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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 San Bernardino county. 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 $17.60. 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 $800.00 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:
Sign up for Anthem I Carelon Medicare Advantage (HMO-POS)
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Drug Coverage
The Anthem I Carelon Medicare Advantage (HMO-POS) plan has an enhanced alternative drug benefit with no deductible. During the initial coverage phase, you will pay no copay for preferred generic drugs and specialty tier drugs. For standard generic drugs, you pay 15% coinsurance at preferred pharmacies and 20% at standard pharmacies. For preferred brand drugs, the coinsurance is 25% at both preferred and standard pharmacies. The coinsurance for non-preferred drugs is 33% at both preferred and standard pharmacies. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Anthem I Carelon Medicare Advantage (HMO-POS) plan offers a range of benefits with varying costs. Many services have no copay, including inpatient hospital stays, outpatient services, primary care, preventive services, hearing exams, vision services, and several dental services. However, services like ambulance, emergency, and some specialist visits have copays or coinsurance. This plan also covers services like hearing aids up to $3,000 per year, and offers coverage for home health, home infusion, and dialysis services, with associated costs. Additionally, the plan includes coverage for medical equipment, diagnostic and radiological services, and skilled nursing facility stays, with specific copays or coinsurance depending on the service.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with no copay. Additional days for 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 include 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, while Individual and Group Sessions for Outpatient Substance Abuse have a $30 copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Anthem I Carelon Medicare Advantage (HMO-POS) plan, but requires prior authorization. You will have a $30 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground ambulance services with a $195 copay, and air ambulance services with 20% coinsurance. Transportation Services to a plan-approved health-related location are covered with no copay, while transportation to any other health-related location is not covered.
Emergency Services See details
Emergency Services include a $120 copay, while Urgently Needed Services have no copay. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $120 copay, with a maximum plan benefit of $50,000.
Primary Care See details
The Anthem I Carelon Medicare Advantage (HMO-POS) plan covers Primary Care Physician Services, Physician Specialist Services, and Additional Telehealth Benefits with no copay. Chiropractic Services are covered with a $20 copay, while Occupational Therapy Services have a $10 copay. Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, and Opioid Treatment Program Services have varying copays. Physical Therapy and Speech-Language Pathology Services have a copay between $0 and $10.
Preventive Services See details
Preventive Services include coverage for annual physical exams with no copay, and additional services like Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay. 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 includes hearing exams with no copay, routine hearing exams with no copay, fitting/evaluation for hearing aids with no copay, and OTC hearing aids with no copay. Prescription hearing aids (all types) are covered with no copay up to a maximum of $3,000 per year, but prescription hearing aids - inner ear, outer ear, and over the ear are not covered.
Vision Services See details
The Anthem I Carelon Medicare Advantage (HMO-POS) plan covers vision services, including eye exams and eyewear. Routine eye exams and eyewear, including contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames, have no copay. However, upgrades are not covered.
Dental Services See details
Dental Services are covered, with no copay for oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services. This plan has a $2,500 maximum benefit per year for Other Dental Services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Anthem I Carelon Medicare Advantage (HMO-POS), including Medicare Part B Insulin Drugs with a $35 copay. 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 by Anthem I Carelon Medicare Advantage (HMO-POS). You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment is covered by the Anthem I Carelon Medicare Advantage (HMO-POS) plan, including Durable Medical Equipment (DME) with a coinsurance of 0% to 20%, and Prosthetics/Medical Supplies with a coinsurance of 0% to 20%. Diabetic Therapeutic Shoes/Inserts have a copay of $25.00, and Diabetic Supplies have a coinsurance of 20% to 20%.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services, are covered. Diagnostic Procedures/Tests and Outpatient X-Ray Services have no copay, while Lab Services have no copay, Diagnostic Radiological Services have a copay of at most $0, and Therapeutic Radiological Services have a copay of at most $50.
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. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Anthem I Carelon Medicare Advantage (HMO-POS), but there is no additional information about the copay or coinsurance. However, the plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Anthem I Carelon Medicare Advantage (HMO-POS), but require prior authorization. There is no copay for days 1-20, and a $100 copay for days 21-100. Additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services include coverage for over-the-counter items, with no copay. Meal benefits are also covered with no copay, but require prior authorization. Acupuncture, 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, 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, Self-Directed Personal Assistance Services, and Dual Eligible SNPs with Highly Integrated Services are not covered.
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