A non-government entity
Anthem Select (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem Select (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Anthem Select (HMO-POS) in 2026, please refer to our full plan details page.
Anthem Select (HMO-POS) is a HMO-POS plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in San Francisco County. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Anthem Select (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 Select (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 Select (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 $160.00 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:
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Drug Coverage
The Anthem Select (HMO-POS) Medicare plan features an Enhanced Alternative drug benefit with a $160.00 prescription drug deductible. Under this plan, you will enjoy no copay for Tier 1 preferred generic drugs at preferred pharmacies or through standard mail, while standard pharmacies charge a $10.00 copay. Other drug tiers require coinsurance, which ranges from 25% for standard generics to 31% for non-preferred drugs during the initial coverage phase. After your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for covered Part D prescription drugs. If you qualify for the low-income subsidy, also known as Extra Help, your drug costs under this plan are reduced to zero.
Additional Benefits
The Anthem Select (HMO-POS) plan offers comprehensive medical coverage with predictable out-of-pocket costs, featuring no coinsurance for many key services. Members benefit from low copays for routine care, including a $5 copay for primary care visits, a $20 copay for specialists, and no copay for annual physicals and routine eye exams. For urgent and emergency needs, there is a $35 copay for urgent care and a $115 copay for emergency room visits, which is waived if you are admitted. Inpatient hospital stays require a daily copay of $360 for the first four days and no copay thereafter, while home health services and laboratory tests are available with no copay or coinsurance. While the plan covers essential services like dialysis with a 20% coinsurance and home infusion, certain benefits such as routine hearing aids, eyewear, and cardiac rehabilitation are not covered. This plan balances robust coverage for major medical needs with affordable copayments for everyday healthcare.
Inpatient Hospital See details
Anthem Select (HMO-POS) partially covers inpatient hospital services with no coinsurance, requiring a daily copay of $360 for days 1 to 4 of acute care and $330 for days 1 to 4 of psychiatric care, with no copay for days 5 and beyond. Non-Medicare-covered stays and acute care upgrades are not covered.
Outpatient Services See details
Anthem Select (HMO-POS) covers outpatient services with no coinsurance, though copays vary by service. Patients will pay a $350 copay per stay for observation services, a $40 copay for outpatient substance abuse sessions, between $0 and $350 for outpatient hospital services, and no copay for ambulatory surgical center or outpatient blood services.
Partial Hospitalization See details
Anthem Select (HMO-POS) covers partial hospitalization benefits with a $40 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Anthem Select (HMO-POS) covers ground and air ambulance services with a $325 copay and no coinsurance, though prior authorization is required. Transportation services are partially covered, offering up to 6 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Anthem Select (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 services are covered with a $35 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $115 copay and no coinsurance up to a $100,000 maximum benefit.
Primary Care See details
Anthem Select (HMO-POS) covers primary care visits for a $5 copay and specialist visits for a $20 copay, both with no coinsurance. Additional services like telehealth, mental health, and physical therapy have copays ranging from no copay up to $40 with no coinsurance, though chiropractic services are only partially covered since routine chiropractic care is not covered.
Preventive Services See details
Anthem Select (HMO-POS) partially covers preventive services with no copay or coinsurance for covered benefits, such as annual physicals, remote access technologies, and kidney disease education. Uncovered sub-services include fitness benefits, weight management, health education, in-home safety assessments, personal emergency response systems, alternative therapies, therapeutic massage, adult day health, nutritional/dietary services, palliative care, caregiver support, and tobacco cessation counseling.
Hearing Services See details
Hearing services are partially covered by Anthem Select (HMO-POS), with covered hearing exams requiring a $20 copay, no coinsurance, and no deductible. However, routine hearing exams, fitting and evaluations, prescription hearing aids, and OTC hearing aids are not covered.
Vision Services See details
Anthem Select (HMO-POS) covers annual routine eye exams with no copay and no coinsurance, while other eye exams may have a copay of up to $20 and no coinsurance. Eyewear is not covered under this plan, which includes no coverage for contact lenses, eyeglasses, lenses, frames, or upgrades.
Dental Services See details
Anthem Select (HMO-POS) partially covers dental services, offering Medicare-covered dental care for a $20 copay and no coinsurance, as well as one annual oral exam and cleaning with no copay or coinsurance. While dental x-rays and fluoride are offered as optional supplemental benefits, other services like restorative, endodontics, periodontics, and orthodontics are not covered.
Home Infusion bundled Services See details
Anthem Select (HMO-POS) covers home infusion bundled services, which require prior authorization and feature a $35 copay and no coinsurance for Medicare Part B insulin drugs. Chemotherapy, radiation, and other covered Medicare Part B drugs under this benefit have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis services are covered under the Anthem Select (HMO-POS) plan with a 20% coinsurance and no copay.
Medical Equipment See details
Anthem Select (HMO-POS) covers durable medical equipment with no copay and coinsurance ranging from no coinsurance to 20%. Prosthetic devices and medical supplies require a 20% coinsurance and no copay, while diabetic supplies and therapeutic shoes are covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Anthem Select (HMO-POS), requiring prior authorization and doctor referrals. Members pay no copay or coinsurance for lab and outpatient X-ray services, a $0 to $120 copay with no coinsurance for diagnostic tests, a $0 to $165 copay with no coinsurance for diagnostic radiological services, and a 20% coinsurance for therapeutic radiological services.
Home Health Services See details
Anthem Select (HMO-POS) covers Home Health Services with no copay and no coinsurance. A doctor referral and prior authorization are required to receive these covered services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under Anthem Select (HMO-POS) because none of the sub-services, including Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD Services, are covered. Since these services are not covered by the plan, there are no copays or coinsurance costs associated with them.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Anthem Select (HMO-POS) with no copay for days 1 to 20, a $218 daily copay for days 21 to 100, and no coinsurance. Prior authorization is required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services under Anthem Select (HMO-POS) are partially covered, offering acupuncture and Medicare Community Resource Support with no copay and no coinsurance. Over-the-counter (OTC) items, meal benefits, and dual-eligible SNP services are not covered under this benefit.
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