A non-government entity
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 2026, 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 Connecticut. This plan received an overall rating of 3.5 out of 5 stars in 2026.
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 a $350.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $13900.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $13900.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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) prescription drug plan features an annual drug deductible of $350. Under this plan, you will pay no copay for Tier 1 preferred generics and Tier 6 select care drugs at preferred pharmacies, standard pharmacies, and through standard mail order. Tier 2 generic drugs are also highly affordable, featuring no copay for standard mail orders and low copays starting at just $2.00 at preferred retail pharmacies. For brand-name and specialty medications, costs are structured as a percentage of the drug cost rather than a flat copayment. Tier 3 preferred brands and Tier 4 non-preferred drugs both require a 25% coinsurance across preferred, standard, and standard mail order pharmacies. Tier 5 specialty drugs require a 29% coinsurance for a one-month supply at all participating pharmacy types.
Additional Benefits
The Anthem Kidney Care (HMO-POS C-SNP) plan offers comprehensive coverage designed to minimize out-of-pocket expenses for essential medical care. Members enjoy no copays and no coinsurance for primary care visits, home health services, and skilled nursing facility stays. For specialized services, including dialysis, diagnostic radiology, and outpatient hospital care, there is no copay, but a standard 20% coinsurance applies. This plan also includes valuable supplemental benefits, featuring no copays or coinsurance for preventive and comprehensive dental care up to a $1,500 annual limit, alongside generous allowances for hearing aids and eyewear. Additionally, members can access up to 36 one-way transportation trips per year and a $50 monthly allowance for over-the-counter items with no copay. Emergency room visits carry a $115 copay, while urgent care visits require a $25 copay.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Anthem Kidney Care (HMO-POS C-SNP) with no plan copay or coinsurance, although Medicare-defined cost shares apply and prior authorization is required. This coverage excludes additional hospital days, upgrades, and non-Medicare-covered stays.
Outpatient Services See details
Outpatient services under Anthem Kidney Care (HMO-POS C-SNP) feature no copays, though a 20% coinsurance and prior authorization requirements apply to outpatient hospital, ambulatory surgical center, and outpatient substance abuse services. Outpatient blood services are fully covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Anthem Kidney Care (HMO-POS C-SNP) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
Anthem Kidney Care (HMO-POS C-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. Transportation services are partially covered with no copay or coinsurance for up to 36 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
Anthem Kidney Care (HMO-POS C-SNP) covers emergency services with a $115 copay and no coinsurance, and urgently needed services with a $25 copay and no coinsurance. Worldwide emergency services are not covered in practice, as worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation are all not covered.
Primary Care See details
Anthem Kidney Care (HMO-POS C-SNP) provides primary care doctor visits and telehealth services with no copay and no coinsurance. Other covered services, including specialist visits, physical and occupational therapy, and mental health care, feature no copay and a 20% coinsurance, while chiropractic services are not covered.
Preventive Services See details
Anthem Kidney Care (HMO-POS C-SNP) covers preventive services, offering no copay and no coinsurance for annual physical exams, kidney disease education, and personal emergency response systems. These benefits are partially covered, as glaucoma screenings and digital rectal exams require a 20% coinsurance, while services like fitness benefits and health education are not covered.
Hearing Services See details
Anthem Kidney Care (HMO-POS C-SNP) covers hearing services with no deductible, featuring routine hearing exams with a 20% coinsurance and no copay, alongside fitting evaluations and Medicare-covered exams with no copay or coinsurance. Prescription hearing aids are partially covered up to $2,000 annually with no copay or coinsurance, though inner ear, outer ear, and over-the-ear types are not covered. Over-the-counter hearing aids are also covered up to $300 per year with no copay or coinsurance.
Vision Services See details
Anthem Kidney Care (HMO-POS C-SNP) partially covers vision services, including one annual routine eye exam with no copay and 20% coinsurance, while other eye exams are not covered. Eyewear is covered up to $250 annually with no copay, featuring contact lenses with 20% coinsurance and eyeglasses with no coinsurance, though upgrades are not covered.
Dental Services See details
Dental services are partially covered by Anthem Kidney Care (HMO-POS C-SNP), which features Medicare-covered dental services with no copay and a 20% coinsurance, alongside preventive and comprehensive dental services with no copay, no coinsurance, and a $1,500 annual maximum. Implant services, orthodontics, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Anthem Kidney Care (HMO-POS C-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have a coinsurance of 0% to 20%.
Dialysis Services See details
Dialysis services are covered by Anthem Kidney Care (HMO-POS C-SNP) with a 20% coinsurance and no copay.
Medical Equipment See details
Medical equipment is covered by Anthem Kidney Care (HMO-POS C-SNP) with no copays, though coinsurance costs vary depending on the item. Durable medical equipment has a 0% to 20% coinsurance, prosthetic devices and medical supplies carry a 20% coinsurance, and diabetic equipment and supplies are covered with no coinsurance.
Diagnostic and Radiological Services See details
Anthem Kidney Care (HMO-POS C-SNP) covers diagnostic and radiological services, including lab tests, X-rays, and therapeutic radiology, subject to prior authorization. There is no copay for these services, but members are responsible for a 20% coinsurance.
Home Health Services See details
Anthem Kidney Care (HMO-POS C-SNP) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered by Anthem Kidney Care (HMO-POS C-SNP) with no copay, but are not covered in practice. Although some services are covered, specific sub-services—including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation—are not covered and require a 20% coinsurance and prior authorization.
Skilled Nursing Facility (SNF) See details
Anthem Kidney Care (HMO-POS C-SNP) covers skilled nursing facility (SNF) services with no copay and no coinsurance, though prior authorization is required. Admission is allowed with less than a three-day prior inpatient hospital stay, but additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Anthem Kidney Care (HMO-POS C-SNP) offers partial coverage for other services with no copay and no coinsurance, which includes Medicare Community Resource Support, a meal benefit for qualifying medical conditions, and a $50 monthly over-the-counter item allowance. Acupuncture is not covered under this benefit.
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