A non-government entity
Anthem I CareMore Medicare Advantage (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem I CareMore 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 CareMore Medicare Advantage (HMO-POS) in 2026, please refer to our full plan details page.
Anthem I CareMore Medicare Advantage (HMO-POS) is a HMO-POS plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Clark County. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Anthem I CareMore 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 CareMore 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 CareMore 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.
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 a $95.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $1250.00 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 CareMore Medicare Advantage (HMO-POS)
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Drug Coverage
The Anthem I CareMore Medicare Advantage (HMO-POS) plan features a low annual drug deductible of $95. Beneficiaries enjoy no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs across preferred pharmacies, standard pharmacies, and standard mail order. Tier 2 generic drugs also have no copay when filled at preferred pharmacies or through standard mail order, though standard retail pharmacies require a copay starting at $10. For brand-name and specialty medications, costs are based on a percentage of the drug price. Tier 3 preferred brands require 25% coinsurance, while Tier 4 non-preferred drugs carry a 30% coinsurance at preferred, standard, and mail-order pharmacies. Specialty medications in Tier 5 require a 31% coinsurance for a one-month supply.
Additional Benefits
The Anthem I CareMore Medicare Advantage (HMO-POS) plan offers comprehensive coverage with many core medical services featuring no copay and no coinsurance. This includes inpatient hospital stays, primary and specialist care, outpatient services, and annual preventive screenings. Emergency room visits require a $120 copay, while ground and air ambulance services carry a $195 copay, both with no coinsurance. Ancillary benefits such as routine dental, vision, and hearing services are also covered with no copay, including allowances for eyewear and hearing aids. For specialized medical needs, diabetic supplies and home health care have no copay, while durable medical equipment, dialysis, and Part B drugs require coinsurance ranging from 0% to 20%. Skilled nursing facility stays are also highly affordable, requiring no copay for the first 20 days of care.
Inpatient Hospital See details
Anthem I CareMore Medicare Advantage (HMO-POS) inpatient hospital benefits are partially covered, providing Medicare-covered acute and psychiatric stays with no copay and no coinsurance. Prior authorization is required, and non-Medicare-covered stays and acute upgrades are not covered.
Outpatient Services See details
Anthem I CareMore Medicare Advantage (HMO-POS) covers outpatient hospital, observation, ambulatory surgical center, and blood services with no copay and no coinsurance. Outpatient substance abuse individual and group sessions are also covered with a $30 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under the Anthem I CareMore Medicare Advantage (HMO-POS) plan with no copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Anthem I CareMore Medicare Advantage (HMO-POS) covers ground and air ambulance services with a $195 copay and no coinsurance, requiring prior authorization. Transportation services are partially covered, offering up to 12 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, though transport to other health-related locations is not covered.
Emergency Services See details
Anthem I CareMore Medicare Advantage (HMO-POS) covers emergency services with a $120 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $20 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $100,000 maximum with a $120 copay and no coinsurance. These emergency cost-sharing amounts do not count toward any plan-level deductible.
Primary Care See details
Anthem I CareMore Medicare Advantage (HMO-POS) provides primary care, specialist visits, therapy, telehealth, and podiatry services with no copay and no coinsurance, though other chiropractic services are not covered. Mental health, psychiatric, and other professional health services feature no coinsurance and copays ranging from $0 to $30, while opioid treatment services require a $30 copay and no coinsurance.
Preventive Services See details
Preventive services are partially covered by Anthem I CareMore Medicare Advantage (HMO-POS) with no copay and no coinsurance for covered options like annual physicals, kidney education, and select screenings. Sub-services not covered include health education, in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, additional smoking cessation, disease management, telemonitoring, and counseling.
Hearing Services See details
Anthem I CareMore Medicare Advantage (HMO-POS) covers hearing services with no copay and no coinsurance, though prior authorization is required. This includes annual routine exams, fitting evaluations, and up to $300 yearly for over-the-counter hearing aids, while prescription hearing aids are partially covered up to $3,000 annually, excluding inner ear, outer ear, and over-the-ear types.
Vision Services See details
Anthem I CareMore Medicare Advantage (HMO-POS) provides partially covered vision services with no copay, no coinsurance, and no deductible. Benefits include one routine eye exam per year and a $225 annual combined maximum for contacts and eyeglasses, but other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Dental services are partially covered by Anthem I CareMore Medicare Advantage (HMO-POS), offering preventive care like cleanings and exams with no copay and no coinsurance up to a $1,800 yearly limit. Comprehensive services such as fillings and root canals are covered with no copay and a 25% coinsurance, while implant services, orthodontics, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Anthem I CareMore Medicare Advantage (HMO-POS) plan with no copay, while covered Part B chemotherapy and other Part B drugs have no copay and a 0% to 20% coinsurance. Covered Part B insulin is available with a $35 copay and no coinsurance, and prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the Anthem I CareMore Medicare Advantage (HMO-POS) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Anthem I CareMore Medicare Advantage (HMO-POS) covers medical equipment, including durable medical equipment and prosthetics, with no copay and a coinsurance of 0% to 20%. Diabetic supplies are covered with no copay and no coinsurance, while diabetic therapeutic shoes and inserts require a $25 copay and no coinsurance. Prior authorization is required for these benefits, and certain manufacturer restrictions apply.
Diagnostic and Radiological Services See details
Anthem I CareMore Medicare Advantage (HMO-POS) covers diagnostic and radiological services with no copay and no coinsurance for lab services, diagnostic procedures, and diagnostic radiology. Outpatient X-rays also feature no copay, while therapeutic radiological services require a 20% coinsurance, with prior authorization required for these services.
Home Health Services See details
Anthem I CareMore Medicare Advantage (HMO-POS) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Anthem I CareMore Medicare Advantage (HMO-POS) covers Cardiac Rehabilitation Services with no copay and no coinsurance, subject to prior authorization. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Anthem I CareMore Medicare Advantage (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but allowing admission without a prior three-day inpatient hospital stay. Patients pay no copay for days 1 through 20 and a $100 daily copay for days 21 through 100, though additional days beyond the standard Medicare limit are not covered.
Other Services See details
Anthem I CareMore Medicare Advantage (HMO-POS) partially covers other services with no copay and no coinsurance, including over-the-counter (OTC) items, meal benefits, and Medicare community resource support, while acupuncture is not covered. Prior authorization is required for the meal benefit, which provides meals for members with a chronic illness or medical condition that requires them to remain at home.
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