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 $4000.00 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 an annual drug deductible of $150. Under this plan, you will pay no copay for Tier 1 preferred generic and Tier 6 select care drugs at preferred, standard, and standard mail-order pharmacies. Additionally, Tier 2 generic drugs have no copay when filled at preferred pharmacies or standard mail-order, though standard pharmacies charge a low copay starting at $5. For higher-tier medications, the plan transitions to coinsurance costs instead of flat copays. Tier 3 preferred brand drugs require a 25% coinsurance, while Tier 4 non-preferred drugs have a 30% coinsurance across all pharmacy types. Tier 5 specialty drugs incur 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 featuring no copay and no coinsurance for primary care visits, telehealth, and preventive services. Specialist visits, urgent care, and emergency room visits require low copayments starting at $20, $35, and $150 respectively, with no coinsurance. For hospital stays, inpatient services require a $350 daily copay for the first five days and no copay thereafter, while outpatient hospital visits range from no copay to a $250 copay with no coinsurance. This plan also includes robust supplemental benefits, such as dental coverage up to $3,000 annually with no copay for preventive services and a 25% coinsurance for comprehensive care. Routine vision and hearing exams feature no copay and no coinsurance, alongside annual allowances of up to $300 for eyewear and $2,000 for prescription hearing aids. Additionally, members can access home health services, cardiac rehabilitation, and up to $35 in quarterly over-the-counter items with no copay or coinsurance.
Inpatient Hospital See details
Anthem Medicare Advantage (HMO-POS) partially covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $350 daily copay for days 1 through 5 and no copay for days 6 and beyond. Prior authorization is required, and certain services such as upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Anthem Medicare Advantage (HMO-POS) covers outpatient services with no coinsurance, featuring a $0 to $250 copay for outpatient hospital visits and a $250 copay per stay for observation services. Ambulatory surgical center and outpatient blood services have no copay and no coinsurance, while outpatient substance abuse sessions have a $20 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Anthem Medicare Advantage (HMO-POS) 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 $250 copay and no coinsurance, though prior authorization is required. Transportation services to plan-approved or other health-related locations are not covered.
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, and transportation services are also covered up to a $100,000 maximum benefit, with each service requiring a $150 copay and no coinsurance.
Primary Care See details
Anthem Medicare Advantage (HMO-POS) offers primary care and telehealth services with no copay and no coinsurance, while specialist visits, therapy, and mental health services require a $20 copay and no coinsurance. For chiropractic services, some services are covered but routine chiropractic care and other chiropractic services are not covered. Most specialist services require prior authorization and have copays ranging from $0 to $20 with no coinsurance.
Preventive Services See details
Preventive services are partially covered by Anthem Medicare Advantage (HMO-POS) with no copay and no coinsurance for covered services like annual physicals, kidney disease education, remote access technologies, and select screenings. Sub-services that are not covered include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, fitness benefits, enhanced disease management, telemonitoring, home/bathroom safety devices, and counseling.
Hearing Services See details
Anthem Medicare Advantage (HMO-POS) covers Medicare-covered hearing exams for a $20 copay and no coinsurance, while routine exams and fitting evaluations have no copay and no coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to $2,000 annually, but inner ear, outer ear, and over the ear hearing aids are not covered. Over-the-counter hearing aids are also covered with no copay or coinsurance up to a $300 yearly limit.
Vision Services See details
Anthem Medicare Advantage (HMO-POS) provides partially covered vision services, which exclude upgrades and other eye exam services. Covered routine eye exams feature no copay and no coinsurance (limited to one per year), while other exams have a copay of $0 to $20 and no coinsurance. Covered eyewear—including contacts, lenses, and frames—has no copay, no coinsurance, and no deductible up to a combined annual maximum of $300.
Dental Services See details
Anthem Medicare Advantage (HMO-POS) dental services are partially covered up to an annual maximum of $3,000, featuring preventive care with no copay and no coinsurance, and comprehensive care with no copay and 25% coinsurance. Maxillofacial prosthetics, implant services, and orthodontics 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. Medicare Part B chemotherapy and other drugs have no copay and 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis services are covered by Anthem Medicare Advantage (HMO-POS) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Anthem Medicare Advantage (HMO-POS) with no copays, though durable medical equipment (DME) features a 0% to 20% coinsurance, and prosthetics and medical supplies require a 20% coinsurance. Diabetic equipment, supplies, and therapeutic shoes are covered with no copay and no coinsurance, though brand limits apply and prior authorization is required for some equipment.
Diagnostic and Radiological Services See details
Anthem Medicare Advantage (HMO-POS) covers diagnostic and radiological services with prior authorization required, offering lab services with no copay and no coinsurance, and diagnostic tests with a copay ranging from $0 to $95 and no coinsurance. Outpatient X-rays have a $50 copay, diagnostic radiological services require a minimum $50 copay, and therapeutic radiological services carry a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered by Anthem Medicare Advantage (HMO-POS) 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 copay and no coinsurance, though prior authorization is required. However, some services are not covered in practice, including standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD).
Skilled Nursing Facility (SNF) See details
Anthem Medicare Advantage (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 through 20 and a $218 copay for days 21 through 100. Prior authorization is required and a 3-day prior hospital stay is not needed, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Anthem Medicare Advantage (HMO-POS) partially covers other services, offering no copay and no coinsurance for chronic illness meal benefits, Medicare Community Resource Support, and up to $35 every three months in over-the-counter (OTC) items. Acupuncture is not covered under this plan.
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