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 has an "Enhanced Alternative" drug benefit type with no deductible. During the initial coverage phase, you will pay no copay for preferred generic drugs at preferred, standard, and standard mail pharmacies. The coinsurance for standard generic drugs ranges from 20% to 25%, and 45% for preferred brand drugs. For non-preferred drugs, you will pay 33% coinsurance, and no copay for specialty tier drugs. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs. You may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Anthem Medicare Advantage (HMO-POS) plan provides coverage for a wide range of services with varying costs. Inpatient hospital stays have a $350 copay for the first seven days, with no copay thereafter. Outpatient services, primary care, and preventive services often have no copay, while specialist visits and mental health services have a $25 copay. Additional benefits include hearing, vision, and dental services, all with no copays for routine exams and eyewear. Emergency services, ambulance services, and home health services are also covered. Other benefits include home infusion, dialysis, medical equipment, and diagnostic services, with varying copays and coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits are covered by the Anthem Medicare Advantage (HMO-POS) plan, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For days 1-7 of an inpatient stay, there is a $350 copay, and for days 8-90, there is no copay. Additional days for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are covered with 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 includes coverage for all outpatient hospital services with a copay between $0 and $350, observation services with a $350 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $25 copay for both individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered with a $40 copay, and requires prior authorization.
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 $250 copay, with no coinsurance, while transportation services to plan-approved health-related locations have no copay.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under this plan. Emergency Services and Worldwide Emergency Coverage have a $140 copay, Urgently Needed Services has a $35 copay, and Worldwide Emergency Transportation also has a $140 copay. Worldwide Urgent Coverage has a $140 copay. There is no coinsurance for any of these services.
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, physician specialist services with a $25 copay, and mental health specialty services with a $25 copay for individual and group sessions. This plan also covers podiatry services with a copay between $0 and $25, other health care professional services with a copay between $0 and $20, psychiatric services with a $25 copay for individual and group sessions, physical therapy and speech-language pathology services with a $25 copay, additional telehealth benefits with no copay, and opioid treatment program services with a $25 copay. Routine chiropractic care is not covered.
Preventive Services See details
Preventive Services include no copay for annual physical exams and glaucoma screenings, and no copay for diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visits. Other services like Health Education, In-Home Safety Assessment, Medical Nutrition Therapy, and others are not covered.
Hearing Services See details
Hearing Services include hearing exams with a $25 copay and no deductible, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to a $3,000 maximum benefit per year, and OTC hearing aids are covered with no copay up to a $300 maximum benefit per year. Prescription hearing aids - inner ear, prescription hearing aids - outer ear, and prescription hearing aids - over the ear are not covered.
Vision Services See details
Vision services include eye exams with a copay of $0-$25, routine eye exams with no copay, and eyewear with no copay, with a combined maximum benefit of $300 per year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are covered.
Dental Services See details
Dental services are covered, 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, all with no copay. This plan offers a maximum of $1,500 per year for other dental services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance is 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 these services.
Medical Equipment See details
Medical equipment benefits include Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, Prosthetics/Medical Supplies with a 20% coinsurance, and Diabetic Equipment with no copay and a 0% coinsurance for both 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, and Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $350, while 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. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Anthem Medicare Advantage (HMO-POS) plan, but the specific services of Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD are not covered. Prior authorization is required for this benefit, and copay information is available from the plan.
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. Additional days beyond Medicare-covered for SNF, and non-Medicare-covered stays for SNF, are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) items with no copay, and a meal benefit with no copay. 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.
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