A non-government entity
Anthem Medicare Advantage 2 (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem Medicare Advantage 2 (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 2 (HMO-POS) in 2025, please refer to our full plan details page.
Anthem Medicare Advantage 2 (HMO-POS) is a HMO-POS plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Select Counties in Virginia. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Anthem Medicare Advantage 2 (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 2 (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 2 (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 $320.00 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 $6700.00 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 2 (HMO-POS) plan has a $320.00 deductible for prescription drugs. After the deductible, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For example, a preferred generic drug has a $1 copay at a preferred pharmacy, or $6 at a standard pharmacy, while a specialty tier drug has no copay. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs. If you qualify for the low-income subsidy, you will pay $0.00.
Additional Benefits
The Anthem Medicare Advantage 2 (HMO-POS) plan offers a wide range of benefits with varying cost-sharing structures. Inpatient hospital stays have a copay, but many outpatient services have no copay, including primary care visits, preventive services, routine vision exams, and many dental services. The plan covers emergency services, ambulance services, and transportation to health-related locations. Additional benefits include coverage for hearing aids, eyewear, and a yearly allowance for dental services. The plan also includes coverage for home health services and skilled nursing facilities. Other services like home infusion, dialysis, and medical equipment have a coinsurance or copay.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For the first 5 days, you'll pay a $395 copay, and days 6-90 have no copay. Additional days for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services, are covered by the Anthem Medicare Advantage 2 (HMO-POS) plan. Outpatient Hospital Services have a copay between $0 and $395, Observation Services have a $395 copay, Ambulatory Surgical Center (ASC) Services have no copay, and both Individual and Group Sessions for Outpatient Substance Abuse have a $40 copay. Outpatient Blood Services have no copay.
Partial Hospitalization See details
Anthem Medicare Advantage 2 (HMO-POS) covers partial hospitalization with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Anthem Medicare Advantage 2 (HMO-POS). Ground ambulance services have a $325 copay, while air ambulance services have a 20% coinsurance. Transportation Services to plan-approved health-related locations are covered with no copay for up to 72 one-way trips per year. 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 by Anthem Medicare Advantage 2 (HMO-POS). Emergency Services has a $125 copay, and Urgently Needed Services has a $50 copay; all other services have a $125 copay.
Primary Care See details
Primary Care Physician Services have no copay, while Chiropractic Services have a $20 copay, with routine care not covered. Occupational Therapy Services have a $40 copay and no coinsurance. Physician Specialist Services have a $35 copay. Mental Health Specialty Services, including individual and group sessions, have a $40 copay. Podiatry Services have a $0-$35 copay for covered services, with routine foot care covered. Other Health Care Professional visits have a $0-$20 copay. Psychiatric Services have a $40 copay for individual and group sessions. Physical Therapy and Speech-Language Pathology Services have a $40 copay and no coinsurance. Additional Telehealth Benefits have no copay. Opioid Treatment Program Services have a $40 copay.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, and additional preventive services, kidney disease education services, and other preventive services with no copay for services like glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. Health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, and telemonitoring services are not covered. This plan also covers a fitness benefit and home and bathroom safety devices and modifications.
Hearing Services See details
The Anthem Medicare Advantage 2 (HMO-POS) plan covers hearing exams with a $35 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to a $2,000 benefit, and OTC hearing aids are covered with no copay up to a $300 annual benefit.
Vision Services See details
Vision services are covered, including eye exams and eyewear. Routine eye exams have no copay, while other eye exams have a copay between $0 and $35. Eyewear has no copay, with a combined maximum benefit of $125 per year for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
Dental Services are covered, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services with no copay. Additional services like 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. Other Dental Services has a maximum benefit of $1,200 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. 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 2 (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 0% to 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay, and Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests have a copay between $0 and $90, and Lab Services have no copay. Diagnostic Radiological Services have a copay between $15 and $395, and Therapeutic Radiological Services have a coinsurance of at least 20%. Outpatient X-Ray Services have a $15 copay.
Home Health Services See details
Home Health Services are covered by the Anthem Medicare Advantage 2 (HMO-POS) plan with no copay and no coinsurance. However, 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 2 (HMO-POS), but the specific services, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services, are not covered. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Anthem Medicare Advantage 2 (HMO-POS), with a $0 copay for days 1-20 and a $214 copay per day for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include Over-the-Counter (OTC) Items and Other 1, both with no copay. 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.
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