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 2025, 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 Indiana. This plan received an overall rating of 3.5 out of 5 stars in 2025.
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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $4150.00 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) plan offers an Enhanced Alternative drug benefit. This plan has no deductible for prescription drugs. In the initial coverage phase, you'll pay varying costs depending on the drug tier and pharmacy. Preferred Generic, and Specialty Tier drugs have no copay. Standard Generic, Preferred Brand, and Non-Preferred drugs have coinsurance costs of 20-45%.
Additional Benefits
The Anthem Medicare Advantage (HMO-POS) plan offers a variety of benefits with varying costs. Inpatient hospital stays have a copay for the first few days, while outpatient services have copays that vary depending on the service. Emergency services, including ambulance, have copays, and primary care services have no copay. The plan also covers preventive services like annual physical exams and offers hearing, vision, and dental services with no or low copays. Additional benefits include home health services and over-the-counter items with no copay, as well as coverage for dialysis services, medical equipment, and diagnostic services, but with coinsurance or copays.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For the first 7 days, there is a $350 copay, and days 8-90 have no copay. Additional days for both Inpatient Hospital-Acute and Psychiatric have no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services are covered, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $350, observation services have a $350 copay, ambulatory surgical center services have no copay, individual and group outpatient substance abuse sessions have a $30 copay, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered with a $40 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $270 copay for both ground and air ambulance services, and no coinsurance. Transportation Services to a plan-approved health-related location are covered with no copay, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Anthem Medicare Advantage (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage have a $140 copay, while Urgently Needed Services have a $35 copay; all services have no coinsurance.
Primary Care See details
Primary Care Physician Services are covered with no copay, while Chiropractic Services have a $20 copay. Occupational Therapy Services, Physician Specialist Services, and Physical Therapy and Speech-Language Pathology Services have a $30 copay. Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services each have a $30 minimum copay. Additional Telehealth Benefits have no copay. Podiatry Services and Other Health Care Professional services have varying copays depending on the specific service.
Preventive Services See details
Preventive Services include Medicare-covered services, annual physical exams, and additional preventive services. Annual physical exams have no copay, and the plan also covers the Personal Emergency Response System (PERS) and fitness benefits with no copay. Other preventive services like Health Education, In-Home Safety Assessment, Medical Nutrition Therapy (MNT), and others are not covered.
Hearing Services See details
Hearing Services include hearing exams with a $30 copay, routine hearing exams with no copay, fitting/evaluation for hearing aids with no copay, prescription hearing aids with a $3,000 annual benefit, and OTC hearing aids with no copay and a $300 annual benefit. Prescription hearing aids - inner ear, outer ear, and over the ear are not covered.
Vision Services See details
The Anthem Medicare Advantage (HMO-POS) plan covers vision services, including eye exams with a copay of $0-$30, and eyewear with no copay, including contact lenses, eyeglass lenses and frames, and upgrades. Routine eye exams are covered with no copay, and you are allowed one per year.
Dental Services See details
Dental services are covered, including oral exams, dental x-rays, and other diagnostic services with no copay. Other dental services are covered up to a maximum of $1200 per year, with no copay for services including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are covered with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Anthem Medicare Advantage (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 0-20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, and require prior authorization. Diagnostic Procedures/Tests have a copay between $0 and $95, while Lab Services have no copay. Diagnostic Radiological Services have a copay between $50 and $350, Therapeutic Radiological Services have 20% coinsurance, and Outpatient X-Ray Services have a $50 copay.
Home Health Services See details
Home Health Services are covered by the Anthem Medicare Advantage (HMO-POS) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but all sub-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 (HMO-POS) with prior authorization required. For days 1-20, there is no copay, and for days 21-100, the copay is $214 per day; additional days beyond Medicare coverage and non-Medicare-covered stays are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items and Meal Benefits with no copay, while acupuncture is not covered. OTC items have a maximum benefit of $110 every three months.
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