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 Southern Virginia Counties. This plan received an overall rating of 3.5 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 a $275.00 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 $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:
Sign up for Anthem Medicare Advantage (HMO-POS)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Anthem Medicare Advantage (HMO-POS) plan has a $275 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs, you will pay a $2 copay at a preferred pharmacy, and $7 at a standard pharmacy. Standard mail-order generic drugs have no copay. Specialty drugs have no copay, and standard mail-order drugs have a 20% coinsurance.
Additional Benefits
The Anthem Medicare Advantage (HMO-POS) plan offers comprehensive coverage with varying cost-sharing. Inpatient hospital stays have a copay, while outpatient services have copays ranging from $0 to $395. Emergency services, primary care, and preventive services are covered, with copays depending on the specific service. Additional benefits include hearing, vision, and dental services, with specific copays and maximum plan benefits. The plan also covers home health services with no copay, and skilled nursing facility stays with a copay after the first 20 days. There is also coverage for diagnostic services, medical equipment, and home infusion with varying cost-sharing.
Inpatient Hospital See details
Inpatient Hospital benefits include Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, both of which require prior authorization. For Inpatient Hospital-Acute, you will pay a $395 copay for days 1-6, and no copay for days 7-90. For Inpatient Hospital Psychiatric, you will pay a $395 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
The Anthem Medicare Advantage (HMO-POS) plan covers outpatient services including all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $395, while observation services have a $395 copay; ASC services and outpatient blood services have no copay, and both individual and group outpatient substance abuse sessions have a $40 copay.
Partial Hospitalization See details
Partial Hospitalization is covered with a $40 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $295 copay for both ground and air ambulance services and no coinsurance. Transportation to a plan-approved health-related location is covered with no copay and no coinsurance, up to 60 one-way trips per year. Transportation to any other health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $125 copay, while Urgently Needed Services have a $25 copay; there is no coinsurance for any of these services.
Primary Care See details
The Anthem Medicare Advantage (HMO-POS) plan covers primary care physician services with no copay, chiropractic services with a $20 copay (prior authorization required), occupational therapy with a $40 copay (prior authorization required), and physician specialist services with a $30 copay (prior authorization required). Mental health specialty services, and psychiatric services, have a $40 copay for individual and group sessions (prior authorization required). Physical therapy and speech-language pathology services have a $40 copay (prior authorization required). Additional telehealth benefits and opioid treatment program services are covered with a $40 copay (prior authorization required). Podiatry services are not covered.
Preventive Services See details
Preventive services include no copay for annual physical exams, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. Additional preventive services, kidney disease education services, and other preventive services have a copay, and some services are not covered, including health education, in-home safety assessments, and several other services.
Hearing Services See details
Hearing exams are covered with a $30 copay, routine hearing exams have no copay, and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered with a maximum plan benefit of $3,000, while OTC hearing aids are covered with no copay and a maximum plan benefit of $300. Prescription hearing aids - inner ear, prescription hearing aids - outer ear, and prescription hearing aids - over the ear are not covered.
Vision Services See details
The Anthem Medicare Advantage (HMO-POS) plan covers vision services, including eye exams with a copay between $0 and $30, and eyewear with no copay. Routine eye exams are covered with no copay, and eyewear benefits include contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames.
Dental Services See details
Dental services are covered, with a maximum plan benefit of $2,000 per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are covered with no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but prior authorization is required. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have between 0% and 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Anthem Medicare Advantage (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, though Durable Medical Equipment for use outside the home is not covered, and Prosthetic Devices and Medical Supplies, both with a 20% coinsurance. Diabetic Equipment is covered, with no copay for Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have a copay between $0 and $100, and Lab Services have no copay. Diagnostic Radiological Services have a copay between $45 and $395, Therapeutic Radiological Services have 20% coinsurance, and Outpatient X-Ray Services have a $45 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, but additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Anthem Medicare Advantage (HMO-POS), but there is no information about the cost sharing for this benefit. All of the sub-services under Cardiac Rehabilitation Services are not covered.
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, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services with the Anthem Medicare Advantage (HMO-POS) plan covers Over-the-Counter (OTC) Items with no copay, and other services such as Acupuncture, Meal Benefit, Dual Eligible SNPs with Highly Integrated Services, 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.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved