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 $150 drug deductible and offers savings on generic medications, including no copay for Tier 1 preferred generic and Tier 6 select care drugs. For Tier 2 generic drugs, you will also enjoy no copay when using a preferred pharmacy or standard mail order, though standard pharmacies charge a copay starting at $5.00 for a one-month supply. Higher-tier medications under this plan are subject to coinsurance rather than flat copayments. Tier 3 preferred brands require a 25% coinsurance, Tier 4 non-preferred drugs carry a 30% coinsurance, and Tier 5 specialty drugs have a 31% coinsurance for a one-month supply.
Additional Benefits
The Anthem Medicare Advantage (HMO-POS) plan offers comprehensive medical coverage with no copay or coinsurance for primary care visits, routine annual physicals, and home health services. For specialized medical care, members pay a $35 copay for specialist visits and a $150 copay for emergency room services, with no coinsurance required for either. Inpatient hospital stays require a daily copay for the first five days ($440 for acute care and $415 for psychiatric care) followed by no copay for additional days. This plan also features robust everyday health benefits, including no copay for routine dental, vision, and hearing exams, alongside allowance limits for eyewear and hearing aids. Preventive dental care features no copay up to a $2,000 annual limit, while comprehensive dental services require a 25% coinsurance. Additionally, diagnostic lab tests and diabetic equipment are covered with no copay, while durable medical equipment and Part B drugs carry a coinsurance ranging from 0% to 20%.
Inpatient Hospital See details
Anthem Medicare Advantage (HMO-POS) covers inpatient hospital services with no coinsurance, but does not cover upgrades or non-Medicare-covered stays. Acute care requires a $440 copay for days 1 through 5 and no copay for days 6 and beyond, while psychiatric care requires a $415 copay for days 1 through 5 and no copay for additional days.
Outpatient Services See details
Anthem Medicare Advantage (HMO-POS) covers outpatient services with no coinsurance, including outpatient hospital services with a copay ranging from $0 to $440 and observation services with a $440 copay per stay. Ambulatory surgical center and outpatient blood services are offered with no copay and no coinsurance, while outpatient substance abuse sessions require a $35 copay and no coinsurance.
Partial Hospitalization See details
Anthem Medicare Advantage (HMO-POS) covers partial hospitalization services with a $40.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Anthem Medicare Advantage (HMO-POS) covers ground and air ambulance services with a $275 copay per service and no coinsurance, requiring prior authorization. Transportation services to plan-approved or other 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 urgently needed services with a $35 copay, with no coinsurance for either benefit. Worldwide emergency, urgent, and transportation services are also covered up to a $100,000 maximum benefit limit, featuring a $150 copay and no coinsurance per service.
Primary Care See details
Anthem Medicare Advantage (HMO-POS) covers primary care and telehealth services with no copay and no coinsurance. Specialist visits, physical and occupational therapies, and mental health services require a $35 copay and no coinsurance, while 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 select screenings, with no copay and no coinsurance. The benefit is partially covered because although remote access technologies are covered with no copay, other sub-services such as fitness benefits, health education, and personal emergency response systems are not covered.
Hearing Services See details
Anthem Medicare Advantage (HMO-POS) covers hearing services, offering routine exams and fitting evaluations with no copay, no deductible, and no coinsurance, while Medicare-covered exams require a $35 copay and no coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to a $2,000 yearly limit, excluding inner ear, outer ear, and over the ear options. Additionally, over-the-counter hearing aids are covered up to $300 annually with no copay and no coinsurance.
Vision Services See details
Anthem Medicare Advantage (HMO-POS) offers partially covered vision services with no coinsurance, including one routine eye exam per year with no copay, while other eye exams are not covered. Eyewear is covered with no copay or coinsurance up to a $300 annual limit, although upgrades are not covered.
Dental Services See details
Dental Services are partially covered by Anthem Medicare Advantage (HMO-POS), offering preventive care with no copay and no coinsurance up to a $2,000 annual maximum. Comprehensive dental procedures are covered with no copay and 25% coinsurance, but 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, subject to prior authorization. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have a 0% to 20% coinsurance.
Dialysis Services See details
Anthem Medicare Advantage (HMO-POS) covers dialysis services 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 prior authorization and coinsurance may apply depending on the item. Durable medical equipment has a 0% to 20% coinsurance, prosthetic devices and medical supplies carry a 20% coinsurance, and diabetic equipment and supplies are covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Anthem Medicare Advantage (HMO-POS) covers diagnostic services with no coinsurance, featuring a $0 to $95 copay for diagnostic procedures and no copay for lab services. Radiological services require prior authorization, with outpatient X-rays requiring a $50 copay, diagnostic radiological services having a minimum $50 copay, and therapeutic radiological services carrying 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, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered with no coinsurance under Anthem Medicare Advantage (HMO-POS), but prior authorization is required. While some services are covered, cardiac rehabilitation (with a $30 copay), intensive cardiac rehabilitation ($30 copay), pulmonary rehabilitation ($15 copay), and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services ($20 copay) are not covered in practice.
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, followed by a $218 copayment for days 21 through 100, with additional days beyond the Medicare limit not covered.
Other Services See details
Anthem Medicare Advantage (HMO-POS) partially covers other services, offering a chronic illness meal benefit and Medicare Community Resource Support with no copay and no coinsurance. Acupuncture and over-the-counter (OTC) items are not covered under this plan.
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