A non-government entity
Anthem Medicare Advantage (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem Medicare Advantage (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Anthem Medicare Advantage (HMO-POS) in 2026, please refer to our full plan details page.
Anthem Medicare Advantage (HMO-POS) is a HMO-POS plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Fresno, Kings, Madera and Tulare Counties. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Anthem Medicare Advantage (HMO-POS) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Anthem Medicare Advantage (HMO-POS).
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 Medicare Advantage (HMO-POS), 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 $3000.00 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:
Sign up for Anthem Medicare Advantage (HMO-POS)
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Drug Coverage
The Anthem Medicare Advantage (HMO-POS) plan offers an enhanced alternative drug benefit with no prescription drug deductible. During the initial coverage phase, you will have no copay for tier 1 preferred generic and tier 5 specialty drugs at preferred, standard, and standard mail pharmacies. For other tiers, standard generic drugs carry a copay of $42 to $47, while tier 3 preferred brand and tier 4 non-preferred drugs require 25% and 33% coinsurance respectively. After your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for Medicare Part D covered drugs. Additionally, if you qualify for Extra Help, your Part D premium can be reduced to $0. Please review the plan's formulary to confirm the cost-sharing tier and coverage details for your specific prescription drugs.
Additional Benefits
The Anthem Medicare Advantage (HMO-POS) plan offers comprehensive medical coverage with predictable out-of-pocket costs and no coinsurance for most primary services. Members benefit from affordable doctor visits, including a $5 copay for primary care, a $15 copay for specialists, and no copay for annual preventive care. If emergency services are needed, there is a $130 copay, while inpatient hospital stays require a $225 copay for days one through seven and no copay for days eight through ninety. This plan also features essential routine benefits for dental, vision, and hearing care to support your overall wellness. You will pay no copay for routine eye exams, preventive dental care, and routine hearing fittings, although comprehensive dental services require a 25% coinsurance. Additionally, the plan covers home health care and quarterly over-the-counter health items with no copay and no coinsurance.
Inpatient Hospital See details
Anthem Medicare Advantage (HMO-POS) partially covers inpatient acute and psychiatric hospital services, excluding upgrades and non-Medicare-covered stays. Covered stays require prior authorization and carry a $225 copay for days 1 through 7, with no copay for days 8 through 90, unlimited additional days, and no coinsurance.
Outpatient Services See details
Anthem Medicare Advantage (HMO-POS) covers outpatient services with no coinsurance, featuring a copay ranging from no copay to $225 for outpatient hospital services and a $225 copay for observation services. There is no copay for ambulatory surgical center and blood services, while outpatient substance abuse sessions require a $40 copay.
Partial Hospitalization See details
Anthem Medicare Advantage (HMO-POS) covers partial hospitalization benefits with a $40 copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Anthem Medicare Advantage (HMO-POS) partially covers ambulance and transportation services, with ground and air ambulance services costing a $295 copay and no coinsurance. Transportation services to plan-approved health-related locations and any health-related locations are not covered.
Emergency Services See details
Anthem Medicare Advantage (HMO-POS) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $35 copay and no coinsurance, while worldwide emergency services, urgent care, and transportation are covered up to a $100,000 maximum benefit with a $130 copay and no coinsurance.
Primary Care See details
Anthem Medicare Advantage (HMO-POS) covers primary care doctor visits with a $5 copay and specialist visits with a $15 copay, with no coinsurance. Chiropractic services are only partially covered because routine chiropractic care is not covered, though additional telehealth services are offered with no copay and no coinsurance.
Preventive Services See details
Anthem Medicare Advantage (HMO-POS) covers preventive services, including annual physical exams, kidney disease education, and glaucoma screenings, with no copay and no coinsurance. Additional preventive services are partially covered, offering personal emergency response systems and remote access technologies with no copay and no coinsurance, while excluding services like fitness benefits, health education, and weight management.
Hearing Services See details
Anthem Medicare Advantage (HMO-POS) covers hearing services, including exams with a $15 copay and no coinsurance, and routine exams or fittings with no copay and no coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to a $1,500 annual limit, excluding inner ear, outer ear, and over the ear models. OTC hearing aids are also covered up to a $300 annual limit with no copay and no coinsurance.
Vision Services See details
Vision services are partially covered by Anthem Medicare Advantage (HMO-POS) with no deductible or coinsurance. Routine eye exams and covered eyewear (up to a $250 annual limit) have no copay, while other eye exams require a copay of up to $15, though eyewear upgrades are not covered.
Dental Services See details
Dental Services are partially covered by Anthem Medicare Advantage (HMO-POS), with maxillofacial prosthetics, implant services, and orthodontics not covered. Medicare-covered dental services require a $15 copay and no coinsurance, preventive services have no copay and no coinsurance up to a $500 annual limit, and covered comprehensive services require a 25% coinsurance and no copay.
Home Infusion bundled Services See details
Anthem Medicare Advantage (HMO-POS) covers home infusion bundled services, which require prior authorization and step therapy. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require no copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Anthem Medicare Advantage (HMO-POS) covers dialysis services with 20% coinsurance and no copay.
Medical Equipment See details
Anthem Medicare Advantage (HMO-POS) covers medical equipment with no copay and 0% to 20% coinsurance for durable medical equipment, and no copay and 20% coinsurance for prosthetics and medical supplies. Diabetic equipment and supplies, including therapeutic shoes and inserts, are also covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Anthem Medicare Advantage (HMO-POS) covers diagnostic and radiological services, requiring prior authorization and a doctor referral. Diagnostic procedures and diagnostic radiological services have copays ranging from $0 to $200 and $0 to $220 respectively with no coinsurance, while therapeutic radiological services require 20% coinsurance with no copay. Lab and outpatient X-ray services are covered with no copay and no coinsurance.
Home Health Services See details
Anthem Medicare Advantage (HMO-POS) covers Home Health Services with no copay and no coinsurance. Prior authorization and a doctor referral are required to receive these covered services.
Cardiac Rehabilitation Services See details
Anthem Medicare Advantage (HMO-POS) does not cover Cardiac Rehabilitation Services, meaning there is no copay or coinsurance, as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
Anthem Medicare Advantage (HMO-POS) partially covers Skilled Nursing Facility (SNF) services with prior authorization, though additional days beyond the Medicare-covered limit are not covered. There is no coinsurance for this benefit, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100.
Other Services See details
Anthem Medicare Advantage (HMO-POS) partially covers other services, offering Medicare Community Resource Support and up to $90 every three months in Over-the-Counter (OTC) items with no copay or coinsurance. Acupuncture, meal benefits, and Dual Eligible SNPs with Highly Integrated Services are not covered.
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