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 Indiana. 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 $150.00 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 $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:
Sign up for Anthem Medicare Advantage (HMO-POS)
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Drug Coverage
The Anthem Medicare Advantage (HMO-POS) plan features an annual drug deductible of $150. You will pay no copay for Tier 1 preferred generic and Tier 6 select care drugs at preferred, standard, and standard mail-order pharmacies. Tier 2 generic drugs also feature no copay at preferred pharmacies and standard mail order, though standard retail pharmacies charge a copay ranging from $5 to $15 depending on the supply. For higher-tier medications, costs are structured as coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 25% coinsurance, Tier 4 non-preferred drugs carry a 30% coinsurance, and Tier 5 specialty drugs require a 31% coinsurance for a one-month supply. These coinsurance percentages remain consistent across preferred, standard, and standard mail-order pharmacies.
Additional Benefits
The Anthem Medicare Advantage (HMO-POS) plan offers comprehensive medical coverage featuring no copay for primary care visits, telehealth, and routine preventive services. For specialized medical needs, members pay a $35 copay for specialist visits and urgently needed care, while emergency services require a $150 copay. Inpatient hospital stays are covered with no coinsurance, requiring daily copays only for the first four days of your stay. This plan also provides robust coverage for dental, vision, and hearing care, offering annual routine exams with no copays and generous allowances for glasses and hearing aids. Additionally, home health services are available with no copay or coinsurance, and skilled nursing facility stays require no copay for the first 20 days. Overall, this plan helps keep healthcare affordable by eliminating coinsurance for the majority of outpatient and everyday medical services.
Inpatient Hospital See details
Anthem Medicare Advantage (HMO-POS) partially covers inpatient hospital services with no coinsurance, requiring prior authorization while excluding upgrades and non-Medicare-covered stays. Medicare-covered acute stays require a $440 copay per day for days 1 through 4 with no copay for days 5 and beyond, while psychiatric stays require a $415 copay per day for days 1 through 4 and no copay for subsequent days.
Outpatient Services See details
Anthem Medicare Advantage (HMO-POS) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services which also have no copay. Outpatient hospital services have a copay of $0 to $440, observation services require a $440 copay per stay, and outpatient substance abuse sessions carry a $35 copay.
Partial Hospitalization See details
Anthem Medicare Advantage (HMO-POS) covers partial hospitalization services with a $40.00 copay and no coinsurance, though prior authorization is required.
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. Routine transportation services to health-related locations are not covered under this plan.
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 $35 copay and no coinsurance. Worldwide emergency, urgent care, and emergency transportation are also covered up to a $100,000 maximum benefit with a $150 copay and no coinsurance per service.
Primary Care See details
Anthem Medicare Advantage (HMO-POS) offers primary care and telehealth services with no copay and no coinsurance, while specialist visits, therapies, and mental health services require a $35 copay and no coinsurance. Podiatry services have a $0 to $35 copay and no coinsurance, and although some chiropractic services are covered, routine and other chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by Anthem Medicare Advantage (HMO-POS) with no copay and no coinsurance for covered care, such as annual physical exams, remote access technologies, kidney disease education, and select screenings. However, the plan does not cover health education, in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, smoking cessation, fitness benefits, enhanced disease management, telemonitoring, home and bathroom safety modifications, and counseling.
Hearing Services See details
Hearing services are covered by Anthem Medicare Advantage (HMO-POS), featuring a $35 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams and OTC hearing aids up to $300. Prescription hearing aids are partially covered up to $2,000 annually with no copay or coinsurance, but inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Anthem Medicare Advantage (HMO-POS), offering one routine eye exam per year and eyewear like contacts and eyeglasses up to a $200 annual limit with no copays, coinsurance, or deductibles. Other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Anthem Medicare Advantage (HMO-POS) provides partially covered dental services up to a $1,500 annual maximum, featuring no copay and no coinsurance for preventive care like exams and cleanings. Comprehensive treatments such as restorative and endodontic services are covered with no copay and a 25% coinsurance, while implant services, orthodontics, and maxillofacial prosthetics 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 a 0% to 20% coinsurance and no copay.
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 and prosthetics with no copay and coinsurance ranging from 0% to 20%, subject to prior authorization. Diabetic equipment, supplies, and therapeutic shoes are covered with no copay and no coinsurance from specified manufacturers.
Diagnostic and Radiological Services See details
Anthem Medicare Advantage (HMO-POS) covers diagnostic and radiological services with prior authorization, featuring no coinsurance for diagnostic services, no copay for lab services, and diagnostic test copays ranging from $0 to $75. Radiological services require a $100 copay plus coinsurance for outpatient X-rays, a minimum $50 copay for diagnostic radiology, and a minimum 20% coinsurance plus a copay for therapeutic radiology.
Home Health Services See details
Home health services are covered under the Anthem Medicare Advantage (HMO-POS) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Anthem Medicare Advantage (HMO-POS) offers Cardiac Rehabilitation Services with no coinsurance, though some services are covered while cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered. These non-covered services require prior authorization and carry copays of $30 for cardiac and intensive cardiac rehab, $15 for pulmonary rehab, and $20 for SET for PAD services.
Skilled Nursing Facility (SNF) See details
Anthem Medicare Advantage (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance and no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day inpatient hospital stay is not required, and additional days beyond the standard 100-day limit are not covered.
Other Services See details
Other services are partially covered by Anthem Medicare Advantage (HMO-POS) with no copay and no coinsurance, including chronic illness meal benefits, Medicare Community Resource Support, and up to $38 every three months for over-the-counter items. Acupuncture is not covered under this benefit.
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