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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 Clark 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.
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 $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 Medicare Advantage (HMO-POS) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, preferred generic drugs have a $7.50 copay at preferred pharmacies and a $0 copay for mail order. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for your Part D covered drugs. This plan offers an enhanced alternative drug benefit. If you qualify for the low-income subsidy, your premium may be reduced.
Additional Benefits
The Anthem I Carelon Medicare Advantage (HMO-POS) plan offers comprehensive coverage with varying costs. Inpatient hospital stays have a $50 copay for the first five days, while many outpatient services like primary care, vision, dental, and home health services have no copay. Emergency services have a $120 copay, and ambulance services have a $195 copay. The plan also covers additional benefits such as hearing exams, hearing aids, and a maximum annual benefit for eyewear. Other benefits include coverage for medical equipment, diagnostic services, and skilled nursing facility stays. The plan provides coverage for many services with no copay, but it's important to review the specific costs associated with each service.
Inpatient Hospital See details
Inpatient Hospital benefits include Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, both of which have a $50 copay 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 are not covered.
Outpatient Services See details
Outpatient Services are covered, including 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, 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 $195 copay, and transportation services to a plan-approved health-related location with no copay for up to 72 one-way trips per year. Transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Anthem I Carelon Medicare Advantage (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage have a $120 copay, while Urgently Needed Services have a $20 copay; all have no coinsurance.
Primary Care See details
The Anthem I Carelon Medicare Advantage (HMO-POS) 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, occupational therapy services, physical therapy and speech-language pathology services, and additional telehealth benefits have no copay. Physician specialist services have a copay between $0 and $10. Mental health specialty services and psychiatric services have a copay between $0 and $30 for individual and group sessions. Podiatry services have a copay of $0 for Medicare-covered services and routine foot care. Other health care professional services have a copay between $0 and $20, and opioid treatment program services have a $30 copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services, annual physical exams with no copay, and other preventive services with varying copays, including Fitness Benefit, Remote Access Technologies, and Home and Bathroom Safety Devices. Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), and several other services are not covered.
Hearing Services See details
The Anthem I Carelon Medicare Advantage (HMO-POS) plan covers 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 are covered with a maximum plan benefit of $3,000 per year, and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision Services include eye exams and eyewear. Eye exams and eyewear have no copay. Routine eye exams are covered once per year. Eyewear has a combined maximum plan benefit coverage of $200 per year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are unlimited.
Dental Services See details
Dental Services are covered, including oral exams, dental x-rays, and other diagnostic services with no copay. Other services like restorative services, endodontics, and orthodontics are covered with no copay, and the plan has a maximum benefit of $1800 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Anthem I Carelon Medicare Advantage (HMO-POS). For Medicare Part B Insulin Drugs, there is a $35 copay. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Anthem I Carelon Medicare Advantage (HMO-POS) plan. There is a 20% coinsurance for dialysis services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 0% to 20% coinsurance, Prosthetics/Medical Supplies with 0% to 20% coinsurance, and Diabetic Equipment. Diabetic Supplies have no copay, while Diabetic Therapeutic Shoes/Inserts have a $25 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures, tests, lab services, and radiological services. Diagnostic procedures and tests have no copay, while lab services have no copay, and diagnostic radiological services have a maximum copay of $150.00. Therapeutic radiological services have a coinsurance of at least 20%. Outpatient X-ray services have no copay.
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; however, Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but not in practice, as 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 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 Medicare Advantage (HMO-POS) plan. There is no copay for days 1-20, and a $100 copay for days 21-100.
Other Services See details
The Anthem I Carelon Medicare Advantage (HMO-POS) plan covers over-the-counter items with no copay, and a maximum benefit of $15 every three months. Meal benefits and other services are also covered with no copay, but meal benefits require prior authorization. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, 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, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, 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, and Self-Directed Personal Assistance Services are not covered.
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