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Anthem I Carelon Chronic Care (HMO-POS C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem I Carelon Chronic Care (HMO-POS C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Anthem I Carelon Chronic Care (HMO-POS C-SNP) in 2025, please refer to our full plan details page.
Anthem I Carelon Chronic Care (HMO-POS C-SNP) is a HMO-POS C-SNP 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 Chronic Care (HMO-POS C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Anthem I Carelon Chronic Care (HMO-POS C-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Anthem I Carelon Chronic Care (HMO-POS C-SNP).
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 Chronic Care (HMO-POS C-SNP), 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 $800.00 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 Chronic Care (HMO-POS C-SNP) plan has an enhanced alternative drug benefit. There is no deductible for prescription drugs. During the initial coverage phase, you will pay no copay for preferred generic drugs at a preferred or standard pharmacy, and no copay for specialty tier drugs. For standard generic drugs, you will pay a $45 or $47 copay depending on the pharmacy. For preferred brand drugs and non-preferred drugs, you will pay 25% or 33% coinsurance, respectively. After your total drug costs reach $2000, you will enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs.
Additional Benefits
The Anthem I Carelon Chronic Care (HMO-POS C-SNP) plan offers a range of benefits with varying cost-sharing. Many services have no copay, including inpatient and outpatient hospital services, primary care, preventive services, and vision and dental services. However, some services have copays, such as outpatient substance abuse, partial hospitalization, ambulance, and emergency services. The plan also covers hearing aids with a maximum benefit, medical equipment with coinsurance, and home health services with no copay. Additionally, the plan provides coverage for OTC items, a meal benefit, and other services. Be aware that some services require prior authorization, and some are not covered by the plan.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric, are covered, with a $0 copay for Medicare-covered stays. Additional days for inpatient hospital acute and psychiatric are covered with no copay. Non-Medicare-covered stays and upgrades for inpatient hospital acute and psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services and observation services with no copay, Ambulatory Surgical Center (ASC) Services with no copay, and outpatient blood services with no copay. Outpatient substance abuse services are covered with a copay of $15 for both individual and group sessions.
Partial Hospitalization See details
Partial hospitalization is covered by the Anthem I Carelon Chronic Care (HMO-POS C-SNP) plan, but requires prior authorization. The copay for this benefit is $15.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered. Ground and air ambulance services have a $100 copay, while transportation services to a plan-approved health-related location have no copay and are limited to 104 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Anthem I Carelon Chronic Care (HMO-POS C-SNP) plan. Emergency Services has a $100 copay, and Urgently Needed Services has no copay. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $100 copay.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered under the Anthem I Carelon Chronic Care (HMO-POS C-SNP) plan. Primary Care Physician Services, Chiropractic Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, and Additional Telehealth Benefits have no copay. Individual and Group Sessions for Mental Health Specialty Services, Individual and Group Sessions for Psychiatric Services, Medicare-covered podiatry services, and Routine Foot Care have no copay. Other Health Care Professional services have a copay between $0 and $20, and Opioid Treatment Program Services have a $15 copay.
Preventive Services See details
Preventive services include no copay for annual physical exams, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. Additional preventive services, including fitness benefits, remote access technologies, and home and bathroom safety devices, are covered, but other services such as health education and counseling are not covered.
Hearing Services See details
The Anthem I Carelon Chronic Care (HMO-POS C-SNP) plan covers hearing exams, routine hearing exams, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a maximum plan benefit of $3,000 per year, and OTC hearing aids are covered with no copay and a maximum benefit of $300 per year. Prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision Services include eye exams and eyewear, with no copay for any service. Routine eye exams are limited to one per year. Eyewear has a combined maximum benefit of $300 per year, and includes coverage for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
Dental services are covered, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services, all with no copay. Other services covered include restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics, all with no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Anthem I Carelon Chronic Care (HMO-POS C-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered, including Durable Medical Equipment (DME) with a coinsurance of 0% to 20%, and Prosthetics/Medical Supplies, Diabetic Equipment, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts with no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with no copay, Lab Services with no copay, Diagnostic Radiological Services with a copay of at most $75, Therapeutic Radiological Services with a copay of at least $60, and Outpatient X-Ray Services with no copay. Prior authorization is required for all services.
Home Health Services See details
Home Health Services are covered by the Anthem I Carelon Chronic Care (HMO-POS C-SNP) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Anthem I Carelon Chronic Care (HMO-POS C-SNP) plan. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $25.
Other Services See details
The Anthem I Carelon Chronic Care (HMO-POS C-SNP) plan covers Over-the-Counter (OTC) Items with no copay and a maximum benefit coverage amount of $89 every three months. The plan also covers a meal benefit with no copay, but requires prior authorization, and offers Medicare Community Resource Support with no copay. Acupuncture, 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, 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, Self-Directed Personal Assistance Services, and Dual Eligible SNPs with Highly Integrated Services are not covered.
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