A non-government entity
Anthem I Carelon Kidney 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 Kidney 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 Kidney Care (HMO-POS C-SNP) in 2025, please refer to our full plan details page.
Anthem I Carelon Kidney 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 Kidney 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 Kidney 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 Kidney 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 Kidney 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:
Sign up for Anthem I Carelon Kidney Care (HMO-POS C-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Anthem I Carelon Kidney Care (HMO-POS C-SNP) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay varying costs based on the drug tier and pharmacy type. For example, preferred generic drugs and specialty tier drugs have no copay. After your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered Part D drugs. This plan's premium may be reduced if you qualify for the low-income subsidy.
Additional Benefits
The Anthem I Carelon Kidney Care (HMO-POS C-SNP) plan offers a wide range of benefits with varying cost-sharing. Many services have no copay, including primary care, outpatient services, preventive services, hearing exams, vision services, dental services, dialysis, and home health services. However, some services have copays, such as inpatient hospital stays, emergency services, partial hospitalization, ambulance, and mental health services. The plan also covers specialized services like home infusion, medical equipment, and diagnostic and radiological services with varying cost-sharing. Additionally, this plan includes coverage for over-the-counter items, and skilled nursing facility services. However, cardiac rehabilitation services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, both with a $110 copay for days 1-5 and no copay for days 6-90. Additional days for both Inpatient Hospital-Acute and Psychiatric are covered with no copay, while 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 coverage for all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services, observation services, ambulatory surgical center services, and outpatient blood services have no copay. Individual and group sessions for outpatient substance abuse services have a copay between $15.00 and $15.00.
Partial Hospitalization See details
Partial Hospitalization is covered by the Anthem I Carelon Kidney Care (HMO-POS C-SNP) plan, and requires prior authorization. You will have a $15 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Anthem I Carelon Kidney Care (HMO-POS C-SNP) plan. Ground and air ambulance services have a $100 copay, while transportation services to a plan-approved health-related location have no copay. Transportation services to any other health-related location are not covered.
Emergency Services See details
Emergency Services are covered by the Anthem I Carelon Kidney Care (HMO-POS C-SNP) plan, with a $120 copay and no coinsurance. Urgently Needed Services have no copay and no coinsurance. Worldwide Emergency Services, including Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, are covered with a $120 copay and no coinsurance, with a maximum plan benefit of $100,000.
Primary Care See details
The Anthem I Carelon Kidney Care (HMO-POS C-SNP) 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 services, physician specialist services, physical therapy, speech-language pathology services, and additional telehealth benefits have no copay. Mental health specialty services, podiatry services, other health care professional services, psychiatric services, and opioid treatment program services have a copay; individual and group sessions for mental health and psychiatric services have no copay, routine foot care and Medicare-covered podiatry services have no copay, other health care professionals have a $0 to $20 copay, and opioid treatment program services have a $15 copay. Routine chiropractic care is not covered.
Preventive Services See details
Preventive Services include Annual Physical Exams with no copay, and additional services like Fitness Benefit and Remote Access Technologies with no copay. Other services like Health Education, In-Home Safety Assessment, and others are not covered.
Hearing Services See details
Hearing Services include hearing exams with no copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a maximum 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 - inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision services include routine eye exams and eyewear. There is no copay for eye exams, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames. Eyewear has a combined maximum plan benefit coverage of $200 per year.
Dental Services See details
Dental services are covered under the Anthem I Carelon Kidney Care (HMO-POS C-SNP) plan, including oral exams, dental x-rays, and other diagnostic and preventive services with no copay, as well as orthodontic services with a $2,500 maximum benefit per year. Restorative, endodontic, periodontic, prosthodontic, maxillofacial prosthetic, implant, and oral and maxillofacial surgery services are also covered with no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with no copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, with coinsurance between 0% and 20%. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by Anthem I Carelon Kidney Care (HMO-POS C-SNP) with no copay and no coinsurance.
Medical Equipment See details
Medical equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered. Durable Medical Equipment has a coinsurance of 0% to 20%, while Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts have no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, diagnostic procedures/tests with no copay, lab services with no copay, all radiological services, diagnostic radiological services with a maximum copay of $75, therapeutic radiological services with a minimum copay of $60, and outpatient X-ray services with no copay. Prior authorization is required for all diagnostic and radiological services.
Home Health Services See details
Home Health Services are covered by the Anthem I Carelon Kidney Care (HMO-POS C-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 not covered by the Anthem I Carelon Kidney Care (HMO-POS C-SNP) plan. The plan does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization. For days 1-31, there is no copay, and for days 32-100, the copay is $25.
Other Services See details
The Anthem I Carelon Kidney Care (HMO-POS C-SNP) plan covers over-the-counter (OTC) items with no copay, and a maximum benefit of $80 every three months. Acupuncture, and services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved