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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 GA. This plan received an overall rating of 3.5 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 $5900.00 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 a copay or coinsurance for your prescriptions depending on the drug tier and the pharmacy you use. For preferred generic drugs, you will pay a $7 copay at a preferred pharmacy, $12 at a standard pharmacy, and no copay for mail order. For specialty tier drugs, there is no copay at any pharmacy. Once 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 Kidney Care (HMO-POS C-SNP) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services, ambulance, emergency services, and many primary care services have copays ranging from $0 to $325. The plan includes coverage for preventive, hearing, vision, and dental services, often with no copay. Additional benefits include coverage for home infusion, dialysis, medical equipment, and diagnostic services, with some services having coinsurance. Skilled nursing facility stays and home health services are covered with no copay, and the plan also covers other services. However, some services like cardiac rehabilitation and certain other "other services" are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For days 1-5, there is a $325 copay, and for days 6-90, there is no copay. Additional days for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are covered with no copay, but Non-Medicare-covered Stay and Upgrades are not covered.
Outpatient Services See details
Outpatient Services include outpatient hospital services with a copay between $0 and $325, observation services with a $325 copay, ambulatory surgical center (ASC) services with no copay, outpatient substance abuse services with a $40 copay for both individual and group sessions, and outpatient blood services with no copay. Prior authorization is required for some services.
Partial Hospitalization See details
Partial Hospitalization is covered under the Anthem Kidney Care (HMO-POS C-SNP) plan, but requires prior authorization. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services with a $220 copay, and transportation services to plan-approved health-related locations with no copay. 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. Emergency Services and Worldwide Emergency Coverage have a $125 copay, while Urgently Needed Services have a $50 copay. Worldwide Urgent Coverage and Worldwide Emergency Transportation also have a $125 copay.
Primary Care See details
The Anthem Kidney Care (HMO-POS C-SNP) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $40 copay, physician specialist services with a copay between $0 and $40, and mental health specialty services with a $40 copay. The plan also covers podiatry services with a copay between $0 and $40, other health care professional services with a copay between $0 and $20, psychiatric services with a $40 copay, and physical therapy and speech-language pathology services with a $40 copay. Additional telehealth benefits have no copay, and opioid treatment program services have a $40 copay.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and additional preventive services, including fitness benefits, remote access technologies, and home and bathroom safety devices, with a copay that varies by service. Other services like health education, in-home safety assessments, and counseling services are not covered. The plan also covers kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit, all with no copay.
Hearing Services See details
Hearing Services include coverage for hearing exams with a $40 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to $2,000 per year, and over-the-counter hearing aids are covered with no copay up to $300 per year. Prescription hearing aids for inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision services include eye exams with a copay of $0-$40, and eyewear, contact lenses, eyeglasses (lenses and frames), and eyeglass lenses with no copay. Upgrades are not covered.
Dental Services See details
Dental Services are covered, including oral exams, dental x-rays, other diagnostic services, cleaning, fluoride treatments, and other preventive services with no copay, and other services with a maximum benefit of $2000 per year. Restorative, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are covered with 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 Kidney Care (HMO-POS C-SNP) plan. There is no copay for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 0-20% coinsurance, Prosthetic Devices with a 20% coinsurance, and Medical Supplies with a 20% coinsurance. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay, and DME for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, diagnostic procedures/tests with a copay between $0 and $175, and lab services with no copay. Radiological Services include coverage for diagnostic radiological services with a copay between $50 and $325, therapeutic radiological services with a coinsurance of at least 20%, and outpatient X-ray services with a $50 copay.
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; however, 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 Kidney Care (HMO-POS C-SNP) plan. The plan also does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Anthem Kidney Care (HMO-POS C-SNP) plan, but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered SNF stays and non-Medicare-covered SNF stays are not covered.
Other Services See details
The "Other Services" benefit for Anthem Kidney Care (HMO-POS C-SNP) includes coverage for Over-the-Counter (OTC) Items and Other 1, with no copay, but 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. OTC items have a maximum plan benefit coverage amount of $0.00 every month.
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