A non-government entity
Anthem I CareMore Medicare Advantage (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem I CareMore Medicare Advantage (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Anthem I CareMore Medicare Advantage (HMO-POS) in 2026, please refer to our full plan details page.
Anthem I CareMore Medicare Advantage (HMO-POS) is a HMO-POS 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 2026.
It's important to know that Anthem I CareMore Medicare Advantage (HMO-POS) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Anthem I CareMore Medicare Advantage (HMO-POS).
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 CareMore Medicare Advantage (HMO-POS), 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 $140.00 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 $1000.00 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 CareMore Medicare Advantage (HMO-POS) plan features an Enhanced Alternative drug benefit with a $140 prescription drug deductible. During the initial coverage phase, Tier 1 preferred generic drugs have no copay at preferred pharmacies and standard mail, or a $10 copay at standard pharmacies. Tiers 2 through 4 require coinsurance ranging from 25% to 31%, while Tier 5 specialty drugs feature no copay. Once your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase and pay nothing for covered Part D prescription drugs. Furthermore, beneficiaries who qualify for the low-income subsidy, or Extra Help, will pay $0 for their Part D coverage.
Additional Benefits
The Anthem I CareMore Medicare Advantage (HMO-POS) plan offers comprehensive medical coverage with many essential services featuring no copay and no coinsurance. Beneficiaries enjoy no copays for inpatient hospital stays, primary care and specialist visits, home health care, and outpatient hospital services. Routine preventive care, diagnostic lab tests, and standard X-rays are also fully covered with no copayments or coinsurance. This plan also includes valuable supplemental benefits such as a $150 quarterly over-the-counter item allowance, up to 44 free one-way transportation trips, and coverage for routine dental, vision, and hearing services. While preventive dental care has no copay, comprehensive dental services require a 25% coinsurance up to a $2,000 annual limit. Other specialized services feature low cost-sharing, including a $25 daily copay for skilled nursing facility days 21 through 100 and a $100 copay for emergency room visits and ambulance rides.
Inpatient Hospital See details
Inpatient Hospital benefits are partially covered by Anthem I CareMore Medicare Advantage (HMO-POS), offering Medicare-covered acute and psychiatric stays with no copay and no coinsurance. Prior authorization is required for covered stays, while upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Anthem I CareMore Medicare Advantage (HMO-POS) covers outpatient services with no coinsurance, featuring no copay for outpatient hospital, observation, ambulatory surgical center, and blood services. Outpatient substance abuse services are also covered with a $15 copay per session and no coinsurance.
Partial Hospitalization See details
Anthem I CareMore Medicare Advantage (HMO-POS) covers partial hospitalization services with a $15.00 copay and no coinsurance. Prior authorization is required for this covered benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Anthem I CareMore Medicare Advantage (HMO-POS), with ground and air ambulance services requiring a $100 copay and no coinsurance. Transportation services are partially covered, offering up to 44 one-way trips per year to plan-approved locations with no copay and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Anthem I CareMore Medicare Advantage (HMO-POS) covers emergency services with a $100 copay, which is waived if admitted to the hospital within 24 hours, and urgently needed services with no copay. Both services have no coinsurance, and worldwide emergency, urgent, and transportation services are covered up to a $50,000 maximum limit with a $100 copay and no coinsurance.
Primary Care See details
Anthem I CareMore Medicare Advantage (HMO-POS) covers primary care, specialist, therapy, mental health, and telehealth services with no copay and no coinsurance. Chiropractic services are partially covered, as routine chiropractic care is not covered, while opioid treatment has a $15 copay and other health professionals require up to a $20 copay, both with no coinsurance.
Preventive Services See details
Anthem I CareMore Medicare Advantage (HMO-POS) partially covers preventive services with no copay and no coinsurance for covered benefits like annual physical exams, kidney disease education, and select screenings. However, sub-services such as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation counseling, disease management, telemonitoring, home modifications, and counseling are not covered.
Hearing Services See details
Anthem I CareMore Medicare Advantage (HMO-POS) covers routine hearing exams, fitting evaluations, and OTC hearing aids up to $300 annually with no copay or coinsurance. Prescription hearing aids are partially covered up to a $3,000 annual limit with no copay or coinsurance, though inner ear, outer ear, and over-the-ear models are not covered. Prior authorization is required for these hearing services.
Vision Services See details
Vision Services are partially covered by Anthem I CareMore Medicare Advantage (HMO-POS), featuring no copay or coinsurance for one routine eye exam per year and a $200 annual eyewear allowance. Prior authorization is required for these services, and eyewear upgrades are not covered.
Dental Services See details
Anthem I CareMore Medicare Advantage (HMO-POS) provides partially covered dental services with up to a $2,000 annual limit, though maxillofacial prosthetics, implant services, and orthodontics are not covered. Covered preventive services feature no copay, while comprehensive services require a 25% coinsurance and prior authorization.
Home Infusion bundled Services See details
Anthem I CareMore Medicare Advantage (HMO-POS) covers home infusion bundled services with prior authorization and potential step therapy. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require no copay and a coinsurance ranging from no coinsurance up to 20%.
Dialysis Services See details
Dialysis services are covered by Anthem I CareMore Medicare Advantage (HMO-POS) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Anthem I CareMore Medicare Advantage (HMO-POS), featuring no coinsurance to 20% coinsurance and no copay for durable medical equipment. Prosthetics, medical supplies, and diabetic supplies carry a 20% coinsurance with no copay, while diabetic therapeutic shoes or inserts require a $25 copay and no coinsurance.
Diagnostic and Radiological Services See details
Anthem I CareMore Medicare Advantage (HMO-POS) covers diagnostic and radiological services with no coinsurance. There is no copay for diagnostic procedures, lab services, diagnostic radiology, and outpatient X-rays, while therapeutic radiological services require a $50 copay.
Home Health Services See details
Home Health Services are covered by Anthem I CareMore Medicare Advantage (HMO-POS) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Anthem I CareMore Medicare Advantage (HMO-POS) plan, including intensive cardiac, pulmonary, and SET for PAD services, meaning there are no copays or coinsurance available for these therapies.
Skilled Nursing Facility (SNF) See details
Anthem I CareMore Medicare Advantage (HMO-POS) partially covers Skilled Nursing Facility (SNF) services with prior authorization, requiring no copay for days 1 through 20 and a $25 daily copay for days 21 through 100, with no coinsurance. Additional days beyond the Medicare-covered limit are not covered under this plan.
Other Services See details
Other Services are partially covered under the Anthem I CareMore Medicare Advantage (HMO-POS) plan, featuring a $150 quarterly over-the-counter item allowance, meal benefits, and community resource support with no copays or coinsurance. Acupuncture and Dual Eligible SNPs with Highly Integrated Services are not covered.
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