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Anthem I Carelon Lung Care (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 (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 (HMO-POS C-SNP) in 2025, please refer to our full plan details page.
Anthem I Carelon Lung Care (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 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 Lung Care (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 (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 (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 (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 $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:
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Drug Coverage
The Anthem I Carelon Lung Care (HMO-POS C-SNP) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs, you will pay a $7.50 copay at a preferred pharmacy or a $12.50 copay at a standard pharmacy, and no copay for standard mail. For specialty tier drugs, you will have no copay. After 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 Lung Care (HMO-POS C-SNP) plan offers comprehensive coverage with no copays for many services, including inpatient hospital stays, outpatient services, preventive services, hearing exams, vision services, dental services, and home health services. The plan also covers ambulance services with a $200 copay, emergency services with a $120 copay, and primary care services with no copay for many services. However, some services like outpatient substance abuse and diagnostic radiological services do have copays or coinsurance, and some services are not covered, such as cardiac rehabilitation and additional personal care services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both with no copay for a Medicare-covered stay. Additional days for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are covered with no copay.
Outpatient Services See details
Outpatient services include coverage for all outpatient hospital services, observation services, and ambulatory surgical center services with no copay. Outpatient substance abuse services have a $30 copay for both individual and group sessions, while outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Anthem I Carelon Lung Care (HMO-POS C-SNP) plan, and requires prior authorization. There is no copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including both ground and air ambulance services which each have a $200 copay. Transportation Services to a plan-approved health-related location are covered with no copay, with a limit of 12 one-way trips per year. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, are covered by the Anthem I Carelon Lung Care (HMO-POS C-SNP) plan. Emergency Services have a $120 copay, Urgently Needed Services have a $30 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have a $120 copay.
Primary Care See details
Under the Anthem I Carelon Lung Care (HMO-POS C-SNP) plan, primary care physician services, chiropractic services, occupational therapy, 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 are covered. Primary care physician services, physician specialist services, physical therapy, and additional telehealth benefits have no copay, while the other services have varying copays depending on the service. Routine chiropractic care is not covered.
Preventive Services See details
Preventive services include no copay for Medicare-covered services and annual physical exams, with additional preventive services subject to a copay. The plan also covers Fitness Benefit, Remote Access Technologies, and Home and Bathroom Safety Devices and Modifications. Other services like health education, in-home safety assessments, and counseling 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. Prescription hearing aids (all types) have no copay, and this plan covers up to $3,000 per year for prescription hearing aids. OTC hearing aids are covered up to $300 per year. Prescription hearing aids - inner ear, prescription hearing aids - outer ear, and prescription hearing aids - over the ear are not covered.
Vision Services See details
Vision Services include eye exams and eyewear. Eye exams and eyewear have no copay, and eyewear has a combined maximum plan benefit of $225.00 per year; upgrades are not covered.
Dental Services See details
Dental services are covered, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services, all with no copay. This plan also covers restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics, all with no copay. There is a maximum benefit of $1,000 per year for other dental services.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered with 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 Anthem I Carelon Lung Care (HMO-POS C-SNP) with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has no copay and a 0% - 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. 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, with a $0 copay for Diagnostic Procedures/Tests and Lab Services, and a copay for Diagnostic and Therapeutic Radiological Services. Outpatient X-Ray Services have a $5 copay, and Therapeutic Radiological Services have 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Anthem I Carelon Lung Care (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 (HMO-POS C-SNP) plan. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Anthem I Carelon Lung Care (HMO-POS C-SNP) plan. For days 1-20, there is no copay, and for days 21-100, the copay is $125.
Other Services See details
Other Services include Over-the-Counter (OTC) Items, Meal Benefit, and Other 1, with no copay for OTC items and meal benefits. 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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