A non-government entity
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 2026, 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 2026.
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 a $295.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $5400.00 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 features an annual drug deductible of $295. Members enjoy no copay for Tier 1 preferred generics, Tier 2 generics, and Tier 6 select care drugs when using preferred pharmacies or standard mail order. Filling Tier 1 and Tier 2 prescriptions at standard pharmacies requires a small copay starting at $5 and $10, respectively. For brand-name and specialty medications, the plan utilizes a coinsurance model instead of flat copays. You will pay 25% coinsurance for Tier 3 preferred brands, 30% coinsurance for Tier 4 non-preferred drugs, and 29% coinsurance for Tier 5 specialty drugs. These coinsurance rates apply consistently across preferred, standard, and mail-order pharmacies.
Additional Benefits
The Anthem Chronic Care (HMO-POS C-SNP) plan offers robust healthcare coverage with no copays or coinsurance for primary care visits, preventive services, and home health care. Specialist visits require a low $20 copay with no coinsurance, while inpatient hospital stays require a $325 daily copay for the first five days and no copay thereafter. Outpatient hospital services range from no copay to a $325 copay with no coinsurance, helping keep overall medical costs predictable. This plan also features valuable everyday benefits, including up to 108 one-way transportation trips per year and a $75 quarterly over-the-counter allowance with no copays. Routine dental, vision, and hearing services are covered with no copays or coinsurance, featuring generous annual allowances such as $2,250 for dental care and $2,000 for hearing aids. Emergency care is covered with a $130 copay, while urgent care services require a $50 copay.
Inpatient Hospital See details
Anthem Chronic Care (HMO-POS C-SNP) covers inpatient acute and psychiatric hospital services with no coinsurance and a copay of $325 per day for days 1 through 5, followed by no copay for additional days. This benefit is partially covered as upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Anthem Chronic Care (HMO-POS C-SNP) covers outpatient hospital services with no coinsurance and a copay ranging from no copay to $325, alongside observation services at a $325 copay per stay with no coinsurance. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $20 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered by Anthem Chronic Care (HMO-POS C-SNP) with a $55.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Anthem Chronic Care (HMO-POS C-SNP) covers ground and air ambulance services with a $275 copay and no coinsurance, requiring prior authorization. Transportation services are partially covered with no copay or coinsurance for up to 108 one-way trips per year to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency services under the Anthem Chronic Care (HMO-POS C-SNP) plan are covered with a $130 copay and no coinsurance, while urgently needed services require a $50 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a maximum plan benefit of $100,000, with a $130 copay and no coinsurance per service.
Primary Care See details
Anthem Chronic Care (HMO-POS C-SNP) offers primary care and telehealth services with no copay and no coinsurance, while specialists, therapy, mental health, and psychiatric services require a $20 copay and no coinsurance. Other professional and podiatry services range from no copay up to a $20 copay with no coinsurance, though chiropractic services are not covered in practice.
Preventive Services See details
Anthem Chronic Care (HMO-POS C-SNP) covers preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, and various screenings. Additional preventive benefits are partially covered with no copay or coinsurance for memory fitness, remote access, and home safety devices (up to $500 annually), but do not cover health education, PERS, alternative therapies, nutritional therapy, and in-home support.
Hearing Services See details
Anthem Chronic Care (HMO-POS C-SNP) covers Medicare-covered hearing exams with a $20 copay and no coinsurance, while routine exams and fitting evaluations have no copay and no coinsurance. Prescription hearing aids are partially covered with no copay and no coinsurance up to $2,000 annually, excluding inner ear, outer ear, and over the ear models, while over-the-counter hearing aids are covered with no copay and no coinsurance up to $300 annually.
Vision Services See details
Vision services are partially covered by Anthem Chronic Care (HMO-POS C-SNP) with no deductibles, no coinsurance, and no copays for covered benefits. Routine eye exams (one per year) and eyewear are covered up to a $300 annual limit, though other eye exams and eyewear upgrades are not covered.
Dental Services See details
Anthem Chronic Care (HMO-POS C-SNP) provides partially covered dental services with no copay and no coinsurance for covered preventive and comprehensive services, up to a $2,250 yearly maximum. While many diagnostic, restorative, and surgical services are covered, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Anthem Chronic Care (HMO-POS C-SNP) covers home infusion bundled services with no copay and no coinsurance, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy and other Part B drugs have no copay and 0% to 20% coinsurance, while Medicare Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Anthem Chronic Care (HMO-POS C-SNP) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Anthem Chronic Care (HMO-POS C-SNP) covers durable medical equipment with no copay and 0% to 20% coinsurance, and prosthetics and medical supplies with no copay and 20% coinsurance. Diabetic equipment, supplies, and therapeutic shoes or inserts are also covered with no copay and no coinsurance, though selection may be limited to specified manufacturers.
Diagnostic and Radiological Services See details
Anthem Chronic Care (HMO-POS C-SNP) covers diagnostic and radiological services, both of which require prior authorization. Diagnostic services feature no coinsurance, with no copay for lab services and a $0 to $90 copay for diagnostic procedures, while radiological services require a $15 copay plus coinsurance for X-rays, a minimum $15 copay for diagnostic radiology, and a copay with a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Anthem Chronic Care (HMO-POS C-SNP) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Anthem Chronic Care (HMO-POS C-SNP) covers Cardiac Rehabilitation Services with no coinsurance, though prior authorization is required. While some services are covered, specific sub-services including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation are not covered in practice and require copays ranging from $15 to $20.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Anthem Chronic Care (HMO-POS C-SNP) with no coinsurance, requiring prior authorization and allowing admission without a prior three-day hospital stay. There is no copay for days 1 through 20, a $218.00 copay for days 21 through 100, and additional days beyond the Medicare-covered period are not covered.
Other Services See details
Anthem Chronic Care (HMO-POS C-SNP) provides partially covered other services with no copay and no coinsurance, which include chronic illness meal benefits, Medicare Community Resource Support, and up to $75 every three months for over-the-counter (OTC) items. Acupuncture is not covered under this benefit.
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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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