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Anthem Kidney Care (HMO-POS C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem Kidney 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 Kidney Care (HMO-POS C-SNP) in 2025, please refer to our full plan details page.
Anthem Kidney 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 Select Counties in CO. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Anthem Kidney 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 Kidney 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 Kidney 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 Kidney 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 $6751.00 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 Kidney Care (HMO-POS C-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, in the initial coverage phase, you will pay a $5 copay at a preferred pharmacy or a $10 copay at a standard pharmacy for preferred generic drugs. After your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Anthem Kidney Care (HMO-POS C-SNP) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have copays, while outpatient services can have copays up to $325. Emergency, primary care, and preventive services often have no copay, while hearing, vision, and dental services are covered with no copays for routine exams and eyewear. This plan also includes coverage for home health services, dialysis, and medical equipment, with some services like ambulance requiring prior authorization. Other benefits include coverage for prescription hearing aids (up to $750/year), and dental services (up to $500/year). However, some services such as additional hours of care, personal care services, and certain therapies are not covered.
Inpatient Hospital See details
Inpatient Hospital services, including Acute and Psychiatric, are covered by the Anthem Kidney Care (HMO-POS C-SNP) plan. For Inpatient Hospital-Acute, you will pay a $289 copay for days 1-6, and no copay for days 7-90; for Inpatient Hospital Psychiatric, you will pay a $325 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay of $0-$325, observation services with a $325 copay, and ambulatory surgical center services with no copay. Additionally, outpatient substance abuse services are covered, with a copay of $40 for both individual and group sessions, and outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Anthem Kidney Care (HMO-POS C-SNP) plan, but requires prior authorization. The copay for this benefit is $40.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground Ambulance Services have a $221 copay, while Air Ambulance Services have a 20% coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $90 copay with no coinsurance. Urgently Needed Services have a $35 copay with no coinsurance. Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $90 copay with no coinsurance, and a maximum plan benefit coverage of $100,000.
Primary Care See details
Under the Anthem Kidney Care (HMO-POS C-SNP) plan, primary care physician services have no copay, chiropractic services have a $15 copay, occupational therapy services have a $35 copay, and physician specialist services have a copay between $0 and $35. Mental health specialty services and psychiatric services both have a $40 copay for individual and group sessions, physical therapy and speech-language pathology services have a $35 copay, and opioid treatment program services have a $40 copay. Additional telehealth benefits and primary care physician services have no copay.
Preventive Services See details
Preventive services include annual physical exams with no copay, and additional preventive services with no copay for glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit. Health education, in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy (MNT), 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, telemonitoring services, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
The Anthem Kidney Care (HMO-POS C-SNP) plan covers hearing exams with a $35 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered, with a plan maximum of $750 per year. OTC hearing aids are covered with no copay, with a plan maximum of $300 per year. Prescription hearing aids - inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a copay of $0-$35, and routine eye exams have no copay. Eyewear includes contact lenses, eyeglasses (lenses and frames), and eyeglass lenses, each with no copay, but 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; however, restorative services, periodontics, prosthodontics (removable and fixed), and orthodontics have limitations. This plan covers other dental services with a maximum benefit of $500 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. 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 Kidney Care (HMO-POS C-SNP) plan with no copay and 20% coinsurance.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with no copay and 0-20% coinsurance, Prosthetic Devices with 20% coinsurance, and Medical Supplies with 20% coinsurance. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for diagnostic procedures and tests with a copay between $0 and $100, lab services with no copay, and outpatient X-ray services with a $5 copay. Therapeutic Radiological Services have a coinsurance of 20% at a minimum, and diagnostic radiological services have a copay of at most $300, with a minimum copay of $5.
Home Health Services See details
Home Health Services are covered by the Anthem Kidney 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 covered by Anthem Kidney Care (HMO-POS C-SNP), but the specific services are not covered. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Anthem Kidney Care (HMO-POS C-SNP) plan, with a $0 copay for days 1-20 and a $196 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, which have no copay. The plan does not cover 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.
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