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 2025, 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 Ventura County. This plan received an overall rating of 3 out of 5 stars in 2025.
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 $6751.00 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 Medicare Advantage (HMO-POS) plan has an "Enhanced Alternative" drug benefit. The plan has no deductible. In the initial coverage phase, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and pharmacy. For example, you will pay a $5 copay for preferred generic drugs at a preferred pharmacy, or 20% coinsurance for standard generic drugs at a preferred pharmacy. Once your total drug costs reach $2,000, you enter the next coverage phase.
Additional Benefits
The Anthem Medicare Advantage (HMO-POS) plan offers comprehensive coverage, including inpatient and outpatient hospital services, with varying copays depending on the specific service. This plan also includes coverage for emergency services, primary care, preventive services, hearing, vision, and dental services, often with low copays or no copay. Additionally, the plan provides benefits for home health, medical equipment, and diagnostic services, with some services requiring coinsurance.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $330 copay for days 1-4, and no copay for days 5-90. For Inpatient Hospital Psychiatric, you will pay a $380 copay for days 1-4, and no copay for days 5-90. Additional days for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are covered with no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, as are Non-Medicare-covered stays for Inpatient Hospital Psychiatric.
Outpatient Services See details
Outpatient services include coverage for outpatient hospital services with a copay between $0 and $310, observation services with a $310 copay, ambulatory surgical center (ASC) services with no copay, outpatient substance abuse services with a $40 copay for both individual and group sessions, and outpatient blood services with no copay. Prior authorization and a doctor referral are required for many of these services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Anthem Medicare Advantage (HMO-POS) plan, but requires prior authorization. You will have a $40 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required. Ground ambulance services have a $380 copay, while air ambulance services have 20% coinsurance; transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $90 copay, Urgently Needed Services have a $35 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $90 copay.
Primary Care See details
The Anthem Medicare Advantage (HMO-POS) plan covers primary care physician services with a $5 copay, chiropractic services with a $15 copay, and occupational therapy services with a $15 copay. It also covers physician specialist services and physical therapy/speech-language pathology services each with a $15 copay, and additional telehealth benefits with no copay. Mental health and psychiatric services, along with podiatry services, other health care professional services, and opioid treatment program services have varying copays depending on the specific service.
Preventive Services See details
The Anthem Medicare Advantage (HMO-POS) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services are covered, but some services like health education, in-home safety assessments, and others are not covered.
Hearing Services See details
Hearing Services includes coverage for hearing exams with a $15 copay, routine hearing exams with no copay, fitting/evaluation for hearing aids with no copay, and OTC hearing aids with no copay. Prescription hearing aids are covered up to $750 per year.
Vision Services See details
Vision Services includes eye exams with a copay of $0-$15, and eyewear with no copay. Routine eye exams are covered with no copay. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are covered with no copay, but upgrades are not covered.
Dental Services See details
Dental Services includes coverage for Medicare dental services with a $15 copay, oral exams with no copay, and prophylaxis (cleaning) with no copay. Dental X-Rays and Fluoride Treatment are offered as optional, supplemental benefits. Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics, removable, Maxillofacial Prosthetics, Implant Services, Prosthodontics, fixed, Oral and Maxillofacial Surgery, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay. Other Medicare Part B drugs, and Medicare Part B Chemotherapy/Radiation Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Anthem Medicare Advantage (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, and Prosthetics/Medical Supplies and Medical Supplies with a 20% coinsurance, and Diabetic Equipment which include Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts with 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, including diagnostic procedures and tests with a coinsurance of up to 20%, and lab services with no copay. Diagnostic radiological services have a coinsurance of up to 20% and no copay, while therapeutic radiological services have a coinsurance of up to 20%, and outpatient X-ray services have no copay.
Home Health Services See details
Home Health Services are covered by the Anthem Medicare Advantage (HMO-POS) 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 by the Anthem Medicare Advantage (HMO-POS) plan, but the specific services are not covered. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Anthem Medicare Advantage (HMO-POS). There is no copay for days 1-20, and a $140 copay for days 21-100. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items with no copay and $35 maximum benefit every three months, and Other 1 services with no copay requiring a doctor's referral; however, Acupuncture, Meal Benefit, Dual Eligible SNPs with Highly Integrated Services, and several other services are not covered.
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