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:
Sign up for Anthem Medicare Advantage (HMO-POS)
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Drug Coverage
The Anthem Medicare Advantage (HMO-POS) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay varying costs depending on the drug tier and pharmacy you use. For preferred generic drugs, and specialty tier drugs, there is no copay. For standard generic drugs, you pay 20% or 25% coinsurance, depending on your pharmacy. For preferred brand and non-preferred drugs, you will pay 45% and 33% coinsurance, respectively. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Anthem Medicare Advantage (HMO-POS) plan offers a range of benefits with varying cost-sharing. It includes inpatient hospital stays with a $350 copay for days 1-7 and no copay for days 8-90, along with outpatient services, such as primary care with no copay, and specialist services with a $25 copay. Emergency services have a $140 copay, and ambulance services have a $295 copay. The plan also covers preventive, hearing, vision, and dental services, often with no copay or a low copay. Hearing aids are covered up to $3000 per year, and there is a $1200 maximum benefit for other dental services. Additionally, the plan includes home health services with no copay, medical equipment with no copay, and covers other services like OTC items and meal benefits with no copay.
Inpatient Hospital See details
Inpatient Hospital services, including acute and psychiatric, are covered, with a $350 copay for days 1-7 and no copay for days 8-90; additional days for both are also covered with no copay, while non-Medicare-covered stays and upgrades are not covered. Prior authorization is required.
Outpatient Services See details
Outpatient services are covered, including all outpatient hospital services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay of $0 - $350, and observation services have a $350 copay. Ambulatory Surgical Center (ASC) Services and outpatient blood services have no copay. Individual and Group sessions for outpatient substance abuse have a copay of $25.
Partial Hospitalization See details
Partial Hospitalization is covered by Anthem Medicare Advantage (HMO-POS) with a $40 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Anthem Medicare Advantage (HMO-POS) plan. Ground and Air Ambulance Services have a $295 copay, with no coinsurance, and Transportation Services to a plan-approved health-related location have no copay and no coinsurance for up to 60 one-way trips per year, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Anthem Medicare Advantage (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have a $140 copay, while Urgently Needed Services has a $35 copay; all services have no coinsurance.
Primary Care See details
The Anthem Medicare Advantage (HMO-POS) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $25 copay, and physician specialist services with a $25 copay. Mental health specialty services, psychiatric services, and opioid treatment program services have a $25 copay for individual and group sessions, and podiatry services have a $0-$25 copay. Physical therapy and speech-language pathology services have a $25 copay, and additional telehealth benefits have no copay.
Preventive Services See details
Preventive services include Medicare-covered and additional preventive services, with no copay for annual physical exams. Health education, in-home safety assessments, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefit, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, and enhanced disease management are not covered.
Hearing Services See details
The Anthem Medicare Advantage (HMO-POS) plan covers hearing exams with a $25 copay, routine hearing exams with no copay, fitting/evaluation for hearing aids with no copay, and OTC hearing aids with no copay. Prescription hearing aids are covered up to $3000 per year, but inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
The Anthem Medicare Advantage (HMO-POS) plan covers vision services, including eye exams with a copay between $0 and $25, and eyewear with no copay. Routine eye exams are limited to one per year with no copay, and eyewear has a combined maximum benefit of $300 per year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are included with no copay.
Dental Services See details
Dental Services are covered, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatments, and other preventive dental services with no copay. Other services like restorative services, endodontics, and periodontics are covered with no copay. There is a $1,200 maximum benefit per year for other dental services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Other Medicare Part B drugs have a coinsurance between 0% and 20%, and Medicare Part B Chemotherapy/Radiation Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Anthem Medicare Advantage (HMO-POS) plan. You will pay 20% coinsurance for dialysis services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with no copay and a coinsurance of 0% to 20%, Prosthetics/Medical Supplies with no copay and a 20% coinsurance, and Diabetic Equipment with no copay for Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. 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 a coinsurance of at least 20%, 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, but additional hours of care and personal care services are not covered. Prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but none of the listed sub-services are covered, including Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Anthem Medicare Advantage (HMO-POS), but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214 per day. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) Items and Meal Benefits with no copay, while 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. OTC items have a maximum benefit of $105.00 every three months.
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