A non-government entity
Anthem Extra Help (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem Extra Help (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Anthem Extra Help (HMO-POS) in 2026, please refer to our full plan details page.
Anthem Extra Help (HMO-POS) is a HMO-POS plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Indiana. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Anthem Extra Help (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 Extra Help (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 Extra Help (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $22.80. 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 $390.00 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:
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Drug Coverage
The Anthem Extra Help (HMO-POS) plan features an annual drug deductible of $390 before coverage fully begins. Under this plan, you will pay no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs filled at a standard pharmacy or through standard mail order. This cost-saving benefit applies to one-month, two-month, and three-month supplies of these medications. For Tier 2 generic, Tier 3 preferred brand, and Tier 4 non-preferred drugs, you will pay a 25% coinsurance for standard pharmacy or standard mail-order services. Specialty drugs categorized under Tier 5 carry a 28% coinsurance for a one-month supply. This clear cost-sharing structure helps you easily plan your healthcare budget with the Anthem Extra Help (HMO-POS) plan.
Additional Benefits
The Anthem Extra Help (HMO-POS) plan offers robust medical coverage featuring no copay for primary care visits, home health services, and routine annual preventive care. For hospital stays, members pay a $290 daily copay for the first six days of inpatient care, with no copay required for day seven and beyond. Emergency room visits carry a $130 copay, while specialist consultations and physical therapy require a $25 copay, all with no coinsurance. Routine dental, vision, and hearing services are highly accessible, featuring no copays for preventive dental care, annual eye exams, and routine hearing tests. Comprehensive dental services are covered up to a $3,000 annual limit with a 25% coinsurance, and prescription hearing aids are covered up to $2,000 annually with no copay. Additionally, the plan covers diabetic supplies and home infusion services with no copay, while durable medical equipment requires no copay and a 0% to 20% coinsurance.
Inpatient Hospital See details
Inpatient hospital services under Anthem Extra Help (HMO-POS) are partially covered with no coinsurance, featuring a $290 copay per day for days 1 through 6 and no copay for days 7 and beyond for both acute and psychiatric stays. While unlimited additional days are covered with no copay, upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Anthem Extra Help (HMO-POS) covers outpatient services with no coinsurance, featuring a $0 to $290 copay for outpatient hospital services and a $290 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are available with no copay or coinsurance, while outpatient substance abuse individual and group sessions require a $25 copay.
Partial Hospitalization See details
Anthem Extra Help (HMO-POS) covers partial hospitalization services with a $40.00 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
Anthem Extra Help (HMO-POS) covers ground and air ambulance services with a $250 copay and no coinsurance, though prior authorization is required. Transportation services to plan-approved or other health-related locations are not covered.
Emergency Services See details
Anthem Extra Help (HMO-POS) covers emergency services with a $130 copay and no coinsurance, and urgently needed services with a $35 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with a $130 copay and no coinsurance, up to a maximum plan benefit of $100,000.
Primary Care See details
Anthem Extra Help (HMO-POS) covers primary care and telehealth services with no copay and no coinsurance, while specialist visits, physical therapy, and mental health services require a $25 copay and no coinsurance. Other services like podiatry and occupational therapy have copays ranging from $0 to $25 with no coinsurance, though chiropractic services are not covered.
Preventive Services See details
Preventive services are covered by Anthem Extra Help (HMO-POS) with no copay and no coinsurance for annual physical exams, kidney disease education, and remote access technologies. This benefit is partially covered, as fitness benefits, health education, personal emergency response systems, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, caregiver support, telemonitoring, home safety modifications, wigs, and counseling are not covered.
Hearing Services See details
Hearing services covered by Anthem Extra Help (HMO-POS) require no coinsurance, featuring a $25 copay for Medicare-covered exams and no copay for routine annual exams, fittings, and hearing aids. Prescription hearing aids are partially covered up to $2,000 annually, though inner ear, outer ear, and over the ear types are not covered, while over-the-counter hearing aids are covered up to $300 annually with prior authorization required.
Vision Services See details
Anthem Extra Help (HMO-POS) offers partially covered vision services with no coinsurance, featuring no copay for one routine eye exam per year and selected eyewear up to a $200 annual limit. Other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Dental services are partially covered by Anthem Extra Help (HMO-POS) up to a $3,000 annual limit, excluding maxillofacial prosthetics, implant services, and orthodontics. Preventive care is provided with no copay and no coinsurance, while covered comprehensive dental services require no copay and a 25% coinsurance.
Home Infusion bundled Services See details
Anthem Extra Help (HMO-POS) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Anthem Extra Help (HMO-POS) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
Anthem Extra Help (HMO-POS) covers durable medical equipment with no copay and 0% to 20% coinsurance, and prosthetics and medical supplies with no copay and 20% coinsurance. Diabetic equipment and supplies are also covered under the plan with no copay and no coinsurance, though manufacturer limitations and prior authorizations may apply.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under Anthem Extra Help (HMO-POS) with prior authorization, offering lab services at no copay and diagnostic procedures for a $0 to $50 copay with no coinsurance. Diagnostic radiological services require a copay starting at $30, outpatient X-rays have a $25 copay plus coinsurance, and therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Home health services are covered by Anthem Extra Help (HMO-POS) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are not covered under the Anthem Extra Help (HMO-POS) plan, which includes no coverage for intensive cardiac, pulmonary, or supervised exercise therapy (SET) rehabilitation.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is partially covered by Anthem Extra Help (HMO-POS) 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 100-day Medicare-covered limit are not covered.
Other Services See details
Anthem Extra Help (HMO-POS) partially covers other services, offering a chronic illness meal benefit and Medicare Community Resource Support with no copay and no coinsurance. Acupuncture and over-the-counter (OTC) items are not covered under this benefit.
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