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Anthem I Carelon Home Care (HMO I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem I Carelon Home Care (HMO I-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 Home Care (HMO I-SNP) in 2025, please refer to our full plan details page.
Anthem I Carelon Home Care (HMO I-SNP) is a HMO I-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 Home Care (HMO I-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 Home Care (HMO I-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 Home Care (HMO I-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 Home Care (HMO I-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. Additionally, this plan comes with a Part B Premium reduction of $30.00. You must continue to pay paying your reduced 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 Home Care (HMO I-SNP) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay varying costs based on the drug tier and pharmacy type. For example, you'll pay no copay for preferred generic drugs at standard and mail order pharmacies, and a $47 copay for standard generic drugs. For preferred brand drugs and non-preferred drugs, you'll pay 25% and 33% coinsurance, respectively. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Anthem I Carelon Home Care (HMO I-SNP) plan offers comprehensive coverage with no copays for many services. This includes inpatient hospital stays, outpatient services, primary care, preventive services, hearing exams, vision services, dental services, home health services, diagnostic procedures/tests, and transportation services. Many other services, such as ambulance, emergency services, home infusion services, medical equipment, and skilled nursing facilities are covered with copays or coinsurance, but not all services are covered. The plan also offers additional benefits such as over-the-counter items, with a maximum benefit. There is a $120 copay for emergency services and a $100 copay for ground and air ambulance. Hearing aids, vision eyewear, and medical equipment are also covered with some limitations.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with prior authorization. There is no copay for a Medicare-covered stay, and additional days are unlimited with no copay per day, but Non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient services, including outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient hospital services, observation services, ASC services, and outpatient blood services have no copay. Individual and group sessions for outpatient substance abuse also have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by Anthem I Carelon Home Care (HMO I-SNP) with no copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Anthem I Carelon Home Care (HMO I-SNP), including ground and air ambulance services with a $100 copay, and transportation services with no copay. Transportation services to any health-related location are limited to 22 one-way trips per year, using rideshare services, bus/subway, van, or medical transport.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have a $120 copay, while Urgently Needed Services has no copay. Worldwide Emergency Services has a maximum plan benefit coverage of $100,000.
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 by this plan. Chiropractic services do not have a copay, but routine care is not covered. Physical therapy and speech-language pathology services, and additional telehealth benefits have no copay. Individual and group sessions for mental health and psychiatric services have no copay. Podiatry and other health care professional, and opioid treatment program services have a $0 copay.
Preventive Services See details
Preventive Services, including annual physical exams, are covered with no copay. Additional preventive services, including Medicare-covered Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, are covered with no copay.
Hearing Services See details
The Anthem I Carelon Home Care (HMO I-SNP) plan covers hearing exams, routine hearing exams, fitting/evaluation for hearing aids, and OTC hearing aids with no copay. Prescription hearing aids are covered with a maximum benefit of $3000 per year, while prescription hearing aids for inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision services include eye exams and eyewear, both with no copay. Routine eye exams are limited to one every year. Eyewear, including contact lenses, eyeglasses (lenses and frames), and eyeglass lenses, are covered, but upgrades are not covered. There is a combined maximum of $200 per year for eyewear.
Dental Services See details
Dental Services are covered, including Medicare Dental Services, Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Fluoride Treatment, Other Preventive Dental Services, 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. Prior authorization is required for some services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Insulin has a $35 copay, and 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 Home Care (HMO I-SNP) plan. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has a coinsurance of 0% to 20% and requires prior authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Anthem I Carelon Home Care (HMO I-SNP) plan. Diagnostic Procedures/Tests have no copay, while Lab Services also have no copay. For Diagnostic Radiological Services, there is a copay of at most $75, and for Therapeutic Radiological Services, there is a copay of at most $60. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Anthem I Carelon Home Care (HMO I-SNP) 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 the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but the plan does not cover additional days beyond Medicare-covered SNF stays or non-Medicare-covered SNF stays. Prior authorization is required, and more copay information is available.
Other Services See details
Other Services include coverage for over-the-counter items and other services, but acupuncture, meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, private duty nursing services, and several other services are not covered. Over-the-counter items have no copay and a maximum plan benefit coverage amount of $130 every three months.
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