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 Sacramento and Yolo 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 $140.00 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 $140.00 annual prescription drug deductible. After meeting this deductible, you pay for your prescriptions based on a tiered system until your yearly out-of-pocket drug costs reach $2,100.00, after which you enter the catastrophic coverage phase and pay nothing for Part D covered drugs. Individuals who qualify for the Low-Income Subsidy can also benefit from reduced premium costs. During the initial coverage phase, Tier 1 preferred generics and Tier 5 specialty drugs have no copay at preferred pharmacies and through standard mail, though Tier 1 generics cost a $10.00 copay at standard pharmacies. For mid-tier drugs, you will pay a coinsurance of 25% for Tier 2 standard generics, 30% for Tier 3 preferred brands, and 31% for Tier 4 non-preferred drugs. These structured cost-sharing rates help you easily predict your monthly medication expenses at preferred, standard, and mail-order pharmacies.
Additional Benefits
The Anthem Medicare Advantage (HMO-POS) plan offers robust coverage for everyday medical needs, featuring a $10 copay for primary care visits and a $45 copay for specialist consultations. For hospital care, inpatient stays require a $350 daily copay for the first five days followed by no copay for days six through 90, while outpatient hospital services range from no copay up to a $275 copay. Emergency room visits carry a $115 copay, which is waived if you are admitted within 24 hours, and urgent care is available with a $35 copay. Routine and preventative benefits are highly affordable, offering no copay for annual physicals, routine eye exams, and routine dental cleanings. Hearing care includes no copay for routine exams and prescription hearing aids up to a $3,000 annual limit, while eyewear is covered with no copay up to a $300 yearly limit. Members also receive a $70 allowance every three months for over-the-counter items and pay no copay for home health services.
Inpatient Hospital See details
Inpatient hospital care is partially covered by Anthem Medicare Advantage (HMO-POS) with a $350 daily copay for days 1 through 5, no copay for days 6 through 90, and no coinsurance for both acute and psychiatric stays. Non-Medicare-covered stays and acute care upgrades are not covered, and prior authorization is required.
Outpatient Services See details
Outpatient services are covered under Anthem Medicare Advantage (HMO-POS) with no coinsurance, featuring no copay for ambulatory surgical center and blood services. Copays range from $0 to $275 for outpatient hospital services, while observation services cost a $275 copay per stay and outpatient substance abuse sessions require a $40 copay.
Partial Hospitalization See details
Partial hospitalization is covered by Anthem Medicare Advantage (HMO-POS) with a $40 copay and no coinsurance. Prior authorization is required to access these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Anthem Medicare Advantage (HMO-POS), with ground and air ambulance rides requiring a $217.00 copay and no coinsurance. While some transportation services are covered, transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
Anthem Medicare Advantage (HMO-POS) covers emergency services with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed care requires a $35 copay and no coinsurance, while worldwide emergency services are covered up to a $100,000 maximum limit with a $115 copay and no coinsurance.
Primary Care See details
Anthem Medicare Advantage (HMO-POS) covers primary care doctor visits with a $10 copay and specialist visits with a $45 copay, with no coinsurance required for either service. Other covered services include telehealth sessions with no copay, physical and occupational therapies for a $25 copay, and mental health visits for a $40 copay, though routine chiropractic care is not covered.
Preventive Services See details
Anthem Medicare Advantage (HMO-POS) offers partial coverage for preventive services, featuring no copays and no coinsurance for covered benefits like annual physical exams, kidney disease education, and remote access technologies. However, several supplemental services are not covered, including fitness benefits, weight management programs, health education, alternative therapies, and personal emergency response systems.
Hearing Services See details
Anthem Medicare Advantage (HMO-POS) covers hearing exams with a $45 copay and no coinsurance, while routine exams and OTC hearing aids are covered with no copay and no coinsurance. Prescription hearing aids are partially covered with no copay and no coinsurance up to $3,000 annually, though inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision Services are covered by Anthem Medicare Advantage (HMO-POS), offering routine eye exams with no copay and other eye exams with a $0 to $45 copay, both with no coinsurance. Eyewear is partially covered with no copay or coinsurance up to a $300 annual limit, but upgrades are not covered.
Dental Services See details
Anthem Medicare Advantage (HMO-POS) provides partially covered dental services, including Medicare-covered dental care for a $45 copay and no coinsurance, alongside routine exams and cleanings for no copay and no coinsurance. However, restorative, endodontic, periodontic, prosthodontic, implant, oral surgery, and orthodontic services are not covered.
Home Infusion bundled Services See details
Anthem Medicare Advantage (HMO-POS) covers home infusion bundled services under prior authorization, with a $35 copay and no coinsurance for Part B insulin drugs. Chemotherapy, radiation, and other Part B drugs require no copay and carry a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Anthem Medicare Advantage (HMO-POS) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Anthem Medicare Advantage (HMO-POS) covers durable medical equipment and prosthetics with no copay and 0% to 20% coinsurance, both of which require prior authorization. Diabetic supplies and therapeutic shoes or 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. Members pay no copay or coinsurance for lab services, a $0 to $50 copay with no coinsurance for diagnostic tests, a $10 to $175 copay with no coinsurance for diagnostic radiology, a $10 copay with no coinsurance for X-rays, and a 20% coinsurance with no copay for therapeutic radiology.
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
Cardiac Rehabilitation Services are not covered under the Anthem Medicare Advantage (HMO-POS) plan, meaning there is no plan coverage, copay, or coinsurance for cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation sub-services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Anthem Medicare Advantage (HMO-POS), as additional days beyond Medicare-covered SNF are not covered. Covered stays require prior authorization and feature no copay for days 1 to 20, a $218 daily copay for days 21 to 100, and no coinsurance.
Other Services See details
Anthem Medicare Advantage (HMO-POS) partially covers Other Services, offering Over-the-Counter (OTC) items up to $70 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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