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 Joaquin 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 $3450.00 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, you will have no copay for Tier 1 preferred generic drugs at preferred pharmacies or standard mail, and no copay for Tier 5 specialty drugs. Other tiers require coinsurance, which ranges from 20% for standard generics to 33% for non-preferred drugs. You will transition to the catastrophic coverage phase once your yearly out-of-pocket drug costs reach $2,100.00. After reaching this limit, you pay nothing for your covered Medicare Part D prescription drugs. Furthermore, individuals who qualify for Extra Help can reduce their Part D premium to $0.00.
Additional Benefits
The Anthem Medicare Advantage (HMO-POS) plan offers comprehensive medical coverage with many services featuring no copayments or coinsurance. Members enjoy no copays for primary care, specialist, and telehealth visits, as well as routine dental, vision, and preventive services. For hospital stays, there is a $150 daily copay for the first five days and no copay thereafter, while emergency room visits carry a $150 copay that is waived if admitted. Outpatient diagnostic services, laboratory tests, and home health care are fully covered with no copay or coinsurance. Prescription Part B insulin requires a flat $35 copay, while dialysis and durable medical equipment may require up to a 20% coinsurance. Additional plan benefits include up to 20 one-way transportation trips with no copay, a $42 quarterly over-the-counter allowance, and acupuncture with no copay.
Inpatient Hospital See details
Anthem Medicare Advantage (HMO-POS) partially covers inpatient hospital acute and psychiatric services, requiring prior authorization and no coinsurance. Covered stays require a $150 daily copay for days 1 through 5 and no copay for days 6 through 90 (including unlimited additional days), while upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by Anthem Medicare Advantage (HMO-POS) with no coinsurance, featuring no copay for ambulatory surgical center and blood services. Other covered benefits require copays, ranging from $5 per session for outpatient substance abuse services to $100 for observation services, and up to $100 for outpatient hospital services.
Partial Hospitalization See details
Partial hospitalization benefits are covered by Anthem Medicare Advantage (HMO-POS) with no 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), as transportation to any health-related location is not covered. Ground and air ambulance services require a $250 copay and no coinsurance, while up to 20 one-way trips to plan-approved health-related locations are offered with no copay and no coinsurance.
Emergency Services See details
Emergency services are covered by Anthem Medicare Advantage (HMO-POS) with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services carry a $10 copay and no coinsurance, while worldwide emergency services are covered up to a $100,000 maximum with a $150 copay and no coinsurance.
Primary Care See details
Primary Care benefits are partially covered by Anthem Medicare Advantage (HMO-POS) with no coinsurance, offering no copay for primary care provider, specialist, telehealth, and physical therapy visits. Mental health, psychiatric, and opioid treatment services require a $5 copay, while podiatry services and routine chiropractic care are not covered.
Preventive Services See details
Preventive services are partially covered by Anthem Medicare Advantage (HMO-POS) with no copay and no coinsurance for covered care, such as annual physical exams and kidney disease education. Sub-services that are not covered include health education, fitness benefits, weight management, alternative therapies, therapeutic massage, adult day health, medical nutrition therapy, nutritional/dietary benefits, palliative care, caregiver and in-home support, smoking cessation, disease management, telemonitoring, counseling, safety assessments, medication reconciliation, readmission prevention, chemotherapy wigs, and bathroom safety devices.
Hearing Services See details
Hearing services are partially covered under Anthem Medicare Advantage (HMO-POS), which offers diagnostic hearing exams with no copay and no coinsurance, requiring a doctor referral and prior authorization. However, routine hearing exams, fitting evaluations, prescription hearing aids, and OTC hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Anthem Medicare Advantage (HMO-POS), offering routine eye exams and eyewear with no copay or coinsurance. While contact lenses, eyeglasses, lenses, and frames are covered up to a $100 annual limit, eyewear upgrades are not covered.
Dental Services See details
Dental services are partially covered by Anthem Medicare Advantage (HMO-POS), with covered services like Medicare dental, annual exams, and cleanings requiring no copay and no coinsurance. While dental x-rays and fluoride are available as optional supplemental benefits, orthodontic, restorative, endodontic, periodontic, prosthodontic, implant, maxillofacial prosthetic, oral surgery, and adjunctive general services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under Anthem Medicare Advantage (HMO-POS) and require prior authorization. Medicare Part B insulin drugs require a $35 copay with no coinsurance, while chemotherapy and other Part B drugs feature 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, including durable medical equipment (DME) with a 0% to 20% coinsurance and no copay. Prosthetic devices and medical supplies are covered with a 20% coinsurance and no copay, while diabetic supplies and therapeutic shoes or inserts are covered with no copay.
Diagnostic and Radiological Services See details
Anthem Medicare Advantage (HMO-POS) covers diagnostic and radiological services, which require prior authorization and a doctor referral. There is no copay or coinsurance for lab services, diagnostic procedures, outpatient X-rays, and diagnostic radiological services, though therapeutic radiological services require a 20% coinsurance.
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 this benefit.
Cardiac Rehabilitation Services See details
Anthem Medicare Advantage (HMO-POS) indicates that some services are covered, but Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Since these sub-services are not covered under the plan, there are no copays or coinsurance costs for them.
Skilled Nursing Facility (SNF) See details
Anthem Medicare Advantage (HMO-POS) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Anthem Medicare Advantage (HMO-POS) covers other services with no copays and no coinsurance, including acupuncture up to 24 treatments per year, a $42 quarterly over-the-counter benefit, chronic illness meals, and community resource support. Dual Eligible SNPs with Highly Integrated Services are not covered.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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