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Anthem I Carelon Premium Savings (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem I Carelon Premium Savings (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 Premium Savings (HMO-POS) in 2025, please refer to our full plan details page.
Anthem I Carelon Premium Savings (HMO-POS) is a HMO-POS plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Los Angeles, Orange and San Bernardino counties. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Anthem I Carelon Premium Savings (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 Premium Savings (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 Premium Savings (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 $62.10. 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 $1500.00 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 Premium Savings (HMO-POS) plan has an enhanced alternative drug benefit and a $0 deductible. In the initial coverage phase, you will pay no copay for preferred generic drugs at preferred and standard pharmacies and standard mail. You will pay 15% coinsurance at preferred pharmacies and mail order, and 20% at standard pharmacies for standard generic drugs. For preferred brand drugs, you will pay 25% coinsurance, and for non-preferred drugs, you will pay 33% coinsurance. Specialty tier drugs have no copay. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Anthem I Carelon Premium Savings (HMO-POS) plan offers comprehensive coverage, including inpatient hospital stays with a $125 copay for days 1-5 and no copay thereafter. Outpatient services, emergency services, and primary care visits have varying copays. The plan also includes coverage for hearing, vision, and dental services, with many services having no copay. This plan provides additional benefits such as ambulance and transportation services, home infusion, and medical equipment. Many preventive services are also covered. This plan also includes coverage for hearing, vision, and dental services, with many services having no copay.
Inpatient Hospital See details
Inpatient Hospital services, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with a copay of $125 for days 1-5, and no copay for days 6-90. Additional days for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are 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 include coverage for Outpatient Hospital Services with a copay between $0 and $100, Observation Services with a $100 copay, Ambulatory Surgical Center (ASC) Services with no copay, Individual and Group Sessions for Outpatient Substance Abuse with a $35 copay, and Outpatient Blood Services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Anthem I Carelon Premium Savings (HMO-POS) plan with a $35 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground ambulance services have a $100 copay, while air ambulance services have a 20% coinsurance. Transportation Services to a plan-approved health-related location are covered with no copay, offering up to 8 one-way trips per year via rideshare services, bus/subway, van, or medical transport. 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 under the Anthem I Carelon Premium Savings (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have a $90 copay. Urgently Needed Services have a $20 copay.
Primary Care See details
Primary Care includes coverage for primary care physician services with a copay between $0 and $5, chiropractic services with a $20 copay, occupational therapy services with a $20 copay, physician specialist services with a copay between $0 and $20, mental health specialty services with a copay between $0 and $20 for individual and group sessions, other health care professional services with a copay between $0 and $20, psychiatric services with a copay between $0 and $20 for individual and group sessions, physical therapy and speech-language pathology services with a copay between $0 and $20, additional telehealth benefits with no copay, and opioid treatment program services with a $35 copay. Podiatry services are not covered.
Preventive Services See details
Preventive services are covered by the Anthem I Carelon Premium Savings (HMO-POS) plan, including an annual physical exam with no copay. Other preventive services such as Health Education, In-Home Safety Assessment, Personal Emergency Response System (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 Benefit, 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, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids. Hearing exams, routine hearing exams, and fitting/evaluation for hearing aids have no copay, while prescription hearing aids and OTC hearing aids also have no copay. Prescription hearing aids have a maximum plan benefit coverage of $3,000 every year, and OTC hearing aids have a maximum benefit of $300 every year.
Vision Services See details
Vision services include coverage for eye exams with a copay of $0 - $20 and eyewear with no copay. Eyewear benefits include coverage for contact lenses, eyeglasses (lenses and frames), and eyeglass lenses with no copay; however, upgrades are not covered.
Dental Services See details
Dental Services are covered, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services with no copay. Restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics also have no copay. Medicare dental services have a copay of $0-$20.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Anthem I Carelon Premium Savings (HMO-POS) plan. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Anthem I Carelon Premium Savings (HMO-POS) plan. There is a coinsurance of 20% for these services.
Medical Equipment See details
Medical Equipment is covered by the Anthem I Carelon Premium Savings (HMO-POS) plan, including Durable Medical Equipment (DME) with 0% to 20% coinsurance, Prosthetics/Medical Supplies with a 0% to 20% coinsurance, and Diabetic Equipment, including Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts, both with a 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services and radiological services, are covered by the Anthem I Carelon Premium Savings (HMO-POS) plan. Diagnostic Procedures/Tests have no copay, while Lab Services, Outpatient X-Ray Services, and Diagnostic Radiological Services have no copay. Therapeutic Radiological Services have a copay of $50.
Home Health Services See details
Home Health Services are covered under the Anthem I Carelon Premium Savings (HMO-POS) 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 covered, but the plan does not cover any of the sub-services including Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Anthem I Carelon Premium Savings (HMO-POS) plan, but require prior authorization. There is no copay for days 1-20, but there is a $100 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Anthem I Carelon Premium Savings (HMO-POS) plan covers over-the-counter items with no copay and a maximum benefit of $125 every three months, as well as a meal benefit with no copay and Medicare Community Resource Support with no copay, while acupuncture and other services are not covered.
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