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Anthem I Carelon Chronic 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 Chronic 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 Chronic Care (HMO-POS C-SNP) in 2025, please refer to our full plan details page.
Anthem I Carelon Chronic 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 Chronic 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 Chronic 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 Chronic 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 Chronic 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 Chronic Care (HMO-POS C-SNP) plan has an enhanced alternative drug benefit with a $0 deductible. During the initial coverage phase, you will pay no copay for preferred generic drugs and specialty tier drugs. For standard generic drugs, you'll pay 20% coinsurance at preferred pharmacies and 25% at standard pharmacies. For preferred brand and non-preferred drugs, you will pay 25% and 33% coinsurance, respectively. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs.
Additional Benefits
The Anthem I Carelon Chronic Care (HMO-POS C-SNP) plan offers comprehensive coverage with no copays for many services, including inpatient hospital stays, outpatient services, primary care, preventive services, hearing exams, vision exams, and dental services. You can expect a $200 copay for ambulance services, and a $120 copay for emergency services. There may be additional costs such as coinsurance for some services like medical equipment and home infusion drugs, and up to a $150 copay for diagnostic radiological services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, with no copay for Medicare-covered stays. Additional days for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are also covered, with no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Non-Medicare-covered stays for Inpatient Hospital Psychiatric 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. Outpatient Hospital Services and Observation Services have no copay, Ambulatory Surgical Center (ASC) Services, and Outpatient Blood Services have no copay. Individual and Group Sessions for Outpatient Substance Abuse have a copay of $30.
Partial Hospitalization See details
Partial Hospitalization is covered with no copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Anthem I Carelon Chronic Care (HMO-POS C-SNP) plan. Ground and air ambulance services have a $200 copay, while transportation services to plan-approved health-related locations have no copay for up to 12 one-way trips per year. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services and Worldwide Emergency Services, are covered under the Anthem I Carelon Chronic Care (HMO-POS C-SNP) plan. Emergency Services and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have a $120 copay. Urgently Needed Services has a $30 copay.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered under the Anthem I Carelon Chronic Care (HMO-POS C-SNP) plan. Primary Care Physician Services, Chiropractic Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, and Additional Telehealth Benefits have no copay. Individual and Group Sessions for Mental Health Specialty Services, and Individual and Group Sessions for Psychiatric Services have a copay between $0 and $30. Other Health Care Professional, and Opioid Treatment Program Services have a $30 copay.
Preventive Services See details
Preventive Services are covered by Anthem I Carelon Chronic Care (HMO-POS C-SNP), including an annual physical exam with no copay, and other services like glaucoma screenings and diabetes self-management training with no copay. Health education, in-home safety assessments, 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 benefits, 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 include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids. Hearing exams, routine hearing exams, fitting/evaluation for hearing aids, and OTC hearing aids have no copay. Prescription hearing aids have a plan-specified maximum benefit of $3,000 per year, and OTC hearing aids have a maximum benefit of $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 routine eye exams and eyewear, with no copay for eye exams, contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames. Eyewear has a combined maximum plan benefit coverage amount of $200 per year, and upgrades are not covered.
Dental Services See details
Dental Services are covered, including Medicare Dental Services, Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Fluoride Treatment, Other Preventive Dental Services, 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. This plan has a $2,000 annual maximum for Other Dental Services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Anthem I Carelon Chronic Care (HMO-POS C-SNP) plan and require prior authorization. Medicare Part B insulin drugs have no 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 Chronic Care (HMO-POS C-SNP) plan with no copay.
Medical Equipment See details
Medical Equipment is covered by the Anthem I Carelon Chronic Care (HMO-POS C-SNP) plan. Durable Medical 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, with no copay for either. Diabetic Equipment is covered, with no copay for Diabetic Supplies or Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services, diagnostic procedures/tests, lab services, and all radiological services. Diagnostic Procedures/Tests and Lab Services have no copay, while Diagnostic Radiological Services have a copay of at most $150.00 and Therapeutic Radiological Services have a coinsurance of at most 20%. Outpatient X-Ray Services have a $5 copay.
Home Health Services See details
Home Health Services are covered by the Anthem I Carelon Chronic 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 Chronic 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 under the Anthem I Carelon Chronic Care (HMO-POS C-SNP) plan, with a $0 copay for days 1-20 and a $125 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 include Over-the-Counter (OTC) Items, Meal Benefit, and Medicare Community Resource Support. Over-the-Counter (OTC) Items have no copay, while the Meal Benefit requires prior authorization and has no copay. 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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