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Anthem I Carelon Lung 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 Lung 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 Lung Care (HMO-POS C-SNP) in 2025, please refer to our full plan details page.
Anthem I Carelon Lung 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 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 Lung 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 Lung 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 Lung 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 Lung 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 $1900.00 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 Lung Care (HMO-POS C-SNP) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay varying costs depending on the drug tier and pharmacy. For preferred generic and specialty drugs, you will have no copay. Standard generic drugs have a $45 or $47 copay, while brand-name and non-preferred drugs have 25% and 33% coinsurance, respectively.
Additional Benefits
The Anthem I Carelon Lung Care (HMO-POS C-SNP) plan offers a wide range of benefits with varying costs. Many services have no copay, including primary care visits, preventive services, vision and dental care, and home health services. Other services, like inpatient hospital stays, outpatient substance abuse, and ambulance services, have copays ranging from $25 to $195. The plan also covers services such as hearing aids, medical equipment, and diagnostic services, with some services incurring coinsurance costs. Additionally, the plan provides coverage for transportation to health-related locations, OTC items, and other services with no copay or maximum benefit amounts.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both of which have a $25 copay for days 1-10, and no copay for days 11-90. Additional days for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric 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 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, ASC services, and outpatient blood services have no copay. Individual and group sessions for outpatient substance abuse have a copay between $30.00 and $30.00.
Partial Hospitalization See details
Partial hospitalization is covered by the Anthem I Carelon Lung Care (HMO-POS C-SNP) plan, with a $30 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services with a $195 copay. Transportation Services to a plan-approved health-related location are covered with no copay, up to 70 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 by the Anthem I Carelon Lung Care (HMO-POS C-SNP) plan. Emergency Services have a $120 copay, while Urgently Needed Services have no copay; all have no coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have a $120 copay, and there is a maximum plan benefit coverage of $100,000.
Primary Care See details
The Anthem I Carelon Lung Care (HMO-POS C-SNP) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with no copay, and physician specialist services with no copay. 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 are also covered, though some services have copays.
Preventive Services See details
Preventive services include Medicare-covered zero dollar preventive services, an annual physical exam with no copay, and additional preventive services, including fitness benefits, remote access technologies, and home and bathroom safety devices and modifications with no copay. Other services like health education, in-home safety assessments, and counseling services are not covered.
Hearing Services See details
Hearing Services include coverage for 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 every year, and OTC hearing aids are covered with no copay and a maximum benefit of $300 every year. Prescription hearing aids for the inner and outer ear, and over the ear are not covered.
Vision Services See details
Vision Services include eye exams and eyewear, with a $0 copay for all services. Routine eye exams are limited to one per year, and eyewear has a combined maximum benefit of $300 per year.
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 with no copay. Restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are covered with no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Anthem I Carelon Lung Care (HMO-POS C-SNP) plan. Medicare Part B Insulin Drugs have a $35 copay, while the coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Anthem I Carelon Lung Care (HMO-POS C-SNP) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has no copay and a coinsurance between 0% and 20%, but DME for use outside the home is not covered; Prosthetics/Medical Supplies have no copay, and a coinsurance applies for Medicare-covered devices and supplies; Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures, lab services, and radiological services. Diagnostic Procedures/Tests have no copay, while Lab Services have no copay. Diagnostic Radiological Services may have a copay up to $150, and Therapeutic Radiological Services have a coinsurance of at least 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by Anthem I Carelon Lung Care (HMO-POS C-SNP) 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 not covered by the Anthem I Carelon Lung Care (HMO-POS C-SNP) plan. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, and require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $100.
Other Services See details
Other Services include Over-the-Counter (OTC) Items, Meal Benefit, Other 1, and additional services. Over-the-Counter (OTC) Items have no copay, and a maximum benefit coverage amount of $79 every three months. Meal Benefit has no copay and requires prior authorization. Other 1 has 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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