of benefits with varying costs. This plan includes coverage for inpatient hospital stays, outpatient services, primary care, preventive services, hearing, vision, dental, and home health services. You can expect to pay a copay for services such as inpatient hospital stays, outpatient services, emergency services, and ambulance services. The plan also provides benefits for medical equipment, diagnostic and radiological services, and skilled nursing facility stays. Additionally, there are no copays for many services including primary care, vision, and hearing exams. The plan also offers benefits like over-the-counter items and a meal benefit.
Inpatient Hospital See details
Inpatient Hospital services, including Acute and Psychiatric, are covered, with a copay of $125 for days 1-5 and no copay for days 6-90. Additional days for both Acute and Psychiatric are covered with no copay, but Non-Medicare-covered stays and Upgrades are not covered.
Outpatient Services See details
Outpatient services include coverage for all outpatient hospital services with a copay between $0 and $125, observation services with a $125 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $15 copay for both individual and group sessions, and outpatient blood services with no copay and a waived three-pint deductible. Prior authorization is required for most services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Anthem I Carelon Medicare Advantage 2 (HMO-POS) plan, with a $15 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Anthem I Carelon Medicare Advantage 2 (HMO-POS) plan. Ground ambulance services have a $100 copay, and air ambulance services have a 20% coinsurance; transportation services to a plan-approved health-related location have no copay, and are limited to 22 one-way trips per year.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, are covered by the Anthem I Carelon Medicare Advantage 2 (HMO-POS) plan. Emergency Services have a $120 copay, while Urgently Needed Services have no copay; Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $120 copay.
Primary Care See details
The Anthem I Carelon Medicare Advantage 2 (HMO-POS) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care, chiropractic, physician specialist, physical therapy, and additional telehealth benefits have a $0 copay, while occupational therapy, other health care professional, mental health specialty services, psychiatric services, and podiatry services have varying copays depending on the service.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and additional preventive services, including fitness benefit and remote access technologies, with a copay. Other preventive services such as health education, in-home safety assessment, and many others are not covered.
Hearing Services See details
Hearing Services include coverage for hearing exams and OTC hearing aids with no copay, and prescription hearing aids with a maximum benefit of $1,500 per year. Routine hearing exams and fitting/evaluation for hearing aids are also covered with no copay and are limited to 1 visit per year. Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered.
Vision Services See details
The Anthem I Carelon Medicare Advantage 2 (HMO-POS) plan covers vision services, including routine eye exams and eyewear. There is no copay for eye exams and eyewear, including contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames, with a combined maximum of $150 every year for eyewear, but upgrades are not covered.
Dental Services See details
Dental services are covered, including oral exams, dental x-rays, and other diagnostic, preventive, and restorative services, with a $1,500 annual maximum benefit and no copay. Orthodontic services are also covered, under Diagnostic and Preventive Dental.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are covered with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Anthem I Carelon Medicare Advantage 2 (HMO-POS) plan. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a coinsurance between 0% and 20%, and Prosthetic Devices and Medical Supplies have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Anthem I Carelon Medicare Advantage 2 (HMO-POS) plan. Diagnostic Procedures/Tests have no copay, Lab Services have no copay, Diagnostic Radiological Services have a copay up to $60, Therapeutic Radiological Services have a copay of $50, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Anthem I Carelon Medicare Advantage 2 (HMO-POS) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. There is a copay for Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Anthem I Carelon Medicare Advantage 2 (HMO-POS) plan, with a $0 copay for days 1-20, and a $25 copay for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Anthem I Carelon Medicare Advantage 2 (HMO-POS) plan covers Over-the-Counter (OTC) items with no copay, and a maximum benefit coverage amount of $55.00 every three months, which can carry forward if unused. The plan also covers a meal benefit with no copay, but requires prior authorization. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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