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 Select counties in Missouri. 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 $210.00 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 $3900.00 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 (HMO-POS) drug coverage includes an annual prescription deductible of $210. You will pay no copay for Tier 1 preferred generics and Tier 6 select care drugs at both preferred and standard pharmacies. Tier 2 generic drugs also feature no copay at preferred pharmacies and standard mail order, while standard pharmacies require a $10 copay for a one-month supply. For higher-tier medications, costs are structured as coinsurance rather than flat copayments. Tier 3 preferred brand drugs require a 25% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require 30% coinsurance at preferred, standard, and standard mail-order pharmacies. This clear cost-sharing structure helps you easily plan for your monthly healthcare expenses.
Additional Benefits
The Anthem Medicare Advantage (HMO-POS) plan offers comprehensive medical coverage with no copay for primary care visits, preventive services, and home health care. For specialist visits, outpatient services, and emergency care, members can expect predictable copayments, such as a $35 specialist copay and a $150 emergency room copay. Inpatient hospital stays require a $325 daily copay for the first six days, after which there is no copay for additional days. This plan also includes valuable supplemental benefits, featuring routine dental, vision, and hearing care with no copayments for preventive services. Dental and hearing benefits provide generous coverage up to $3,000 annually, alongside a $300 annual limit for eyewear and a $90 quarterly over-the-counter item allowance. Most medical equipment and dialysis services are covered with no copay and coinsurance ranging from 0% to 20%.
Inpatient Hospital See details
Anthem Medicare Advantage (HMO-POS) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $325 daily copay for days 1 through 6 and no copay for days 7 and beyond. Prior authorization is required, and certain services like non-Medicare-covered stays and hospital upgrades are not covered.
Outpatient Services See details
Anthem Medicare Advantage (HMO-POS) covers outpatient services with no coinsurance, featuring no copays for ambulatory surgical center and blood services. Outpatient hospital copays range from $0 to $325, observation services require a $325 copay per stay, and outpatient substance abuse sessions have a $30 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 benefit.
Ambulance and Transportation Services See details
Anthem Medicare Advantage (HMO-POS) covers ground and air ambulance services with a $295 copay and no coinsurance, subject to prior authorization. Some transportation services are covered, but transportation to plan-approved health-related locations and any health-related locations are not covered.
Emergency Services See details
Anthem Medicare Advantage (HMO-POS) covers emergency services with a $150 copay and no coinsurance, and urgently needed services with a $45 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $100,000 maximum plan benefit limit with a $150 copay and no coinsurance.
Primary Care See details
Anthem Medicare Advantage (HMO-POS) covers primary care physician services and telehealth benefits with no copay and no coinsurance, while specialist, physical therapy, and occupational therapy visits require a $35 copay and no coinsurance. Mental health, psychiatric, and opioid treatment sessions carry a $30 copay and no coinsurance, but chiropractic services are not covered in practice.
Preventive Services See details
Preventive services are covered by Anthem Medicare Advantage (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 supplemental services such as fitness benefits, health education, in-home safety assessments, and weight management programs are not covered.
Hearing Services See details
Anthem Medicare Advantage (HMO-POS) covers hearing exams with a $35 copay and no coinsurance for Medicare-covered exams, while routine exams and fittings have no copay and no coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to $3,000 annually, though inner ear, outer ear, and over the ear types are not covered. OTC hearing aids are covered with no copay or coinsurance up to $300 per year, and prior authorization is required for these services.
Vision Services See details
Anthem Medicare Advantage (HMO-POS) offers partially covered vision services with no coinsurance, featuring a $0 to $35 copay for eye exams and no copay for eyewear up to a $300 annual limit. One routine eye exam is covered per year with no copay, but other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Dental services are partially covered by Anthem Medicare Advantage (HMO-POS) up to a $3,000 annual limit, featuring preventive services with no copay and no coinsurance. Covered comprehensive services require no copay and a 25% coinsurance, though maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Anthem Medicare Advantage (HMO-POS) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while Part B chemotherapy, radiation, and other drugs require 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Anthem Medicare Advantage (HMO-POS) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Anthem Medicare Advantage (HMO-POS) covers durable medical equipment (DME) with no copay and 0% to 20% coinsurance, and prosthetics and medical supplies with no copay and 20% coinsurance. Diabetic equipment, supplies, and therapeutic shoes are also covered with no copay and no coinsurance, though prior authorization and manufacturer limitations may apply.
Diagnostic and Radiological Services See details
Anthem Medicare Advantage (HMO-POS) covers diagnostic and radiological services with prior authorization, featuring no copay or coinsurance for lab services and a $0 to $95 copay with no coinsurance for diagnostic tests. Radiological services require a $90 copay for X-rays, a minimum $75 copay for diagnostic radiological services, and a minimum 20% coinsurance for therapeutic radiological services.
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
Cardiac Rehabilitation Services are not covered under the Anthem Medicare Advantage (HMO-POS) plan, including intensive cardiac, pulmonary, and supervised exercise therapy (SET) services.
Skilled Nursing Facility (SNF) See details
Anthem Medicare Advantage (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $20 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, prior 3-day inpatient hospital stays are not required for admission, and additional days beyond the standard Medicare benefit are not covered.
Other Services See details
Other services are partially covered by Anthem Medicare Advantage (HMO-POS) with no copay and no coinsurance, which includes chronic illness meal benefits, community resource support, and a $90 quarterly over-the-counter item allowance. Acupuncture is not covered under this plan benefit.
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