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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 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 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 $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 Kidney Care (HMO-POS C-SNP) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay different amounts depending on the drug tier and the pharmacy you use. For example, you will pay a $5 copay for preferred generic drugs at a preferred pharmacy, and 20% coinsurance for standard generic drugs at a preferred pharmacy. 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. This plan offers an enhanced alternative drug benefit.
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, including primary care, preventive services, hearing, vision, dental, home health, and dialysis, come with no copay. Other services, such as inpatient hospital stays, outpatient services, emergency services, and ambulance services, have copays ranging from $20 to $195. The plan also includes coverage for medical equipment, diagnostic and radiological services, and skilled nursing facility stays, with some services subject to coinsurance or copays. Additionally, the plan provides benefits like OTC items, meal benefits, and transportation services with no copay, and also offers limited coverage for prescription hearing aids and eyewear.
Inpatient Hospital See details
Inpatient Hospital benefits include Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with a $160 copay for days 1-5, and no copay for days 6-90. Additional days for both acute and psychiatric care are covered with no copay, while non-Medicare-covered stays and upgrades 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 have a copay between $0 and $50, while observation services have a $50 copay. Ambulatory Surgical Center (ASC) Services and outpatient blood services have no copay. Individual and group sessions for outpatient substance abuse have a copay of $30.
Partial Hospitalization See details
Partial Hospitalization is covered by Anthem I Carelon Kidney Care (HMO-POS C-SNP) with a $30 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services includes coverage for ground and air ambulance services with a $195 copay, and transportation services to a plan-approved health-related location with no copay. Transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Anthem I Carelon Kidney Care (HMO-POS C-SNP) plan. Emergency Services has a $120 copay, while Urgently Needed Services has no copay, and Worldwide Emergency Services has a $120 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
The Anthem I Carelon Kidney Care (HMO-POS C-SNP) plan covers primary care physician services, occupational therapy, physician specialist services, individual and group mental health specialty sessions, podiatry services, other health care professional services, individual and group psychiatric sessions, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Chiropractic services have a $20 copay, while all other covered services have either no copay or a copay of $30. Routine chiropractic care is not covered.
Preventive Services See details
Preventive services include Medicare-covered services, annual physical exams with no copay, and additional preventive services. The plan does not cover Health Education, In-Home Safety Assessments, Personal Emergency Response Systems (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefits, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, and Counseling Services. The plan also covers Fitness Benefit, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay.
Hearing Services See details
The Anthem I Carelon Kidney Care (HMO-POS C-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, but inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear with no copay. Routine eye exams are covered once per year, and eyewear has a combined maximum benefit of $200 per year.
Dental Services See details
Dental services are covered, including oral exams, dental x-rays, other diagnostic services, prophylaxis, fluoride treatment, and other preventive services, all with no copay. Restorative services, endodontics, periodontics, prosthodontics, maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics 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 0-20%. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the Anthem I Carelon Kidney Care (HMO-POS C-SNP) plan. There is no copay for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. For DME, there is no copay and the coinsurance is between 0% and 20%, and for Prosthetic Devices, the coinsurance is between 0% and 20%; however, Durable Medical Equipment for use outside the home is not covered. For Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts, there is no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures/tests, lab services, and outpatient X-ray services, are covered with no copay. Diagnostic Radiological Services have a copay of up to $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 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 under the Anthem I Carelon Kidney Care (HMO-POS C-SNP) plan. The plan does not cover any Cardiac Rehabilitation Services, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Anthem I Carelon Kidney Care (HMO-POS C-SNP) plan, but require prior authorization. For days 1-20, there is no copay, while for days 21-100, there is a $100 copay. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
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 $75 every three months. This plan does not cover Acupuncture, 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, 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. The plan also provides Meal Benefits with no copay, but requires prior authorization. Other Services and Medicare Community Resource Support are available with no copay.
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