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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 2025, 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 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 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 $8.10. 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 $590.00 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 $2900.00 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 Extra Help (HMO-POS)
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Drug Coverage
The Anthem Extra Help (HMO-POS) plan has an enhanced alternative drug benefit. The plan has a deductible of $590.00. After the deductible, you will pay 25% coinsurance for most drugs, regardless of the pharmacy used. However, specialty tier drugs have no copay. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Anthem Extra Help (HMO-POS) plan offers a wide range of benefits with varying costs. Inpatient hospital stays have a $300 copay for the first 5 days, with no copay for the rest of the stay, and outpatient services have copays ranging from $0 to $300. Emergency services have a $140 copay, and primary care has no copay. This plan includes additional coverage for preventive, hearing, vision, and dental services, with some services having no copay. It also provides coverage for ambulance and transportation services, with a copay or coinsurance depending on the service. Other benefits include home health services with no copay, and skilled nursing facilities with a copay after the first 20 days.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For the first 5 days of an inpatient hospital stay, there is a $300 copay, and days 6-90 have no copay; additional days and psychiatric care have no copay.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $300, observation services with a $300 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services, including individual and group sessions, have a copay of $40. Finally, outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by Anthem Extra Help (HMO-POS) with a $40 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with coverage for ground ambulance services requiring a $300 copay and air ambulance services requiring 20% coinsurance. Transportation Services to plan-approved health-related locations are covered with no copay, up to 84 one-way trips per year, and includes rideshare services, bus/subway, van, and medical transport, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services and Worldwide Emergency Coverage have a $140 copay, while Urgently Needed Services have a $25 copay; all have no coinsurance.
Primary Care See details
The Anthem Extra Help (HMO-POS) plan covers Primary Care Physician Services with no copay. Chiropractic Services require a $20 copay, but routine care is not covered. Occupational Therapy Services have a $30 copay. Physician Specialist Services have a $25 copay. Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services have a $40 copay for individual and group sessions. Physical Therapy and Speech-Language Pathology Services have a $30 copay. Additional Telehealth Benefits have no copay. Podiatry Services have a copay between $0 and $25, and Routine Foot Care is covered. Other Health Care Professional services have a copay between $0 and $20.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, as well as an annual physical exam with no copay. This plan also covers additional preventive services including fitness benefits, personal emergency response systems, remote access technologies, home and bathroom safety devices and modifications, kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit, all with no copay.
Hearing Services See details
Hearing Services with the Anthem Extra Help (HMO-POS) plan include hearing exams with a $25 copay, routine hearing exams and fitting/evaluation for hearing aids with no copay, and prescription hearing aids with a plan-specified amount of $3000, and OTC hearing aids with no copay and a maximum amount of $300 per year. Prescription hearing aids for the inner, outer, and over the ear are not covered.
Vision Services See details
Vision services include eye exams with a copay of $0-$25, and eyewear with a combined maximum plan benefit of $300 per year with no copay. Routine eye exams, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are covered with no copay.
Dental Services See details
Dental Services are covered, with a $3,000 annual maximum benefit. Medicare Dental Services and Other Dental Services are covered with no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Anthem Extra Help (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%, and Prosthetics/Medical Supplies with a 20% coinsurance. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay, while Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services and radiological services. Diagnostic Procedures/Tests have a copay between $0 and $100, and Lab Services have no copay. Diagnostic Radiological Services have a copay up to $300, and Therapeutic Radiological Services have a coinsurance of at least 20%. Outpatient X-Ray Services have a $20 copay.
Home Health Services See details
Home Health Services are covered by the Anthem Extra Help (HMO-POS) plan with no copay and no coinsurance, but Additional Hours of Care and Personal Care Services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, SET for PAD Services, and Additional Cardiac Rehabilitation 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 the Anthem Extra Help (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 coverage and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Anthem Extra Help (HMO-POS) plan covers Over-the-Counter (OTC) items with no copay and a maximum benefit coverage amount of $110 every three months. The plan also covers a Meal Benefit with no copay, and "Other 1" services with no copay. Acupuncture, 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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