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Anthem I Carelon Premium Savings 2 (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem I Carelon Premium Savings 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 Premium Savings 2 (HMO-POS) in 2025, please refer to our full plan details page.
Anthem I Carelon Premium Savings 2 (HMO-POS) is a HMO-POS plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Los Angeles, Orange, and San Bernardino Counties. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Anthem I Carelon Premium Savings 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 Premium Savings 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 Premium Savings 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. Additionally, this plan comes with a Part B Premium reduction of $52.10. 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 $4000.00 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 Premium Savings 2 (HMO-POS) plan has an enhanced alternative drug benefit. There is no deductible for prescription drugs. In the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy used. For example, preferred generic drugs have a $7 copay at preferred pharmacies, while standard mail order has no copay. After 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 Premium Savings 2 (HMO-POS) plan offers a range of benefits with varying cost-sharing structures. Inpatient hospital stays have a copay, while outpatient services, including primary care and specialist visits, have copays ranging from $5 to $35. Preventive services, hearing, and vision services often have no copay, and dental services have no copay for some services. Additional benefits include coverage for ambulance services, emergency services, and home health services, with specific copays or coinsurance amounts. The plan also covers services like home infusion, dialysis, and medical equipment, with associated cost-sharing. Other services like OTC items and meal benefits are covered, while some services like podiatry and certain dental services are not covered.
Inpatient Hospital See details
Inpatient Hospital services, including Acute and Psychiatric, are covered. For days 1-5, the copay is $175 per admission, and there is no copay for days 6-90. Additional days for both Acute and Psychiatric are covered with no copay. Non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services for the Anthem I Carelon Premium Savings 2 (HMO-POS) plan cover outpatient hospital services with a copay between $0 and $150, observation services with a $150 copay, and ambulatory surgical center services with no copay. The plan also covers outpatient substance abuse services with a $35 copay for both individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will have a $35 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground ambulance services have a $100 copay, while air ambulance services have a 20% coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services has a $120 copay, Urgently Needed Services has a $20 copay, and Worldwide Emergency Services has a $120 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
Primary Care Physician Services have a $5 copay, Chiropractic Services have a $20 copay, and Occupational Therapy Services have a $20 copay. Physician Specialist Services have a copay between $0 and $35, while Mental Health Specialty Services, Psychiatric Services, and Other Health Care Professional services have varying copays. Physical Therapy and Speech-Language Pathology Services have a copay between $0 and $20. Additional Telehealth Benefits have no copay, and Opioid Treatment Program Services have a $35 copay. Podiatry Services are not covered.
Preventive Services See details
Preventive Services are covered by the Anthem I Carelon Premium Savings 2 (HMO-POS) plan. Annual physical exams are covered with no copay, while additional preventive services, kidney disease education services, and other preventive services have a $0 minimum copay, and a $0 maximum copay.
Hearing Services See details
Hearing Services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids. Hearing exams, routine hearing exams, and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered up to a maximum of $1500, and OTC hearing aids are covered up to $300, both combined for both ears; both have no copay.
Vision Services See details
The Anthem I Carelon Premium Savings 2 (HMO-POS) plan covers vision services, including eye exams with a copay of $0-$20 and eyewear with a $0 copay. Contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames are covered, while upgrades are not covered.
Dental Services See details
Dental services include oral exams, dental x-rays, and prophylaxis (cleaning) with no copay, and fluoride treatment as an optional supplemental benefit; however, orthodontic services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics, maxillofacial prosthetics, implant services, prosthodontics, fixed, oral and maxillofacial surgery, and orthodontics are not covered. Medicare Dental Services require prior authorization and may have a copay between $0 and $20.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with a prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Anthem I Carelon Premium Savings 2 (HMO-POS) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment is covered by the Anthem I Carelon Premium Savings 2 (HMO-POS) plan. Durable Medical Equipment has a coinsurance between 0% and 20% with no copay, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies, including Medicare-covered Prosthetic Devices and Medical Supplies, are covered with no copay and a coinsurance. Diabetic Equipment, including Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts, is covered with a 20% coinsurance and no copay.
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 up to $150, Therapeutic Radiological Services with up to 20% coinsurance, and Outpatient X-Ray Services with no copay. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by the Anthem I Carelon Premium Savings 2 (HMO-POS) plan with no copay and no coinsurance, but 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. Prior authorization is required, and there is a copay for some services, with more details available.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Anthem I Carelon Premium Savings 2 (HMO-POS) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $100 per day. Additional days beyond Medicare and non-Medicare-covered stays are not covered.
Other Services See details
The Anthem I Carelon Premium Savings 2 (HMO-POS) plan covers Over-the-Counter (OTC) items with no copay, and a maximum benefit coverage amount of $50 every three months. The plan also covers a meal benefit with no copay and 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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