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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 San Bernardino. 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 $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:
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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 a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, you'll pay a $9.50 copay at a preferred pharmacy for preferred generic drugs. In the initial coverage phase, your costs continue until your total drug costs reach $2,000. Once you reach this amount, you enter the catastrophic coverage phase, where you will pay nothing for covered Part D drugs.
Additional Benefits
The Anthem I Carelon Lung Care 2 (HMO-POS C-SNP) plan offers a wide array of benefits with varying cost-sharing. Many services, such as primary care, hearing exams, vision services, dental, and home health services, come with no copay. The plan also covers inpatient hospital stays with a copay, and outpatient services with no copay for most services. The plan also provides coverage for emergency services, ambulance services, and transportation to health-related locations. Additionally, the plan covers hearing aids, and offers benefits for over-the-counter items and meal benefits. However, some services like cardiac rehabilitation and additional hours of care are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered. For days 1-10, there is a $25 copay, and for days 11-90, there is no copay. Additional days for inpatient hospital are covered with no copay. Non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. There is no copay for outpatient hospital services, observation services, ambulatory surgical center services, and outpatient blood services. Individual and group sessions for outpatient substance abuse services have a copay of $25.
Partial Hospitalization See details
Partial Hospitalization is covered by the Anthem I Carelon Lung Care 2 (HMO-POS C-SNP) plan with no copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $150 copay for both ground and air ambulance services, and no coinsurance; Transportation Services to a plan-approved health-related location are covered with no copay and no coinsurance for up to 10 one-way trips per year, while Transportation Services to any health-related location is not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, are covered by the Anthem I Carelon Lung Care 2 (HMO-POS C-SNP) plan. Emergency Services and Worldwide Emergency Coverage have a $120 copay, while Urgently Needed Services has no copay.
Primary Care See details
The Anthem I Carelon Lung Care 2 (HMO-POS C-SNP) plan covers primary care physician services with no copay, and chiropractic services with a $20 copay. The plan also covers occupational therapy, physical therapy, speech-language pathology services, and additional telehealth benefits with no copay, as well as physician specialist services with no copay. Mental health and psychiatric services have a copay between $0 and $25, and opioid treatment program services have a $30 copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services and an annual physical exam with no copay. Additional preventive services, kidney disease education services, and other preventive services are also covered, with no copay for glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit.
Hearing Services See details
Hearing Services include hearing exams with no copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to $3,000 per year with no copay, while OTC hearing aids have no copay up to $300 per year.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams and eyewear have no copay. Eyewear has a combined maximum plan benefit coverage amount of $225 per year, and upgrades are not covered.
Dental Services See details
The Anthem I Carelon Lung Care 2 (HMO-POS C-SNP) plan covers a variety of dental services, including oral exams, dental x-rays, and other diagnostic and preventive services, all with no copay, up to a maximum of $2,500 per year. Additionally, the plan covers orthodontic services, restorative services, and more, all 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 covered with 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Anthem I Carelon Lung Care 2 (HMO-POS C-SNP), with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered. DME has a coinsurance of 0-20%, while Prosthetic Devices have a 0-20% coinsurance, and Medical Supplies have a 0-20% coinsurance. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services, diagnostic procedures/tests with no copay, lab services with no copay, and outpatient X-ray services with no copay; however, there is a copay for diagnostic radiological services up to $150, and a coinsurance of at least 20% for therapeutic radiological services. 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. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Anthem I Carelon Lung Care 2 (HMO-POS C-SNP) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, and Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by the Anthem I Carelon Lung Care 2 (HMO-POS C-SNP) plan, with a $0 copay for days 1-20 and a $50 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items and Meal Benefits with no copay, while acupuncture is not covered. The OTC benefit includes nicotine replacement therapy and Naloxone coverage. Several additional services, including Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, are not covered.
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* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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