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 San Diego 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 $3400.00 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 no prescription drug deductible. During the initial coverage phase, members enjoy no copay for Tier 1 preferred generic drugs and Tier 5 specialty tier drugs at preferred and standard pharmacies, as well as through standard mail. For other tiers, costs range from a $42 copay for Tier 2 standard generics at preferred pharmacies to 33% coinsurance for Tier 4 non-preferred drugs. Once your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase and pay nothing for covered Medicare Part D prescriptions. Additionally, individuals who qualify for the low-income subsidy can see their Part D premium reduced to $0. Please review the plan's formulary to verify if your specific prescription medications are covered.
Additional Benefits
The Anthem Medicare Advantage (HMO-POS) plan offers robust medical coverage with affordable out-of-pocket costs, featuring a $10 copay for primary care visits, a $35 copay for specialists, and no copay for telehealth services. For hospital care, inpatient stays require a $295 daily copay for the first seven days and no copay thereafter, while outpatient services range from no copay up to a $325 copay. Emergency care is also available with a $150 copay, which is waived if you are admitted to the hospital within 24 hours. Routine dental, vision, and hearing services are highly accessible, offering annual exams and preventive care with no copay or coinsurance. The plan also includes coverage for diabetic supplies and home health services with no copay, though there is a 20% coinsurance for dialysis and certain medical equipment. Notably, this plan does not cover cardiac rehabilitation services or routine health-related transportation.
Inpatient Hospital See details
Anthem Medicare Advantage (HMO-POS) covers inpatient acute and psychiatric hospital stays with a daily copay of $295 for days 1 through 7, no copay for days 8 through 90, and no coinsurance. This benefit is partially covered, as prior authorization is required, and upgrades as well as non-Medicare-covered stays are not covered.
Outpatient Services See details
Anthem Medicare Advantage (HMO-POS) covers outpatient services with no coinsurance and copays ranging from no copay for ambulatory surgical and blood services up to $325 for observation and hospital outpatient services. Outpatient substance abuse services are also covered with a $20 copay.
Partial Hospitalization See details
Anthem Medicare Advantage (HMO-POS) covers partial hospitalization services with a $20.00 copay and no coinsurance. Prior authorization is required to access these covered benefits.
Ambulance and Transportation Services See details
Anthem Medicare Advantage (HMO-POS) partially covers ambulance and transportation services, offering ground and air ambulance services with a $297.00 copay, no coinsurance, and prior authorization requirements. For transportation benefits, some services are covered, but transportation to plan-approved health-related locations and any health-related locations are not covered.
Emergency Services See details
Anthem Medicare Advantage (HMO-POS) covers emergency services with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $30 copay and no coinsurance, while worldwide emergency services, urgent care, and emergency transportation 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 physician visits for a $10 copay and specialists for a $35 copay, with no coinsurance. Chiropractic services are partially covered with a $20 copay and no coinsurance, as routine chiropractic care is not covered, while telehealth services are offered with no copay and no coinsurance.
Preventive Services See details
Preventive services are partially covered by Anthem Medicare Advantage (HMO-POS) with no copay and no coinsurance for covered services, which include annual physical exams, kidney disease education, and remote access technologies. The plan does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, fitness benefits, disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Anthem Medicare Advantage (HMO-POS) covers hearing exams with a $35 copay and no coinsurance for Medicare-covered visits, and no copay or coinsurance for annual routine exams and fittings. Prescription hearing aids are partially covered with no copay or coinsurance up to a $3,000 annual limit, though inner ear, outer ear, and over-the-ear types are not covered. Over-the-counter hearing aids are also covered up to $300 annually with no copay or coinsurance.
Vision Services See details
Anthem Medicare Advantage (HMO-POS) partially covers vision services with no coinsurance, though eyewear upgrades are not covered. Routine eye exams and covered eyewear have no copay, while other eye exams carry a copay of $0 to $35, with eyewear coverage limited to a $100 annual maximum.
Dental Services See details
Dental services are partially covered by Anthem Medicare Advantage (HMO-POS) up to a $1,000 annual limit, featuring no copay and no coinsurance for preventive care like cleanings and exams. Medicare-covered dental has a $35 copay and no coinsurance, while covered comprehensive services require a 25% coinsurance and no copay; however, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Anthem Medicare Advantage (HMO-POS) covers home infusion bundled services with prior authorization, requiring a $35 copay and no coinsurance for Medicare Part B insulin. Other covered Part B drugs, including chemotherapy and radiation treatments, carry up to 20% coinsurance and no copay.
Dialysis Services See details
Anthem Medicare Advantage (HMO-POS) covers dialysis services with a 20% coinsurance and no copay.
Medical Equipment See details
Anthem Medicare Advantage (HMO-POS) covers medical equipment, including durable medical equipment with no copay and 0% to 20% coinsurance, and prosthetics and medical supplies with no copay and 20% coinsurance. 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 doctor referrals for care. Lab services have no copay, outpatient X-rays require a $10 copay, diagnostic radiological services carry a $10 to $120 copay, and diagnostic procedures and therapeutic radiological services require a 20% coinsurance with no copay.
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, as all key sub-services—including cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation—are not covered.
Skilled Nursing Facility (SNF) See details
Anthem Medicare Advantage (HMO-POS) partially covers Skilled Nursing Facility (SNF) services, requiring prior authorization with no coinsurance. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, but additional days beyond those covered by Medicare are not covered.
Other Services See details
Anthem Medicare Advantage (HMO-POS) partially covers other services, offering over-the-counter (OTC) items and Medicare Community Resource Support with no copay or coinsurance. Acupuncture, meal benefits, and dual-eligible SNP services are not covered by this plan.
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