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Anthem Chronic Care (HMO-POS C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem Chronic 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 Chronic Care (HMO-POS C-SNP) in 2025, please refer to our full plan details page.
Anthem Chronic 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 Select Counties in Virginia. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Anthem Chronic 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 Chronic 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 Chronic 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 Chronic 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 $4150.00 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 Chronic Care (HMO-POS C-SNP) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, preferred generic drugs have a $7.50 copay at a preferred pharmacy, but standard mail order has no copay. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase. In this phase, you will pay nothing for your Part D covered drugs. However, you may still have some costs for drugs excluded under any enhanced benefit.
Additional Benefits
The Anthem Chronic Care (HMO-POS C-SNP) plan offers comprehensive coverage, including inpatient and outpatient hospital services, with varying copays. You'll find no copays for primary care visits, preventive services, vision, and dental services, as well as home health services. The plan also provides coverage for hearing, mental health, and substance abuse services, with copays ranging from $20 to $55.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, with a copay of $325 for days 1-5 and no copay for days 6-90. Additional days for both services are covered with no copay, while non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
The Anthem Chronic Care (HMO-POS C-SNP) plan covers outpatient services, including all outpatient hospital services, observation services, and ambulatory surgical center services. Outpatient hospital services have a copay between $0 and $325, while observation services have a $325 copay. Outpatient substance abuse services have a $40 copay for individual and group sessions, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Anthem Chronic Care (HMO-POS C-SNP) plan, and requires prior authorization. You will pay a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Anthem Chronic Care (HMO-POS C-SNP) plan. Ground and air ambulance services have a $275 copay, with no coinsurance. Transportation services to a plan-approved health-related location have no copay and no coinsurance, with a limit of 84 one-way trips per year, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Anthem Chronic Care (HMO-POS C-SNP) plan. Emergency Services and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have a $140 copay, while Urgently Needed Services have a $50 copay; there is no coinsurance for any of these services.
Primary Care See details
Primary Care coverage includes Primary Care Physician Services with no copay, Chiropractic Services with a $20 copay (routine care not covered), Occupational Therapy Services with a $40 copay, Physician Specialist Services with a $20 copay, and Mental Health Specialty Services with a $40 copay for individual and group sessions. This plan also covers Podiatry Services with a copay between $0 and $20 (routine foot care covered), Other Health Care Professional with a copay between $0 and $20, Psychiatric Services with a $40 copay for individual and group sessions, Physical Therapy and Speech-Language Pathology Services with a $40 copay, Additional Telehealth Benefits with no copay, and Opioid Treatment Program Services with a $40 copay.
Preventive Services See details
Preventive services include coverage for Medicare-covered services, annual physical exams, and additional preventive services, with no copay for annual physicals, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit. Health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and other services are not covered.
Hearing Services See details
Hearing Services include hearing exams with a $20 copay, routine hearing exams with no copay, fitting/evaluation for hearing aids with no copay, and OTC hearing aids with no copay and a maximum benefit of $300 per year for both ears combined. Prescription hearing aids are partially covered, with a maximum benefit of $2,000 per year for both ears combined, but inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services include coverage for eye exams with a copay of $0-$20, and eyewear with no copay. Routine eye exams, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are all covered with no copay.
Dental Services See details
The Anthem Chronic Care (HMO-POS C-SNP) plan covers a variety of dental services, including oral exams, dental x-rays, and other diagnostic and preventive services, with no copay. Restorative services, endodontics, periodontics, prosthodontics, maxillofacial prosthetics, implant services, oral surgery, and orthodontics are also covered, with no copay and prior authorization required. The plan has a maximum benefit of $3,000 per year for other dental services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the Anthem Chronic Care (HMO-POS C-SNP) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, are covered. DME has no copay and a coinsurance between 0% and 20%, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance, Medical Supplies have a 20% coinsurance, and Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with all diagnostic services and radiological services requiring prior authorization. Diagnostic Procedures/Tests have a copay between $0 and $90, while Lab Services have no copay. Diagnostic Radiological Services have a copay between $15 and $325, and Therapeutic Radiological Services have a 20% coinsurance. Outpatient X-Ray Services have a $15 copay.
Home Health Services See details
Home Health Services are covered by the Anthem Chronic Care (HMO-POS C-SNP) plan with no copay and no coinsurance, though additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the specific sub-services including Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, and Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services are not covered. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. You will have no copay for days 1-20, and a $214 copay per day for days 21-100. Additional days beyond Medicare-covered for SNF, and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Under the Anthem Chronic Care (HMO-POS C-SNP) plan, acupuncture, meal benefits, 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. Over-the-counter items and "Other 1" have no copay.
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* 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.
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