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 $3500.00 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) prescription drug plan features a $210 annual drug deductible. You can save on medication costs with no copay for Tier 1 (Preferred Generic) and Tier 6 (Select Care) drugs at preferred, standard, and standard mail-order pharmacies. Tier 2 (Generic) medications also have no copay at preferred pharmacies and standard mail order, while standard retail pharmacies charge a $10 copay for a one-month supply. For brand-name and specialty medications, your costs are based on coinsurance. Tier 3 (Preferred Brand) drugs require a 25% coinsurance, while Tier 4 (Non-Preferred Drug) and Tier 5 (Specialty Tier) drugs require a 30% coinsurance at preferred, standard, and standard mail-order pharmacies. These coinsurance rates apply to all available supply durations, helping you easily estimate your out-of-pocket prescription expenses.
Additional Benefits
The Anthem Medicare Advantage (HMO-POS) plan offers comprehensive coverage with no copay and no coinsurance for primary care visits, preventive services, and home health care. Specialist visits require a $40 copay, while emergency room services carry a $150 copay. For hospital stays, inpatient services require a $325 daily copay for the first eight days and no copay thereafter, while outpatient hospital copays range up to $325. This plan also features robust supplemental benefits, including dental care with no copays for preventive services and up to $3,000 in annual coverage. Vision and hearing benefits include routine exams with no copay, a $375 annual limit for eyewear, and up to $3,000 for prescription hearing aids. Additionally, members benefit from no copays on diabetic equipment and diagnostic lab services, though durable medical equipment and dialysis require up to 20% coinsurance.
Inpatient Hospital See details
Anthem Medicare Advantage (HMO-POS) offers partially covered inpatient hospital services with no coinsurance, though prior authorization is required. Medicare-covered acute and psychiatric stays require a $325 daily copay for days 1 through 8 and no copay for day 9 and beyond, while upgrades and non-Medicare-covered stays 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 outpatient blood services. Outpatient hospital services have a copay ranging from $0 to $325, and outpatient substance abuse sessions require a $25 copay, with prior authorization required for certain services.
Partial Hospitalization See details
Partial hospitalization is covered by Anthem Medicare Advantage (HMO-POS) 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 $270 copay and no coinsurance, though prior authorization is required. Transportation services to plan-approved or health-related locations are not covered.
Emergency Services See details
Emergency Services are covered by Anthem Medicare Advantage (HMO-POS) with a $150 copay and no coinsurance, and urgently needed services require a $45 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with a $150 copay and no coinsurance, up to a maximum plan benefit of $100,000.
Primary Care See details
Anthem Medicare Advantage (HMO-POS) covers primary care and telehealth visits with no copay and no coinsurance, while specialist visits require a $40 copay and no coinsurance. Other services, including physical therapy, occupational therapy, and mental health services, feature copays ranging from $20 to $25 with no coinsurance, though routine chiropractic care is not covered.
Preventive Services See details
Preventive services are covered by Anthem Medicare Advantage (HMO-POS) with no copay and no coinsurance, including annual physical exams, kidney disease education, glaucoma screenings, and diabetes self-management training. While remote access technologies are covered, other additional preventive services such as fitness benefits, health education, and in-home safety assessments are not covered.
Hearing Services See details
Hearing services are covered by Anthem Medicare Advantage (HMO-POS) with no coinsurance, requiring a $40 copay for Medicare-covered exams and no copay for annual routine exams, fittings, and OTC devices up to $300. 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 models are not covered.
Vision Services See details
Anthem Medicare Advantage (HMO-POS) offers partially covered vision services with no copay and no coinsurance, including one routine eye exam per year and a $375 annual limit for eyewear like contacts and eyeglasses. Other eye exam services and eyewear upgrades are not covered under this plan.
Dental Services See details
Anthem Medicare Advantage (HMO-POS) covers dental services up to $3,000 annually, offering preventive care with no copay and no coinsurance, and comprehensive services with no copay and a 25% coinsurance. This benefit is partially covered, as 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 require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and 0% to 20% coinsurance.
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, though prior authorization and coinsurance requirements vary by item. Durable medical equipment requires a 0% to 20% coinsurance, prosthetic devices and medical supplies carry a 20% coinsurance, and diabetic equipment is available with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Anthem Medicare Advantage (HMO-POS) covers diagnostic and radiological services, requiring prior authorization for both. Diagnostic tests have no coinsurance and a copay of $0 to $95, lab services have no copay or coinsurance, diagnostic radiological services require a minimum $50 copay, and outpatient X-rays have a $90 copay, while therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered by Anthem Medicare Advantage (HMO-POS) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by Anthem Medicare Advantage (HMO-POS) with no coinsurance and require prior authorization. While some services are covered, cardiac rehabilitation ($40 copay), intensive cardiac rehabilitation ($40 copay), pulmonary rehabilitation ($20 copay), and supervised exercise therapy for peripheral artery disease ($30 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Anthem Medicare Advantage (HMO-POS) covers skilled nursing facility (SNF) care with no coinsurance, requiring a $20 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, and while a prior three-day hospital stay is not needed for admission, additional days beyond the 100-day Medicare limit are not covered.
Other Services See details
Other services are partially covered by Anthem Medicare Advantage (HMO-POS), featuring no copay and no coinsurance for over-the-counter (OTC) items up to $130 every three months, chronic illness meals, and Medicare Community Resource Support. Acupuncture is not covered under this benefit.
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