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 San Diego 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 $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 has an enhanced alternative drug benefit. There is no deductible for prescription drugs. During the initial coverage phase, you will pay no copay for preferred generic drugs at preferred and standard pharmacies, as well as standard mail order. You will also pay no copay for drugs in the specialty tier. For other tiers, you will pay coinsurance between 20% and 35% depending on the drug and pharmacy.
Additional Benefits
The Anthem Medicare Advantage (HMO-POS) plan offers comprehensive coverage with varying costs. Inpatient hospital stays have a $295 copay for days 1-7, and no copay for days 8-90, while outpatient services have copays ranging from $0 to $325. Many services have no copay, including preventive services, routine eye exams, eyewear, dental services, and home health services. The plan includes coverage for emergency services with a $90 copay, and primary care physician visits have a $10 copay. Hearing aids are covered up to $3000 per year with no copay. The plan also provides coverage for prescription drugs, durable medical equipment, and other services, with costs varying based on the specific service.
Inpatient Hospital See details
Inpatient hospital services, including acute and psychiatric, are covered by the Anthem Medicare Advantage (HMO-POS) plan. For days 1-7, there is a $295 copay, and for days 8-90, there is no copay. Non-Medicare-covered stays and upgrades for inpatient hospital acute and psychiatric are not covered.
Outpatient Services See details
Outpatient services are covered by Anthem Medicare Advantage (HMO-POS), including outpatient hospital services with a copay between $0 and $325, observation services with a $325 copay, ambulatory surgical center services with no copay, individual and group outpatient substance abuse sessions with a $20 copay, and outpatient blood services with no copay. Prior authorization and a doctor referral may be required for some services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Anthem Medicare Advantage (HMO-POS) plan, but requires prior authorization. You will pay a $20 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground ambulance services have a $250 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 under the Anthem Medicare Advantage (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage have a $90 copay, Urgently Needed Services have a $30 copay, and Worldwide Urgent Coverage and Worldwide Emergency Transportation also have a $90 copay.
Primary Care See details
The Anthem Medicare Advantage (HMO-POS) plan covers primary care physician services with a $10 copay, chiropractic services with a $20 copay, occupational therapy services with a $35 copay, physician specialist services with a $35 copay, mental health specialty services with a $20 copay for individual and group sessions, podiatry services with a copay that ranges from $0-$35, other health care professional services with a copay that ranges from $10-$20, psychiatric services with a $20 copay for individual and group sessions, physical therapy and speech-language pathology services with a $35 copay, additional telehealth benefits with no copay, and opioid treatment program services with a $20 copay. Routine chiropractic care is not covered.
Preventive Services See details
The Anthem Medicare Advantage (HMO-POS) plan covers preventive services, including an annual physical exam with no copay, and also covers additional preventive services, such as fitness benefits and remote access technologies. The plan does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, or counseling services.
Hearing Services See details
Hearing services include hearing exams with a $35 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to $3000 per year with no copay, and OTC hearing aids are covered with no copay up to $300 per year. Prescription hearing aids for the inner and outer ear are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a copay of $0-$35, and routine eye exams are covered with no copay. Eyewear, including contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames, are covered with no copay, but upgrades are not covered, and there is a combined maximum benefit of $100 per year.
Dental Services See details
Dental Services are covered, including Medicare Dental Services with a $35 copay. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatments, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, and orthodontics are covered with no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. For Medicare Part B Insulin Drugs, the copay is $35.00. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Anthem Medicare Advantage (HMO-POS) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment is covered, with Durable Medical Equipment (DME) subject to a coinsurance between 0% and 20%, and requires authorization. Prosthetics/Medical Supplies have a coinsurance of 20%, while Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services are covered. Diagnostic procedures/tests have at most 20% coinsurance, and lab services have no copay. Diagnostic radiological services have a copay of $10-$120, therapeutic radiological services have at most 20% coinsurance, and outpatient X-ray services have a $10 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, including Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Anthem Medicare Advantage (HMO-POS) plan, but require prior authorization. For days 1-20, there is no copay, but for days 21-100, the copay is $140. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include Over-the-Counter (OTC) Items and "Other 1" services, both with no copay. Acupuncture, meal benefits, Dual Eligible SNPs, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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