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 Southern Virginia Counties. This plan received an overall rating of 3.5 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 a $250.00 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 $8550.00 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)
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Drug Coverage
The Anthem Medicare Advantage (HMO-POS) plan features an annual drug deductible of $250. You can save on prescriptions with no copay for Tier 1 preferred generic and Tier 2 generic drugs at preferred pharmacies and standard mail order. Standard pharmacies charge a copay starting at $5 for these generic tiers, while Tier 6 select care drugs have no copay at any location. For higher-tier medications, Tier 3 preferred brand drugs require a 25% coinsurance payment across all pharmacies. Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 30% coinsurance cost, with specialty medications limited to a one-month supply.
Additional Benefits
The Anthem Medicare Advantage (HMO-POS) plan offers comprehensive medical coverage with no copay and no coinsurance for primary care visits, preventive services, and home health care. Specialist visits, physical therapy, and outpatient mental health services require a $35 copay, while emergency room visits carry a $115 copay with no coinsurance. Inpatient hospital stays require a daily copay of $395 for the first few days, after which there is no copay, and outpatient hospital services range from no copay up to a $395 copay. Routine dental, vision, and hearing services are partially covered with no copay and no coinsurance, including allowance limits for eyewear and hearing aids. For specialized medical needs, diabetic supplies have no copay, while dialysis and durable medical equipment incur a coinsurance of up to 20 percent. Skilled nursing facility stays feature no copay for the first 20 days, followed by a $218 daily copay for days 21 through 100 with no coinsurance.
Inpatient Hospital See details
Anthem Medicare Advantage (HMO-POS) covers inpatient acute and psychiatric hospital stays with no coinsurance, though prior authorization is required. Acute stays require a $395 daily copay for days 1 through 6 (with no copay for days 7 and beyond), while psychiatric stays require a $395 daily copay for days 1 through 5 (with no copay for days 6 and beyond). Upgrades and non-Medicare-covered stays are not covered under this plan.
Outpatient Services See details
Anthem Medicare Advantage (HMO-POS) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and blood services. Outpatient hospital services require a copay between $0 and $395, observation services have a $395 copay per stay, and outpatient substance abuse sessions carry a $35 copay.
Partial Hospitalization See details
Anthem Medicare Advantage (HMO-POS) covers partial hospitalization services with a $40.00 copay and no coinsurance. Prior authorization is required to receive this coverage.
Ambulance and Transportation Services See details
Anthem Medicare Advantage (HMO-POS) covers ground and air ambulance services with a $265 copay and no coinsurance, subject to prior authorization. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Anthem Medicare Advantage (HMO-POS) covers emergency services with a $115 copay and no coinsurance, and urgently needed services with a $25 copay and no coinsurance. Worldwide emergency, urgent care, and emergency transportation are also covered up to a $100,000 maximum benefit limit with a $115 copay and no coinsurance per service.
Primary Care See details
Anthem Medicare Advantage (HMO-POS) provides primary care physician services and telehealth benefits with no copay and no coinsurance. Specialist visits, physical therapy, occupational therapy, and mental health services require a $35 copay and no coinsurance, while podiatry is not covered and some chiropractic services are covered with a $15 copay and no coinsurance, though routine and other chiropractic services are not.
Preventive Services See details
Anthem Medicare Advantage (HMO-POS) covers preventive services, including annual physical exams, kidney disease education, and remote access technologies, with no copay and no coinsurance. Additional preventive services are only partially covered, with exclusions including fitness benefits, weight management programs, health education, and in-home safety assessments.
Hearing Services See details
Anthem Medicare Advantage (HMO-POS) hearing services feature a $35 copay and no coinsurance for Medicare-covered exams, while annual routine exams, fittings, and OTC hearing aids (up to $300 annually) require no copay and no coinsurance. Prescription hearing aids are partially covered up to $3,000 annually with no copay and no coinsurance, though inner ear, outer ear, and over the ear devices are not covered.
Vision Services See details
Vision services are partially covered by Anthem Medicare Advantage (HMO-POS) with no coinsurance, offering one annual routine eye exam and eligible eyewear with no copay up to a $125 yearly limit. Other eye exam services and eyewear upgrades are not covered under this plan.
Dental Services See details
Anthem Medicare Advantage (HMO-POS) dental services are partially covered, offering Medicare-covered dental and select preventive care—including exams, cleanings, x-rays, and fluoride—with no copay and no coinsurance. However, other diagnostic services, restorative care, endodontics, periodontics, prosthodontics, implants, oral surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Anthem Medicare Advantage (HMO-POS) with no copay, though prior authorization and step therapy apply. Covered Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance ranging from 0% 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 with no copays, featuring 0% to 20% coinsurance for durable medical equipment (DME) and 20% coinsurance for prosthetics and medical supplies. Diabetic supplies and therapeutic shoes are covered with no copays and no coinsurance, though manufacturer limitations and prior authorization requirements apply.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Anthem Medicare Advantage (HMO-POS) with prior authorization required. Lab services require no copay or coinsurance, diagnostic tests have a $0 to $100 copay with no coinsurance, and radiological services incur a $45 copay for X-rays, a minimum $45 copay for diagnostic radiology, and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home Health Services are covered under the Anthem Medicare Advantage (HMO-POS) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Anthem Medicare Advantage (HMO-POS) does not cover Cardiac Rehabilitation Services, meaning there is no copay or coinsurance available for these treatments. This exclusion applies to all related services, including intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease.
Skilled Nursing Facility (SNF) See details
Anthem Medicare Advantage (HMO-POS) partially covers skilled nursing facility (SNF) services with no coinsurance, though prior authorization is required and additional days beyond the Medicare-covered limit are not covered. There is no prior three-day hospital stay required, and you will pay no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100.
Other Services See details
Anthem Medicare Advantage (HMO-POS) partially covers other services with no copay and no coinsurance for Medicare Community Resource Support and Over-the-Counter (OTC) items, which include a $35 quarterly limit. However, acupuncture and meal benefits are not covered under this plan.
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