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Anthem I Carelon Lung Care 2 (HMO-POS C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem I Carelon Lung Care 2 (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 I Carelon Lung Care 2 (HMO-POS C-SNP) in 2025, please refer to our full plan details page.
Anthem I Carelon Lung Care 2 (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 Los Angeles, Orange. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Anthem I Carelon Lung Care 2 (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 I Carelon Lung Care 2 (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 I Carelon Lung Care 2 (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 I Carelon Lung Care 2 (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 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 Lung Care 2 (HMO-POS C-SNP) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay either a copay or coinsurance depending on the drug tier and pharmacy used. For example, preferred generic drugs and specialty tier drugs have no copay, while standard generic drugs have either 20% or 25% coinsurance depending on the pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase and pay nothing for Part D-covered drugs. If you qualify for the low-income subsidy, you will pay $0.00 for your Part D drugs.
Additional Benefits
The Anthem I Carelon Lung Care 2 (HMO-POS C-SNP) plan offers comprehensive coverage with a focus on minimizing out-of-pocket costs. Many services have no copay, including inpatient hospital stays, outpatient services, preventive services, hearing exams, vision services, dental services, and home health services. Emergency services have a $120 copay, and ambulance services have a $150 copay. The plan covers primary care, with no copay for most services, and offers additional benefits like transportation to health-related locations with no copay for up to 22 one-way trips per year. It also includes coverage for home infusion, dialysis, medical equipment, diagnostic and radiological services, and skilled nursing facility care. Some services have coinsurance or copays, and prior authorization may be required for certain services.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric services, are covered with no copay. Additional days for inpatient hospital are covered with no copay, but non-Medicare-covered stays and upgrades for inpatient hospital are not covered.
Outpatient Services See details
Outpatient Services are covered, including all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center Services, and Outpatient Blood Services have no copay, while Individual and Group Sessions for Outpatient Substance Abuse each have a copay of $25.
Partial Hospitalization See details
Partial Hospitalization is covered by Anthem I Carelon Lung Care 2 (HMO-POS C-SNP) with no copay required. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services, with a $150 copay for each service. Transportation Services to a plan-approved health-related location are covered with no copay, up to 22 one-way trips per year using rideshare services, bus/subway, van, or medical transport, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Anthem I Carelon Lung Care 2 (HMO-POS C-SNP) plan. Emergency Services and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have a $120 copay, while Urgently Needed Services has no copay. Worldwide Emergency Services has a maximum plan benefit coverage of $100,000.
Primary Care See details
The Anthem I Carelon Lung Care 2 (HMO-POS C-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional services, 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. Mental health specialty services, psychiatric services, and opioid treatment program services have a copay that varies from $0 to $25, and other health care professional services have a copay that varies from $0 to $20.
Preventive Services See details
Preventive Services include Medicare-covered services, an annual physical exam with no copay, and additional preventive services. Additional preventive services include Fitness Benefit, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, Kidney Disease Education Services, 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, Medical Nutrition Therapy, 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, and Telemonitoring Services are not covered.
Hearing Services See details
Hearing Services includes hearing exams, routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids. Hearing exams, routine hearing exams, and OTC hearing aids have no copay, and prescription hearing aids have a $3,000 annual benefit.
Vision Services See details
The Anthem I Carelon Lung Care 2 (HMO-POS C-SNP) plan covers vision services, including eye exams and eyewear. Eye exams and eyewear have no copay, while eyewear has a combined maximum plan benefit of $225 per year.
Dental Services See details
Dental services are covered, including oral exams, dental x-rays, other diagnostic services, cleaning, fluoride treatment, and other preventive services with no copay. Restorative services, adjunctive general services, endodontics, periodontics, removable prosthodontics, maxillofacial prosthetics, implant services, fixed prosthodontics, oral and maxillofacial surgery, and orthodontics are also covered with no copay. There is a $2,500 annual maximum for other dental services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, requiring prior authorization. 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 by the Anthem I Carelon Lung Care 2 (HMO-POS C-SNP) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment coverage includes Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a coinsurance of 0-20% and requires prior authorization, while DME for use outside the home is not covered. Prosthetic Devices and Medical Supplies have no copay, and Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with no copay, lab services with no copay, diagnostic radiological services with a copay up to $75, therapeutic radiological services with a minimum copay of $60, and outpatient X-ray services with no copay. Prior authorization is required for all services.
Home Health Services See details
Home Health Services are covered by the Anthem I Carelon Lung Care 2 (HMO-POS C-SNP) 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 under the Anthem I Carelon Lung Care 2 (HMO-POS C-SNP) plan, but the specific services under this benefit are not covered. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Anthem I Carelon Lung Care 2 (HMO-POS C-SNP) plan, but require prior authorization. There is no copay for days 1-31, and a $50 copay for days 32-100. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Anthem I Carelon Lung Care 2 (HMO-POS C-SNP) plan covers Over-the-Counter (OTC) Items with no copay, and Meal Benefits with no copay and prior authorization required. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, and several other services are not covered.
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