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Anthem I Carelon Medicare Advantage (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem I Carelon 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 Carelon Medicare Advantage (HMO-POS) in 2025, please refer to our full plan details page.
Anthem I Carelon 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 2025.
It's important to know that Anthem I Carelon 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 Carelon 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 Carelon 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. Additionally, this plan comes with a Part B Premium reduction of $7.30. You must continue to pay paying your reduced 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 $499.00 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 Medicare Advantage (HMO-POS) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay either a copay or coinsurance depending on the drug tier and pharmacy used. For preferred generic drugs, you have no copay at preferred, standard, and mail order pharmacies, while the coinsurance for other tiers varies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Anthem I Carelon Medicare Advantage (HMO-POS) plan offers comprehensive coverage with a focus on low-cost access to healthcare. Many services have no copay, including inpatient and outpatient hospital services, primary care visits, preventive services, hearing exams, vision exams, dental services, and home health services. Additionally, the plan provides coverage for prescription hearing aids, eyewear, and over-the-counter items, with specific benefit limits. This plan also covers a range of services with copays or coinsurance. These include emergency services, ambulance services, partial hospitalization, and services like opioid treatment and home infusion drugs. The plan also covers skilled nursing facility stays with a copay after the first 20 days.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both of which require prior authorization and have no copay for a Medicare-covered stay. Additional days for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are also 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 includes coverage for Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services. Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, and Outpatient Blood Services have no copay. Individual and Group Sessions for Outpatient Substance Abuse have a copay of $15.
Partial Hospitalization See details
Partial Hospitalization is covered by the Anthem I Carelon Medicare Advantage (HMO-POS) plan. You will have a $15 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $100 copay for ground ambulance services and a 20% coinsurance for air ambulance services. Transportation services to a plan-approved health-related location are covered with no copay for up to 40 one-way trips per year, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services has a $90 copay, Urgently Needed Services has no copay, and Worldwide Emergency Services has a $90 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, with a maximum plan benefit coverage of $50,000.
Primary Care See details
The Anthem I Carelon Medicare Advantage (HMO-POS) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits and opioid treatment program services. Primary care physician services, chiropractic services, physician specialist services, physical therapy and speech-language pathology services, and additional telehealth benefits have no copay. Other benefits have a copay, including $15 for opioid treatment program services. Chiropractic services, mental health specialty services, podiatry services, other health care professional, psychiatric services, physical therapy and speech-language pathology services and opioid treatment program services require prior authorization. Routine chiropractic care is not covered.
Preventive Services See details
Preventive services include annual physical exams with no copay, and additional preventive services. The plan also covers fitness benefits and remote access technologies with no copay. Some services are not covered, including health education, in-home safety assessments, and counseling services.
Hearing Services See details
Hearing services include hearing exams with no copay, routine hearing exams with no copay, fitting/evaluation for hearing aids with no copay, prescription hearing aids with a maximum benefit of $3,000 per year and no copay, and OTC hearing aids with no copay and a maximum benefit of $300 per year. Prescription hearing aids - inner ear, prescription hearing aids - outer ear, and prescription hearing aids - over the ear are not covered.
Vision Services See details
Vision services are covered, including routine eye exams and eyewear. Routine eye exams and eyewear have no copay, and there is a combined maximum plan benefit coverage of $350 every year for eyewear.
Dental Services See details
The Anthem I Carelon Medicare Advantage (HMO-POS) plan covers dental services, including oral exams, dental x-rays, and other services with no copay, up to a maximum of $2,500 per year. The plan also covers orthodontic services with no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered, with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Anthem I Carelon Medicare Advantage (HMO-POS) plan. There is a 20% coinsurance for this benefit.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, and Prosthetics/Medical Supplies with a 20% coinsurance. Diabetic Therapeutic Shoes/Inserts have a $25 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests have no copay, Lab Services have no copay, Diagnostic Radiological Services have a maximum copay of $0, Therapeutic Radiological Services have a copay of $50, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Anthem I Carelon Medicare Advantage (HMO-POS) plan with no copay and no coinsurance. However, Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required, and copays apply.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Anthem I Carelon Medicare Advantage (HMO-POS), with prior authorization required. For days 1-20, there is no copay, and for days 21-100, the copay is $25.
Other Services See details
The Anthem I Carelon Medicare Advantage (HMO-POS) plan covers Over-the-Counter (OTC) Items with no copay, and a maximum benefit coverage amount of $175 every three months. The plan also covers meal benefits and other services with no copay, but 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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