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 Ventura 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 a $210.00 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 $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 offers an Enhanced Alternative drug benefit with a $210 prescription drug deductible. After meeting this deductible, you will pay no copay for Tier 1 preferred generic drugs at preferred pharmacies or through standard mail, while standard pharmacies require a $10 copay. For Tier 2 standard generic drugs, a 25% coinsurance applies at preferred, standard, and standard mail pharmacies. Tier 3 preferred brand drugs and Tier 4 non-preferred drugs require a 30% coinsurance during the initial coverage phase. Once your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase and pay nothing for covered Part D drugs. If you qualify for the low-income subsidy, your Part D premium cost is reduced to $0.
Additional Benefits
The Anthem Medicare Advantage (HMO-POS) plan offers comprehensive medical coverage with predictable costs, featuring no copays for telehealth, preventive care, and routine home health services. Primary care visits require a low $5 copay, while inpatient hospital stays charge daily copays for the first four days and no copay for subsequent days. Emergency services are covered with a $115 copay, and urgent care visits require a $35 copay, with no coinsurance for either service. For supplemental care, members benefit from routine dental cleanings, annual eye exams, and hearing evaluations with no copay. The plan also covers prescription hearing aids up to $750 annually and eyewear up to $150 annually with no copay, though certain advanced dental treatments and transportation services are not covered. Additionally, diagnostic labs and diabetic supplies are available with no copay, helping you manage ongoing health needs affordably.
Inpatient Hospital See details
Inpatient hospital benefits are partially covered by Anthem Medicare Advantage (HMO-POS) with no coinsurance, though upgrades and non-Medicare-covered stays are not covered. Acute care requires prior authorization and charges a $330 daily copay for days 1 through 4 and no copay for days 5 through 90, while psychiatric care requires a $380 daily copay for days 1 through 4 and no copay for days 5 through 90.
Outpatient Services See details
Anthem Medicare Advantage (HMO-POS) covers outpatient services with no coinsurance, including no copay for ambulatory surgical center and blood services. Outpatient substance abuse sessions require a $40 copay, while outpatient hospital and observation services have copays ranging up to $310.
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
Ambulance and transportation services are partially covered by Anthem Medicare Advantage (HMO-POS), offering ground and air ambulance services with a $325 copay and no coinsurance. However, transportation services to plan-approved or any other health-related locations are not covered under this plan.
Emergency Services See details
Anthem Medicare Advantage (HMO-POS) covers emergency services with a $115 copay and urgently needed services with a $35 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $100,000 maximum with a $115 copay and no coinsurance.
Primary Care See details
Primary Care benefits are partially covered by Anthem Medicare Advantage (HMO-POS), as routine chiropractic care is not covered. Covered services require no coinsurance, with copays ranging from $5 for primary care visits to $40 for psychiatric and mental health services, while telehealth benefits are available with no copay.
Preventive Services See details
Anthem Medicare Advantage (HMO-POS) covers preventive services, including annual physical exams and kidney disease education, with no copays and no coinsurance. However, the benefit is only partially covered as several supplemental services, such as fitness benefits, weight management programs, and alternative therapies, are not covered.
Hearing Services See details
Anthem Medicare Advantage (HMO-POS) covers hearing services with no coinsurance, offering routine hearing exams and fitting evaluations for no copay and other hearing exams for a $15 copay. Prescription hearing aids are partially covered with no copay up to $750 annually, excluding inner ear, outer ear, and over-the-ear types. OTC hearing aids are also covered with no copay up to a $300 annual limit.
Vision Services See details
Anthem Medicare Advantage (HMO-POS) offers partially covered vision services with no coinsurance, featuring eye exams for a $0 to $15 copay and one routine annual exam with no copay. Covered eyewear, including contacts and eyeglasses, has no copay or coinsurance up to a $150 annual limit, though upgrades are not covered.
Dental Services See details
Anthem Medicare Advantage (HMO-POS) partially covers dental services, offering Medicare-covered dental care for a $15 copay and no coinsurance, alongside annual oral exams and cleanings with no copay and no coinsurance. Dental X-rays and fluoride are available as optional supplemental benefits, but restorative, endodontic, periodontic, prosthodontic, orthodontic, implant, and oral surgery services are not covered.
Home Infusion bundled Services See details
Anthem Medicare Advantage (HMO-POS) covers Home Infusion bundled Services with prior authorization, offering Medicare Part B insulin for a $35 copay and no coinsurance. Other covered Part B chemotherapy, radiation, and miscellaneous drugs require no copay and carry a coinsurance ranging from no coinsurance up 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, featuring 0% to 20% coinsurance and no copay for durable medical equipment (DME), and a 20% coinsurance with no copay for prosthetic devices and medical supplies. 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 diagnostic procedures, diagnostic radiology, and therapeutic radiology requiring a 20% coinsurance and no copay. Lab services and outpatient X-rays are provided with no copay, though all services require a doctor referral and prior authorization.
Home Health Services See details
Home health services are covered by Anthem Medicare Advantage (HMO-POS) with no copay and no coinsurance, although a doctor referral and prior authorization are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Anthem Medicare Advantage (HMO-POS) plan, as none of the sub-services—including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation—are covered.
Skilled Nursing Facility (SNF) See details
Anthem Medicare Advantage (HMO-POS) partially covers Skilled Nursing Facility (SNF) services, as additional days beyond the Medicare-covered limit are not covered. For covered days, which require prior authorization, there is no copay or coinsurance for days 1 through 20, and a $218 daily copay with no coinsurance for days 21 through 100.
Other Services See details
Anthem Medicare Advantage (HMO-POS) partially covers other services, offering over-the-counter (OTC) items up to $64 every three months and Medicare Community Resource Support with no copay or coinsurance. Acupuncture, meal benefits, and Dual Eligible SNPs with highly integrated services are not covered.
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