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Anthem Chronic Care (HMO-POS C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem Chronic 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 Chronic Care (HMO-POS C-SNP) in 2025, please refer to our full plan details page.
Anthem Chronic 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 Jefferson County. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Anthem Chronic 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 Chronic 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 Chronic 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 Chronic 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 $4150.00 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 Chronic 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 depending on the drug tier and pharmacy. Preferred and standard generic drugs have no copay, and specialty tier drugs have no copay. For other drugs, you will pay coinsurance, which varies depending on the tier and pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs.
Additional Benefits
The Anthem Chronic Care (HMO-POS C-SNP) plan offers comprehensive coverage with a variety of benefits. This plan includes coverage for inpatient hospital stays, outpatient services, and emergency services, with varying copays depending on the service. It also offers no copay for primary care physician visits, routine hearing and eye exams, and dental services. Additional benefits include coverage for hearing aids, eyewear, and dental services up to a maximum annual benefit. The plan also covers home health services, ambulance and transportation services, and medical equipment, with different cost-sharing structures like copays and coinsurance.
Inpatient Hospital See details
Inpatient hospital services, including acute and psychiatric care, are covered by Anthem Chronic Care (HMO-POS C-SNP). For inpatient hospital-acute, you will pay a $345 copay for days 1-7, and no copay for days 8-90; additional days are covered with no copay. For inpatient hospital psychiatric, you will pay a $345 copay for days 1-6, and no copay for days 7-90; additional days are covered with no copay. Non-Medicare covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay between $0 and $345, observation services with a $345 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $15 copay for both individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Anthem Chronic Care (HMO-POS C-SNP) plan, with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground Ambulance Services have a $325 copay, while Air Ambulance Services have a 20% coinsurance. Transportation Services to a plan-approved health-related location are covered with no copay, up to 60 one-way trips per year. Transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Anthem Chronic Care (HMO-POS C-SNP) plan. Emergency Services have a $140 copay, Urgently Needed Services have a $50 copay, and Worldwide Emergency Services have a $140 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
The Anthem Chronic Care (HMO-POS C-SNP) plan covers primary care physician services with no copay, and chiropractic services for a $15 copay. Occupational therapy services, physical therapy and speech-language pathology services have a $15 copay. Additional telehealth benefits have no copay, while mental health and psychiatric services have a $15 copay for individual and group sessions. Podiatry services have a $0-$15 copay, and other health care professional services have a $0-$20 copay. Opioid treatment program services have a $15 copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, an annual physical exam with no copay, and additional preventive services. Additional preventive services, kidney disease education services, and other preventive services have a copay, and specific services like health education, in-home safety assessments, and others are not covered.
Hearing Services See details
Hearing Services include hearing exams with a $15 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered, and OTC hearing aids are covered with no copay up to a maximum of $300 per year for both ears combined. 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 - $15, and routine eye exams have no copay. Eyewear, including contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames have no copay, and there is a combined maximum plan benefit of $300 per year; upgrades are not covered.
Dental Services See details
Dental Services are covered, with a maximum benefit of $3,000 per year. Medicare Dental Services and other dental services including 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 and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics, all have no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Anthem Chronic Care (HMO-POS C-SNP) plan, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered, with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Anthem Chronic Care (HMO-POS C-SNP) plan. You will pay 20% coinsurance for these services.
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. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with a copay for diagnostic procedures and tests ranging from $0 to $90, and no copay for lab services. For radiological services, there is a copay of at most $345 for diagnostic services, and a coinsurance of at least 20% for therapeutic services, while outpatient X-ray services have a $15 copay.
Home Health Services See details
Home Health Services are covered under the Anthem Chronic 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, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required, and there is a copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Anthem Chronic Care (HMO-POS C-SNP) plan covers Over-the-Counter (OTC) Items and Meal Benefits with no copay. Other services like 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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