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Anthem I Carelon Home Care (HMO I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem I Carelon Home Care (HMO I-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 Home Care (HMO I-SNP) in 2025, please refer to our full plan details page.
Anthem I Carelon Home Care (HMO I-SNP) is a HMO I-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 Home Care (HMO I-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 Home Care (HMO I-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 Home Care (HMO I-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 Home Care (HMO I-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 $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 Home Care (HMO I-SNP) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay different amounts depending on the drug tier and the pharmacy you use. For example, you will pay a $7.50 copay at a standard pharmacy for preferred generic drugs, and no copay for preferred generic drugs through the standard mail order option. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered Part D drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Anthem I Carelon Home Care (HMO I-SNP) plan offers comprehensive coverage with a variety of benefits. This includes coverage for inpatient and outpatient services, with varying copays, as well as primary care, preventive, hearing, vision, and dental services, often with no copay. The plan also provides coverage for home health services, medical equipment, and diagnostic services. Additional benefits include ambulance and transportation services, emergency services, and home infusion bundled services. The plan also offers coverage for dialysis services, and over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with a $50 copay for days 1-5 and no copay for days 6-90; Additional Days for Inpatient Hospital-Acute and Additional Days for Inpatient Hospital Psychiatric have no copay. Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services, including outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient hospital services have a copay between $0 and $50, observation services have a $50 copay, ASC services have no copay, individual and group sessions for outpatient substance abuse have no copay, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Anthem I Carelon Home Care (HMO I-SNP) plan with no copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including Medicare-covered 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 6 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 under the Anthem I Carelon Home Care (HMO I-SNP) plan. Emergency Services have a $120 copay, while Urgently Needed Services have no copay. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $120 copay, with a maximum plan benefit coverage of $100,000.
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 Home Care (HMO I-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. Chiropractic Services does not cover routine care, and Occupational Therapy Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, and Opioid Treatment Program Services have varying copays.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and additional preventive services that may have a copay. Kidney disease education services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are also covered with no copay. Health education, in-home safety assessment, personal emergency response system, 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 benefit, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, and counseling services are not covered.
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, and OTC hearing aids are covered with no copay up to $300 per year. Prescription hearing aids - inner ear, outer ear, and over the ear are not covered.
Vision Services See details
The Anthem I Carelon Home Care (HMO I-SNP) plan covers vision services, including eye exams and eyewear. Routine eye exams, contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames have no copay, while upgrades are not covered.
Dental Services See details
The Anthem I Carelon Home Care (HMO I-SNP) plan covers dental services, with a maximum benefit of $1750 per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services, as well as restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics have no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the Anthem I Carelon Home Care (HMO I-SNP) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical equipment is covered by the Anthem I Carelon Home Care (HMO I-SNP) plan, with Durable Medical Equipment (DME) subject to a coinsurance of 0% to 20%, and Prosthetic Devices and Medical Supplies covered with a coinsurance of 0% to 20%. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures, lab services, and radiological services. Diagnostic Procedures/Tests and Lab Services have no copay, while Diagnostic Radiological Services have a copay of up to $150, and Therapeutic Radiological Services have a coinsurance of up to 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Anthem I Carelon Home Care (HMO I-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 covered, but not Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. The copay information is available below.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but the copay information is not provided. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Anthem I Carelon Home Care (HMO I-SNP) plan covers Over-the-Counter (OTC) Items with no copay, and a maximum plan benefit coverage amount of $205 every three months. This plan also covers "Other 1" services with no copay. Acupuncture, Meal Benefit, 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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