Anthem I Carelon Premium Savings (HMO)
California Medicare Advantage Plan (2024 Plan)
by Anthem Blue Cross Partnership Plan
Additional Coverage
HearingVisionDental
Overall Government Star Rating
No Rating (new plan)
Plan Name
Anthem I Carelon Premium Savings (HMO)
Insurance Carrier
Anthem Blue Cross Partnership Plan
Plan Type
Medicare Advantage Plan With Part D Prescription Drug Coverage
Anthem I Carelon Premium Savings (HMO) is a Medicare Advantage Plan With Part D Prescription Drug Coverage, which is available in California and offered by the health insurance company Anthem Blue Cross Partnership Plan. This plan’s network type is HMO which determines in-network doctors who accept the health plan and whether a referral is needed.
Primary doctor visit
$0-5 copay per visit
Specialist visit
$0-20 copay per visit
ER visit
$90 copay per visit (always covered)
Anthem I Carelon Premium Savings (HMO) has a monthly premium cost of $0 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $1,500 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for Anthem I Carelon Premium Savings (HMO) are defined below.
Yes
Part D Prescription Drug Coverage
Anthem I Carelon Premium Savings (HMO) is a Medicare Advantage plan which does include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. Anthem I Carelon Premium Savings (HMO) includes coverage for hearing, vision, dental.
Medicare Advantage health plans can offer even more additional benefits. Anthem I Carelon Premium Savings (HMO) includes coverage for the following additional benefits:
Other benefits
Over the counter drug benefits
Home and bathroom safety devices
Health Portion of Premium
Health Plan Max Out-of-Pocket
Nationwide Coverage included
Hearing Coverage included
Doctor Services
Tests, labs, & imaging
Diagnostic tests & procedures
Diagnostic radiology services (like MRI)
Emergency care
$90 copay per visit (always covered)
Urgent care
$20 copay per visit (always covered)
Hospital Services
Inpatient hospital coverage
$125 per day for days 1 through 5
$0 per day for days 6 through 90
Outpatient hospital coverage
Skilled nursing facility
Skilled nursing facility
$0 per day for days 1 through 20
$100 per day for days 21 through 100
Preventive services
Ambulance
Therapy services
Occupational therapy visit
Physical therapy & speech & language therapy visit
Mental health services
Outpatient group therapy with a psychiatrist
Outpatient individual therapy with a psychiatrist
Outpatient group therapy visit
Outpatient individual therapy visit
Opioid treatment services
Opioid treatment services
Other services
Durable medical equipment (like wheelchairs & oxygen)
0-20% coinsurance per item
Prosthetics (like braces, artificial limbs)
0-20% coinsurance per item
Tier drug costs for: Standard retail pharmacy drug cost for 1-month
Tiers | Initial coverage phase | Gap coverage phase1 | Catastrophic coverage phase |
---|
Preferred Generic | $0.00 copay | |
Generic drugs :
$0 copay Brand-name drugs :
$0 copay |
Generic | $0.00 copay | |
Preferred Brand | $40.00 copay | |
Non-Preferred Drug | $100.00 copay | |
Specialty Tier | 33% | |
1 For all other drugs, you pay 25% for generic drugs and 25% for brand-name drugs. |
Part B Drugs
Hearing
Preventive Dental
Comprehensive dental
Prosthodontics, other oral/maxillofacial surgery, other services
Vision
Eyeglasses (frames & lenses)
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