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 Santa Clara 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 $2899.00 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 a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have a $4 copay at preferred pharmacies, and standard mail order has no copay. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered drugs. If you qualify for the low-income subsidy, you will pay $0.00 for Part D.
Additional Benefits
The Anthem Medicare Advantage (HMO-POS) plan offers comprehensive coverage with varying costs. Inpatient hospital stays have a copay of $95 for days 1-5, but no copay for days 6-90. Outpatient services have a range of copays, with many services having no copay, and emergency services have a $90 copay. This plan includes no copay for many services, such as primary care, preventive services, hearing exams, vision services, and dental exams. Other benefits include coverage for ambulance services, home health, and skilled nursing facilities, with specific copays and coinsurance amounts. The plan also has coverage for over-the-counter items, with a maximum plan benefit coverage amount of $40 every three months.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you have a $95 copay for days 1-5 and no copay for days 6-90; for Inpatient Hospital Psychiatric, you have a $120 copay for days 1-5 and no copay for days 6-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services are covered, including all outpatient hospital services, with a copay of $0 to $200. Observation services have a $200 copay, and ambulatory surgical center services have no copay. Outpatient substance abuse services have a copay of $25, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered with a $40 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $175 copay for both ground and air ambulance services. Transportation services to a plan-approved health-related location are covered with no copay, offering up to 8 one-way trips per year via rideshare, bus/subway, van, or medical transport; transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are covered under the Anthem Medicare Advantage (HMO-POS) plan. Emergency Services have a $90 copay with no coinsurance, Urgently Needed Services have a $10 copay with no coinsurance, and Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $90 copay with no coinsurance.
Primary Care See details
The Anthem Medicare Advantage (HMO-POS) plan covers primary care physician services, physician specialist services, physical therapy, speech-language pathology services, and additional telehealth benefits with no copay. Chiropractic services have a $20 copay, while individual and group mental health and psychiatric sessions have a $25 copay. Opioid treatment program services have a copay between $25. Podiatry services and other health care professional services are covered with no copay.
Preventive Services See details
Preventive services include an annual physical exam with no copay, additional preventive services with a copay, and services like glaucoma screening, diabetes self-management training, and barium enemas with no copay, as well as other services that are not covered. Personal Emergency Response System (PERS), Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), and fitness benefits are covered with no copay.
Hearing Services See details
The Anthem Medicare Advantage (HMO-POS) plan covers hearing exams, routine hearing exams, and fitting/evaluation for hearing aids with no copay, and prescription hearing aids with a maximum benefit of $3000 per year, and OTC hearing aids with no copay and a maximum benefit of $300 per year. Prescription hearing aids - inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Under the Anthem Medicare Advantage (HMO-POS) plan, vision services include eye exams and eyewear. Eye exams and eyewear have no copay. Eyewear has a combined maximum benefit of $150 per year.
Dental Services See details
The Anthem Medicare Advantage (HMO-POS) plan covers oral exams and prophylaxis (cleaning) with no copay, though each service is limited to one visit per year. Dental X-Rays and Fluoride Treatments are available as optional, supplemental benefits, so you may have to pay more for access to these benefits. Orthodontic services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Anthem Medicare Advantage (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with a coinsurance of 0% to 20%, Prosthetics/Medical Supplies with a 20% coinsurance, and Diabetic Equipment with no copay for Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services and lab services with no copay, and for diagnostic radiological services with no copay, but therapeutic radiological services have a 20% coinsurance. Outpatient X-Ray Services also have no 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, but 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 Anthem Medicare Advantage (HMO-POS), but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $100.
Other Services See details
The Anthem Medicare Advantage (HMO-POS) plan covers acupuncture with no copay, but requires prior authorization and is limited to 24 treatments per year. Over-the-counter items are covered with no copay, and a maximum plan benefit coverage amount of $40 every three months, which carries over if unused, and also includes nicotine replacement therapy and naloxone. Other services like meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others are not covered.
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