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 Orange and Los Angeles 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 a $255.00 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 Maximum Out-Of-Pocket cost of $7550.00 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 a $255 annual prescription drug deductible. During the initial coverage phase, you can get Tier 1 preferred generic drugs with no copay through standard mail, a $3 copay at preferred pharmacies, or an $8 copay at standard pharmacies. For other tiers, you will pay a 25% coinsurance for standard generics and 30% coinsurance for preferred brands and non-preferred drugs. After your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase where you pay nothing for covered Medicare Part D prescription drugs. Those who qualify for Extra Help or the Low-Income Subsidy may also see their costs reduced to zero. You should review the plan formulary to verify coverage for your specific medications.
Additional Benefits
The Anthem Medicare Advantage (HMO-POS) plan covers primary care visits with a $20 copay, specialist visits with a $50 copay, and telehealth services with no copay. For hospital care, inpatient acute stays require a $403 daily copay for the first five days, while outpatient hospital visits range from no copay to a $403 copay. Emergency room visits carry a $115 copay, and urgent care is available for a $35 copay, all with no coinsurance. Preventive services, home health care, and routine dental and vision exams are available with no copay or coinsurance. The plan also covers diabetic supplies with no copay, while durable medical equipment requires up to 20% coinsurance and no copay. Medicare-covered dental and hearing exams are available with a $50 copay, though routine hearing aids and some specialized dental treatments are not covered.
Inpatient Hospital See details
Anthem Medicare Advantage (HMO-POS) partially covers inpatient hospital services with no coinsurance, though prior authorization is required. Acute stays require a $403 daily copay for days 1 to 5 and no copay for additional days, while psychiatric stays require a $374 daily copay for days 1 to 5 and no copay thereafter. Upgrades for acute care and non-Medicare-covered stays for both acute and psychiatric care are not covered.
Outpatient Services See details
Anthem Medicare Advantage (HMO-POS) covers outpatient services with no coinsurance, though copays vary depending on the specific service. Members will pay a copay of $0 to $403 for outpatient hospital visits, $403 per stay for observation services, $40 for substance abuse sessions, and no copay for ambulatory surgical center and blood services.
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 access these covered services.
Ambulance and Transportation Services See details
Anthem Medicare Advantage (HMO-POS) covers ground and air ambulance services with a $271.00 copay and no coinsurance, subject to prior authorization. For transportation benefits, some services are covered but transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Emergency services are partially covered by Anthem Medicare Advantage (HMO-POS), featuring a $115 copay and no coinsurance for emergency care, and a $35 copay and no coinsurance for urgent care. Worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation are not covered.
Primary Care See details
Anthem Medicare Advantage (HMO-POS) covers primary care physician services for a $20 copay and specialist visits for a $50 copay, both with no coinsurance. Chiropractic services are partially covered with a $15 copay and no coinsurance, though routine chiropractic care is not covered, while telehealth services are available 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 or coinsurance. Additional preventive services are only partially covered, excluding benefits such as fitness programs, weight management, health education, alternative therapies, in-home support, and personal emergency response systems.
Hearing Services See details
Hearing services are partially covered by Anthem Medicare Advantage (HMO-POS), offering covered hearing exams with a $50 copay, no coinsurance, and no deductible, though prior authorization and a doctor referral are required. However, routine hearing exams, fitting and evaluations for hearing aids, prescription hearing aids, and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Anthem Medicare Advantage (HMO-POS), featuring no copay and no coinsurance for routine eye exams and eyewear up to a $150 annual limit. Other eye exams have a copay of $0 to $50 with no coinsurance, while eyewear upgrades are not covered.
Dental Services See details
Anthem Medicare Advantage (HMO-POS) partially covers dental services, offering Medicare-covered dental care for a $50 copay and no coinsurance, as well as annual exams and cleanings with no copay and no coinsurance. However, several services are not covered, including orthodontics, restorative services, endodontics, periodontics, prosthodontics, implants, and oral surgery.
Home Infusion bundled Services See details
Anthem Medicare Advantage (HMO-POS) covers home infusion bundled services, with prior authorization and step therapy required for some treatments. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered by Anthem Medicare Advantage (HMO-POS) with no copay and a 20% coinsurance.
Medical Equipment See details
Anthem Medicare Advantage (HMO-POS) covers medical equipment, including durable medical equipment (DME) with no copay and coinsurance ranging from no coinsurance to 20%. Prosthetic devices and medical supplies require no copay and 20% coinsurance, while diabetic supplies and therapeutic shoes are covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Anthem Medicare Advantage (HMO-POS) covers diagnostic and radiological services with prior authorization and doctor referrals. Lab services have no copay or coinsurance, diagnostic tests range from no copay to a $235 copay with no coinsurance, outpatient X-rays require a $65 copay with no coinsurance, and diagnostic radiological services carry a $65 to $275 copay with no coinsurance, while therapeutic radiological services require a 20% coinsurance and no copay.
Home Health Services See details
Anthem Medicare Advantage (HMO-POS) covers home health services with no copay and no coinsurance. A doctor referral and prior authorization are required to access this benefit.
Cardiac Rehabilitation Services See details
Anthem Medicare Advantage (HMO-POS) notes that some services are covered, but Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD services are not covered. Since these services are not covered, there are no associated copays or coinsurance costs for members.
Skilled Nursing Facility (SNF) See details
Anthem Medicare Advantage (HMO-POS) partially covers Skilled Nursing Facility (SNF) services, requiring prior authorization but no prior three-day inpatient hospital stay. Patients pay no copay or coinsurance for days 1 through 20, and a $218 daily copay with no coinsurance for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Anthem Medicare Advantage (HMO-POS) partially covers other services, offering Medicare Community Resource Support with no copay and no coinsurance. However, acupuncture, over-the-counter items, meal benefits, and dual eligible SNPs with highly integrated services are not covered.
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