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 Mateo 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 $4900.00 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 features 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 at preferred pharmacies, standard pharmacies, and standard mail. For Tier 2 standard generic drugs, the cost is a $42 copay at preferred pharmacies and standard mail, or a $47 copay at standard pharmacies. For other medication tiers, you will pay a 25% coinsurance for Tier 3 preferred brand drugs and a 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 Medicare Part D covered drugs.
Additional Benefits
The Anthem Medicare Advantage (HMO-POS) plan offers comprehensive medical coverage with predictable cost-sharing, including no copay for primary care visits, preventive services, and home health care. For hospital stays, members pay a $250 daily copay for the first five days of inpatient care and no copay thereafter, while outpatient hospital services range from no copay to a $250 copay. Emergency room visits require a $130 copay, which is waived if admitted, and urgent care is available for a $35 copay. Specialist visits and Medicare-covered dental services are accessible with a copay of $15 to $40, and routine annual dental and eye exams are available with no copay. Diagnostic lab tests and diabetic supplies also feature no copay, though diagnostic imaging and durable medical equipment may require copays up to $150 or coinsurance up to 20 percent. Skilled nursing facility care is covered with no copay for the first 20 days, followed by a $218 daily copay for days 21 through 100.
Inpatient Hospital See details
Inpatient Hospital benefits are partially covered by Anthem Medicare Advantage (HMO-POS), requiring a $250 daily copay for days 1 through 5, no copay for days 6 and beyond, and no coinsurance for acute and psychiatric stays. Prior authorization is required, 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. Copays range from $0 to $250 for outpatient hospital services, while patients pay a $250 copay per stay for observation services, a $40 copay for outpatient substance abuse sessions, and no copay for ambulatory surgical center or blood services.
Partial Hospitalization See details
Anthem Medicare Advantage (HMO-POS) covers partial hospitalization services with a $40 copay and no coinsurance. Prior authorization is required to access these benefits.
Ambulance and Transportation Services See details
Anthem Medicare Advantage (HMO-POS) partially covers ambulance and transportation services, offering ground and air ambulance coverage with a $275 copay and no coinsurance. Prior authorization is required for ambulance services, and transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
Anthem Medicare Advantage (HMO-POS) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $35 copay and no coinsurance, while worldwide emergency care and transportation are covered up to a $100,000 limit with a $130 copay and no coinsurance.
Primary Care See details
Primary care benefits are offered by Anthem Medicare Advantage (HMO-POS) with no copay and no coinsurance for primary care provider visits and telehealth services. Other services, including specialist visits, physical therapy, and mental health care, are covered with copays ranging from $15 to $40 and no coinsurance, though routine chiropractic care is not covered.
Preventive Services See details
Preventive services are partially covered by Anthem Medicare Advantage (HMO-POS), featuring no copays and no coinsurance for covered services like annual exams, kidney disease education, and remote access technologies. However, multiple supplemental services are not covered, including fitness benefits, weight management, alternative therapies, therapeutic massage, PERS, in-home safety assessments, adult day health, and counseling.
Hearing Services See details
Anthem Medicare Advantage (HMO-POS) covers some hearing services with a $25 copay and no coinsurance, although a doctor referral and prior authorization are required. Routine hearing exams, hearing aid fittings and evaluations, prescription hearing aids, and over-the-counter hearing aids are not covered under this plan.
Vision Services See details
Vision services are partially covered by Anthem Medicare Advantage (HMO-POS), which offers eye exams with a $0 to $25 copay and no coinsurance, including one routine exam annually with no copay. For eyewear, some services are covered but contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Anthem Medicare Advantage (HMO-POS) partially covers dental services, offering Medicare-covered dental services for a $25 copay and no coinsurance, plus annual oral exams and cleanings with no copay or coinsurance. However, several treatments are not covered, including restorative, endodontic, periodontic, prosthodontic, oral surgery, implant, and orthodontic services.
Home Infusion bundled Services See details
Anthem Medicare Advantage (HMO-POS) covers home infusion bundled services subject to prior authorization. Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and 0% to 20% coinsurance.
Dialysis Services See details
Anthem Medicare Advantage (HMO-POS) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Anthem Medicare Advantage (HMO-POS), offering durable medical equipment (DME) with 0% to 20% coinsurance and prosthetics or medical supplies with 20% coinsurance. Diabetic supplies and therapeutic shoes or inserts are covered with no copay, though prior authorization is required for DME and prosthetics.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Anthem Medicare Advantage (HMO-POS), requiring doctor referrals and prior authorization. Members pay no coinsurance for lab services (no copay), diagnostic tests (no copay to $50 copay), outpatient X-rays ($10 copay), and diagnostic radiological services ($10 to $150 copay), while therapeutic radiological services require a 20% coinsurance and 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
Anthem Medicare Advantage (HMO-POS) offers Cardiac Rehabilitation Services where some services are covered, but cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered. Since none of these services are covered in practice, there are no copays or coinsurance costs associated with this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Anthem Medicare Advantage (HMO-POS), with prior authorization required. There is no copay and no coinsurance for days 1 to 20, and a $218 daily copay with no coinsurance for days 21 to 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Anthem Medicare Advantage (HMO-POS) partially covers Other Services, offering Medicare Community Resource Support with no copay and no coinsurance, though a doctor referral is required. Sub-services including acupuncture, over-the-counter items, meal benefits, and Dual Eligible SNPs are not covered under this plan.
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