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:
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Drug Coverage
The Anthem Medicare Advantage (HMO-POS) plan features a low annual drug deductible of $150. Under this plan, you will pay no copay for Tier 1 preferred generics and Tier 6 select care drugs at preferred, standard, and standard mail-order pharmacies. Tier 2 generic medications also feature no copay at preferred pharmacies and standard mail order, while standard pharmacies require a copay starting at $5 for a one-month supply. For higher-tier medications, costs are based on coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 25% coinsurance, and Tier 4 non-preferred drugs carry a 30% coinsurance. Specialty drugs in Tier 5 have a 31% coinsurance for a one-month supply at preferred, standard, and standard mail-order pharmacies.
Additional Benefits
The Anthem Medicare Advantage (HMO-POS) plan offers comprehensive medical coverage with predictable costs, featuring no copays or coinsurance for primary care visits, telehealth, and routine preventive services. For more intensive care, inpatient hospital stays require a daily copay for the first five days and no copay thereafter, while emergency room visits carry a $150 copay. Specialist visits, physical therapy, and urgent care are accessible with a standard $35 copay and no coinsurance. This plan also includes valuable supplemental benefits, including routine vision and hearing exams with no copays, alongside allowances of up to $2,000 for prescription hearing aids and $200 for eyewear. Preventive dental care is fully covered with no copay up to a $2,000 annual limit, while comprehensive dental services require a 25% coinsurance. Additionally, members benefit from home health services with no copay and a $38 quarterly allowance for over-the-counter items.
Inpatient Hospital See details
Anthem Medicare Advantage (HMO-POS) partially covers inpatient hospital services with no coinsurance, though prior authorization is required. For acute stays, there is a $440 daily copay for days 1 through 5 and no copay for days 6 and beyond, while psychiatric stays require a $415 daily copay for days 1 through 5 and no copay thereafter. 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 a copay of $0 to $440 for outpatient hospital services and $440 per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions have a $35 copay with no coinsurance.
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 Medicare-covered ground and air ambulance services with a $295 copay and no coinsurance, though prior authorization is required. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Emergency services are covered by Anthem Medicare Advantage (HMO-POS) with a $150 copay and no coinsurance, while urgent care services require a $35 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $100,000 maximum limit, each carrying a $150 copay and no coinsurance.
Primary Care See details
Anthem Medicare Advantage (HMO-POS) provides primary care and telehealth services with no copay and no coinsurance, while specialists, physical therapy, and mental health services require a $35 copay and no coinsurance. Chiropractic services are partially covered with a $20 copay and no coinsurance, though routine chiropractic care is not covered.
Preventive Services See details
Anthem Medicare Advantage (HMO-POS) covers preventive services, including annual physical exams, kidney disease education, and remote access technologies, with no copay and no coinsurance. This benefit is partially covered, as the plan does not cover fitness benefits, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management, alternative therapies, or therapeutic massage.
Hearing Services See details
Hearing services are covered by Anthem Medicare Advantage (HMO-POS) with no deductible and no coinsurance, offering no copay for annual routine exams and fittings, and a $35 copay for Medicare-covered exams. 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 prescription hearing aids are not covered. Over-the-counter hearing aids are also covered up to $300 annually with no copay or coinsurance.
Vision Services See details
Vision services are partially covered by Anthem Medicare Advantage (HMO-POS) with no deductible and no coinsurance, although upgrades and other eye exam services are not covered. Covered benefits include one annual routine eye exam with no copay (other eye exams have a $0 to $35 copay) and eyewear up to a $200 yearly limit with no copay.
Dental Services See details
Dental Services are partially covered by Anthem Medicare Advantage (HMO-POS), providing preventive care with no copay and no coinsurance up to a $2,000 annual limit. Covered comprehensive services require 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 chemotherapy, radiation, and other Part B drugs have no copay and a 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 medical equipment with no copays, although coinsurance and prior authorization requirements may apply. Durable medical equipment has a 0% to 20% coinsurance, prosthetic devices and medical supplies carry a 20% coinsurance, and diabetic equipment is covered with no coinsurance.
Diagnostic and Radiological Services See details
Anthem Medicare Advantage (HMO-POS) covers diagnostic and radiological services with prior authorization, including lab services with no copay or coinsurance, and diagnostic tests with a $0 to $95 copay and no coinsurance. Outpatient X-rays require a $50 copay with coinsurance, diagnostic radiological services have a minimum $50 copay and no coinsurance, and therapeutic radiological services require a copay and a minimum 20% coinsurance.
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 covered by Anthem Medicare Advantage (HMO-POS) with no coinsurance and require prior authorization, though some services are covered while standard cardiac, intensive cardiac, pulmonary, and SET for PAD services are not covered. Copayments for these services range from $15 to $30.
Skilled Nursing Facility (SNF) See details
Anthem Medicare Advantage (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Anthem Medicare Advantage (HMO-POS) covers select other services with no copay and no coinsurance, including a chronic illness meal benefit, Medicare Community Resource Support, and a $38 quarterly over-the-counter (OTC) item allowance. Acupuncture is not covered under this plan.
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