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 Kern County. 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 $2800.00 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) drug coverage offers an Enhanced Alternative plan design with no prescription drug deductible. During the initial coverage phase, you pay no copay for Tier 1 preferred generic drugs at preferred pharmacies or through standard mail, though standard pharmacies require a $5 copay. For other tiers, cost-sharing is managed through coinsurance, starting at 15% for Tier 2 standard generics at preferred pharmacies and rising to 33% for Tier 4 non-preferred drugs. Once your out-of-pocket spending reaches $2,100, you enter the catastrophic coverage phase and pay nothing for covered Part D drugs. Individuals qualifying for the low-income subsidy, or Extra Help, can also see their Part D premium reduced to $0. It is recommended to review the plan's formulary to confirm the coverage tiers for your specific prescriptions.
Additional Benefits
The Anthem Medicare Advantage (HMO-POS) plan offers robust coverage for essential medical services, with no copays or coinsurance for inpatient hospital stays, primary care, specialist visits, and home health care. Outpatient hospital services, lab tests, and X-rays are also available with no copay or coinsurance, while emergency room visits carry a $150 copay that is waived upon admission. Other medical costs are kept low with a $10 copay for urgent care and a $250 copay for ambulance services. For supplemental care, this plan features no copays or coinsurance for routine dental, vision, and hearing exams, including up to $3,000 annually for prescription hearing aids and a $100 annual allowance for eyewear. Comprehensive dental services are covered with a 25% coinsurance, and durable medical equipment carries a 0% to 20% coinsurance with no copay. Additionally, members benefit from up to 72 one-way transportation trips per year to approved health locations and a $56 quarterly allowance for over-the-counter items with no copay or coinsurance.
Inpatient Hospital See details
Anthem Medicare Advantage (HMO-POS) inpatient hospital benefits are partially covered, offering Medicare-covered acute and psychiatric stays with no copay and no coinsurance. Specific services that are not covered under this plan include upgrades for acute care and non-Medicare-covered stays for both acute and psychiatric hospitalizations.
Outpatient Services See details
Outpatient services under the Anthem Medicare Advantage (HMO-POS) plan are covered with no copay and no coinsurance for outpatient hospital, observation, ambulatory surgical center, and blood services. Outpatient substance abuse services, including individual and group sessions, are covered with a $25 copay and no coinsurance.
Partial Hospitalization See details
Anthem Medicare Advantage (HMO-POS) covers partial hospitalization services with a $40 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
Anthem Medicare Advantage (HMO-POS) covers ground and air ambulance services with a $250 copay and no coinsurance, though prior authorization is required. Transportation services are partially covered, offering up to 72 one-way trips per year to plan-approved health-related locations with no copay or coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by Anthem Medicare Advantage (HMO-POS) with a $150 copay and no coinsurance, with the copay waived if admitted to the hospital within 24 hours. Urgently needed services require a $10 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $100,000 maximum limit with a $150 copay and no coinsurance.
Primary Care See details
Anthem Medicare Advantage (HMO-POS) covers primary care, specialist visits, therapy services, telehealth, and podiatry with no copay and no coinsurance. Chiropractic services are partially covered with a $20 copay and no coinsurance, as routine chiropractic care is not covered, while psychiatric, mental health, and opioid treatment services require a $25 copay and no coinsurance.
Preventive Services See details
Anthem Medicare Advantage (HMO-POS) partially covers preventive services with no copay or coinsurance for covered benefits like annual physical exams, glaucoma screenings, and diabetes training. However, it does not cover health education, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional or dietary benefits, home-based palliative care, in-home support, caregiver support, smoking cessation, fitness, enhanced disease management, telemonitoring, or counseling services.
Hearing Services See details
Hearing services are covered by Anthem Medicare Advantage (HMO-POS) with no copays or coinsurance for exams, fittings, and hearing aids. Prescription hearing aids are partially covered up to $3,000 annually, though inner ear, outer ear, and over-the-ear models are not covered, while OTC hearing aids are covered up to $300 per year.
Vision Services See details
Anthem Medicare Advantage (HMO-POS) partially covers vision services, offering routine eye exams and eyewear with no copay and no coinsurance, though eyewear upgrades are not covered. The plan features a $100 annual maximum allowance for eyewear, including eyeglasses and contact lenses, and covers one routine eye exam every year.
Dental Services See details
Anthem Medicare Advantage (HMO-POS) partially covers dental services up to a $500 annual limit, offering preventive care with no copay and no coinsurance, and comprehensive services with a 25% coinsurance and no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Anthem Medicare Advantage (HMO-POS) with prior authorization required. 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
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 with no copays for all services, though prior authorization is required for some items. Durable medical equipment requires 0% to 20% coinsurance, and prosthetics and medical supplies carry a 20% coinsurance. Diabetic supplies and therapeutic shoes or inserts 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 a doctor referral required. Lab services and outpatient X-rays are available with no copay and no coinsurance, while other diagnostic procedures require a $0 to $15 copay with no coinsurance. Diagnostic radiological services carry a $0 to $95 copay with no coinsurance, and therapeutic radiological services require a 20% coinsurance with no copay.
Home Health Services See details
Home Health Services are covered by Anthem Medicare Advantage (HMO-POS) with no copay and no coinsurance. Prior authorization and a doctor referral are required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Anthem Medicare Advantage (HMO-POS) plan, as all sub-services—including intensive cardiac, pulmonary, and SET for PAD rehabilitation—are excluded from coverage. Because these services are not covered, there are no copays or coinsurance costs for members.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are partially covered by Anthem Medicare Advantage (HMO-POS) with no coinsurance, requiring prior authorization. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered under the Anthem Medicare Advantage (HMO-POS) plan, which offers over-the-counter items up to $56 every three months and Medicare Community Resource Support with no copay and no coinsurance. Acupuncture, meal benefits, and dual eligible SNPs with highly integrated services are not covered.
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