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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 Connecticut. 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 a $310.00 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 $12450.00 (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 $12450.00 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) plan has a $310 deductible for prescription drugs. During the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For example, in the initial coverage phase, preferred generic drugs have a $2 copay at preferred pharmacies, while standard mail order has no copay. 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 cost-sharing options. Many services, such as primary care visits, routine eye exams, and home health services, have no copay. Emergency services have a copay of $110, while urgent care has a copay of $25. The plan also covers a variety of services with coinsurance, including outpatient services, hearing services, and dental services. Additionally, the plan offers coverage for transportation to health-related locations with no copay, as well as coverage for OTC items and meal benefits with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered with coinsurance, while additional days and non-Medicare-covered stays for both acute and psychiatric care are not covered. Prior authorization is required for both acute and psychiatric care.
Outpatient Services See details
Outpatient services include coverage for Outpatient Hospital Services and Observation Services with a 20% coinsurance, Ambulatory Surgical Center (ASC) Services, and Outpatient Substance Abuse Services with a 20% coinsurance for individual and group sessions. Outpatient Blood Services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Anthem Kidney Care (HMO-POS C-SNP) plan. This benefit requires prior authorization and has a copay of $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services, including ground and air ambulance services, are covered by the Anthem Kidney Care (HMO-POS C-SNP) plan. Ground and air ambulance services have a 20% coinsurance, while transportation services to a plan-approved health-related location have no copay, with up to 80 one-way trips per year using rideshare services, bus/subway, van, or medical transport. Transportation services to any health-related location is not covered.
Emergency Services See details
Emergency Services are covered, with a $110 copay for emergency services and a $25 copay for urgently needed services. Worldwide Emergency Services, including coverage, urgent coverage, and transportation, are not covered.
Primary Care See details
The Anthem Kidney Care (HMO-POS C-SNP) plan covers primary care physician services with no copay, and chiropractic services with 20% coinsurance. 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, and opioid treatment program services are also covered, with coinsurance of at least 20%. Additional telehealth benefits are covered with no copay.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, and other services like glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. Glaucoma screenings, barium enemas, and digital rectal exams have a 20% coinsurance, while the other services have no copay.
Hearing Services See details
Hearing services include hearing exams, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids. Routine hearing exams and fitting/evaluation for hearing aids have no copay and the routine hearing exam has a coinsurance of at most 20%. Prescription hearing aids have no copay and a maximum benefit of $2000 per year. OTC hearing aids have no copay, and a maximum benefit of $300 per year.
Vision Services See details
The Anthem Kidney Care (HMO-POS C-SNP) plan covers vision services, including eye exams and eyewear. Routine eye exams have no copay, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames have no copay. Eyewear has a 20% coinsurance and a combined maximum plan benefit coverage of $125 per year.
Dental Services See details
Dental Services are covered under the Anthem Kidney Care (HMO-POS C-SNP) plan, with a 20% coinsurance for Medicare Dental Services. Other Dental Services have a maximum plan benefit of $1,000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have 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 Anthem Kidney Care (HMO-POS C-SNP) with no copay and 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with no copay and 0-20% coinsurance, Prosthetics/Medical Supplies with no copay and 20% coinsurance, and Diabetic Equipment with no copay for Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Anthem Kidney Care (HMO-POS C-SNP) plan. All diagnostic services and all radiological services have no copay, but may have up to 20% coinsurance for specific services like diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services.
Home Health Services See details
Home Health Services are covered under 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 not covered by the Anthem Kidney Care (HMO-POS C-SNP) plan, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but prior authorization is required. The plan does not offer additional days beyond Medicare-covered SNF stays, and non-Medicare-covered SNF stays are also not covered.
Other Services See details
The Anthem Kidney Care (HMO-POS C-SNP) plan covers Over-the-Counter (OTC) Items and Meal Benefits with 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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