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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 San Bernardino County. 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 $2500.00 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 a copay or coinsurance depending on the drug tier and pharmacy used. For example, preferred generic drugs have a $5 copay at preferred pharmacies and a $10 copay at standard pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Anthem I Carelon Medicare Advantage 2 (HMO-POS) plan offers a wide range of benefits with varying costs. The plan covers inpatient hospital stays with a $125 copay for days 1-5, and no copay for days 6 and beyond. Outpatient services, including specialist and primary care physician visits, have no copay, while emergency services have a $120 copay. Additional benefits include coverage for hearing and vision services with no copays, and a yearly maximum benefit for hearing aids and eyewear. Dental services, including oral exams, x-rays, and cleanings, also have no copay. The plan also covers ambulance services, some home health services, and skilled nursing facility stays with no copay or low copays.
Inpatient Hospital See details
Inpatient Hospital services, including acute and psychiatric, are covered with prior authorization. For days 1-5, there is a $125 copay, and for days 6-90, there is no copay. Additional days for inpatient hospital services are covered with no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services include outpatient hospital services with a copay between $0 and $125, observation services with a $125 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services have a $30 copay for both individual and group sessions, and outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by Anthem I Carelon Medicare Advantage 2 (HMO-POS) with a $30 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 $175 copay, while air ambulance services have a 20% coinsurance. Transportation Services to a plan-approved health-related location have no copay.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services and Worldwide Emergency Coverage, Urgent Coverage, and Transportation have a $120 copay, while Urgently Needed Services has no copay. Worldwide Emergency Services has a maximum benefit of $50,000.
Primary Care See details
Under the Anthem I Carelon Medicare Advantage 2 (HMO-POS) plan, primary care physician services and physician specialist services have no copay, while chiropractic services have a $20 copay. Occupational therapy services have a $10 copay, and physical therapy and speech-language pathology services have a copay between $0 and $10.
Preventive Services See details
Preventive services, including annual physical exams, are covered under the Anthem I Carelon Medicare Advantage 2 (HMO-POS) plan. The annual physical exam has no copay, while additional preventive services may have a copay. Other preventive services like health education, in-home safety assessments, and others are not covered.
Hearing Services See details
Hearing Services include routine hearing exams, fitting and evaluation for hearing aids, prescription hearing aids, and OTC hearing aids. Routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription Hearing Aids (all types) have no copay and are covered up to a $1500 maximum benefit per year. OTC hearing aids have no copay, and are covered up to a $300 maximum benefit per year. Prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
The Anthem I Carelon Medicare Advantage 2 (HMO-POS) plan covers vision services, including eye exams and eyewear. Eye exams and eyewear have no copay, and eyewear has a combined maximum benefit of $150 per year.
Dental Services See details
Dental services are covered, including Medicare dental services, other dental services, and orthodontic services. There is no copay for 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. The plan has a maximum benefit of $1750 per year for other dental services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, requiring prior authorization. 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 by the Anthem I Carelon Medicare Advantage 2 (HMO-POS) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance of 0-20%, Prosthetics/Medical Supplies with a coinsurance, and Diabetic Equipment, including Diabetic Supplies with 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts with a $25 copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services includes coverage for all diagnostic services, diagnostic procedures/tests, and lab services with no copay, and outpatient X-Ray services with no copay. Diagnostic radiological services have a copay of at most $150, and therapeutic radiological services have a coinsurance of at most 20%.
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 the plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Anthem I Carelon Medicare Advantage 2 (HMO-POS) plan. There is no copay for days 1-20, and a $100 copay for days 21-100.
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 of $57.00 every three months. The plan also covers a Meal Benefit with no copay and requires prior authorization, and "Other 1" services with no copay. 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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