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Anthem Kidney Care (PPO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem Kidney Care (PPO 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 (PPO C-SNP) in 2025, please refer to our full plan details page.
Anthem Kidney Care (PPO C-SNP) is a PPO C-SNP plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Select Counties in California. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Anthem Kidney Care (PPO 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 (PPO 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 (PPO 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 (PPO 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 $130.00 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 (PPO C-SNP) plan has a $130 deductible for prescription drugs. After you meet your deductible, you will pay the following costs. For preferred and standard generic drugs, and specialty tier drugs, you will have no copay. For preferred brand drugs, you will pay 25% coinsurance. For non-preferred drugs, you will pay 31% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs. If you qualify for the low-income subsidy, you will pay no premium for Part D drugs.
Additional Benefits
The Anthem Kidney Care (PPO C-SNP) plan offers a range of benefits with varying cost-sharing options. Many services have no copay, including primary care visits, home health services, and dental services like oral exams and cleanings. There is a $90 copay for emergency services, and a $55 copay for partial hospitalization. The plan also includes coinsurance for certain services, such as 20% for outpatient hospital services, hearing exams, and vision exams. Additionally, the plan covers over-the-counter items with a monthly maximum benefit, and transportation services with no copay for 52 one-way trips per year.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, but the plan does not specify the cost sharing details. Additional Days for Inpatient Hospital-Acute, Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital and observation services have a 20% coinsurance, while ASC services and outpatient substance abuse services also have a 20% coinsurance, but the specific services covered are not detailed. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Anthem Kidney Care (PPO C-SNP) plan, but requires prior authorization. You will pay a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Anthem Kidney Care (PPO C-SNP) plan. Ground and Air Ambulance Services have a 20% coinsurance, while Transportation Services have no copay, and Transportation Services to a plan-approved health-related location are covered for 52 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. For Emergency Services, there is a $90 copay and no coinsurance, while Urgently Needed Services have a $25 copay and no coinsurance. Worldwide Emergency Services are not covered.
Primary Care See details
The Anthem Kidney Care (PPO C-SNP) plan covers primary care physician services with no copay, while chiropractic services have a 20% coinsurance. Occupational therapy services, physician specialist services, and physical therapy/speech-language pathology services have a 20% coinsurance. Additionally, mental health specialty services, psychiatric services, and opioid treatment program services all have 20% coinsurance for covered services, and additional telehealth benefits are covered with no copay.
Preventive Services See details
Preventive Services include coverage for annual physical exams with no copay, and additional services like glaucoma screenings with 20% coinsurance. Some services, such as Health Education, are not covered.
Hearing Services See details
Hearing Services include hearing exams with a coinsurance of 20% and a copay for Medicare-covered benefits and fitting/evaluation for hearing aids with no copay, both requiring prior authorization. Prescription Hearing Aids are covered with no copay, and OTC Hearing Aids are covered with no copay.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a 20% coinsurance, and routine eye exams have no copay, with a maximum plan benefit of $69 per year. Eyewear has a 20% coinsurance, and contact lenses, eyeglasses (lenses and frames), and eyeglass lenses have no copay, with a combined maximum benefit of $300 per year; however, upgrades are not covered.
Dental Services See details
Dental Services are covered, with a 20% coinsurance for Medicare Dental Services. Other covered dental services include oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable), maxillofacial prosthetics, implant services, prosthodontics (fixed), oral and maxillofacial surgery, and orthodontics, all 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 other Medicare Part B drugs with 0-20% coinsurance. Medicare Part B Chemotherapy/Radiation Drugs are also covered with 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Anthem Kidney Care (PPO C-SNP) plan with no copay and 20% coinsurance.
Medical Equipment See details
Medical Equipment is covered by the Anthem Kidney Care (PPO C-SNP) plan, with no copay for Durable Medical Equipment (DME), and a coinsurance of 0-20%. Prosthetic Devices and Medical Supplies are covered with no copay, and a 20% coinsurance. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay, and Diabetic Supplies are limited to those from specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with no copay. You will pay a coinsurance of at most 20% for 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 (PPO 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 under the Anthem Kidney Care (PPO C-SNP) plan. Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are also not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. The plan does not cover additional days beyond Medicare-covered for SNF, nor does it cover non-Medicare-covered stays.
Other Services See details
The Anthem Kidney Care (PPO C-SNP) plan covers Over-the-Counter (OTC) Items with no copay, and a maximum benefit coverage amount of $50 per month. The plan also covers meal benefits with no copay and other services 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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