A non-government entity
Anthem Medicare Advantage 3 (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem Medicare Advantage 3 (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 3 (HMO-POS) in 2026, please refer to our full plan details page.
Anthem Medicare Advantage 3 (HMO-POS) is a HMO-POS plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Select Counties in Virginia. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Anthem Medicare Advantage 3 (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 3 (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 3 (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 $295.00 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 $4250.00 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 3 (HMO-POS) plan features an annual drug deductible of $295. For Tier 1 preferred generic and Tier 2 generic drugs, you will pay no copay when filling prescriptions through a preferred pharmacy or standard mail order. If you use a standard pharmacy, Tier 1 drugs require a copay of $5 to $15, while Tier 2 drugs carry a copay of $10 to $30 depending on the supply length. For higher-tier medications, cost-sharing is based on coinsurance rather than flat copays. Tier 3 preferred brand drugs and Tier 4 non-preferred drugs require a 25% coinsurance across preferred, standard, and standard mail-order services. Tier 5 specialty drugs carry a 29% coinsurance for a one-month supply at all participating pharmacy types.
Additional Benefits
The Anthem Medicare Advantage 3 (HMO-POS) plan offers comprehensive medical coverage with affordable cost-sharing, featuring no copay or coinsurance for primary care visits, telehealth, and preventive services. Specialist visits, physical therapy, and mental health services require a $25 copay, while emergency care has a $130 copay. For hospital stays, there is no coinsurance, though inpatient admissions require a $375 daily copay for the first few days and no copay for additional days. This plan also includes valuable supplemental benefits, such as routine vision and preventive dental care with no copays or coinsurance, alongside a generous $2,500 annual dental limit. Members can take advantage of hearing aid coverage up to $2,000 annually, as well as a $32 quarterly over-the-counter allowance with no copay. Additionally, essential medical equipment and home health services are covered, with no copay for diabetic supplies and home health visits.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Anthem Medicare Advantage 3 (HMO-POS) with no coinsurance, requiring a $375 daily copay for days 1 to 6 of acute stays and days 1 to 5 of psychiatric stays, with no copay for additional days. Prior authorization is required, and upgrades as well as non-Medicare-covered stays are not covered.
Outpatient Services See details
Anthem Medicare Advantage 3 (HMO-POS) outpatient services are covered with no coinsurance, featuring a $0 to $375 copay for outpatient hospital services and a $375 copay per stay for observation services. Ambulatory surgical center and outpatient blood services have no copay or coinsurance, while outpatient substance abuse individual and group sessions carry a $25 copay.
Partial Hospitalization See details
Partial hospitalization services are covered by Anthem Medicare Advantage 3 (HMO-POS) with a $40.00 copay and no coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
Ambulance services are covered by Anthem Medicare Advantage 3 (HMO-POS) with a $260 copay and no coinsurance for both ground and air transportation, which require prior authorization. Transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
Anthem Medicare Advantage 3 (HMO-POS) covers emergency services with a $130 copay and no coinsurance, and urgently needed services with a $50 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $100,000 maximum plan benefit, each requiring a $130 copay and no coinsurance.
Primary Care See details
Anthem Medicare Advantage 3 (HMO-POS) covers primary care and telehealth services with no copay and no coinsurance. Specialist visits, physical therapy, and mental health services require a $25 copay and no coinsurance, while podiatry and chiropractic services are not covered.
Preventive Services See details
Anthem Medicare Advantage 3 (HMO-POS) provides partially covered preventive services with no copay and no coinsurance for covered benefits, such as annual physical exams, kidney disease education, and remote access technologies. However, several supplemental services are not covered, including fitness benefits, health education, in-home safety assessments, nutritional counseling, and personal emergency response systems.
Hearing Services See details
Anthem Medicare Advantage 3 (HMO-POS) covers hearing services, including Medicare-covered exams for a $25 copay and no coinsurance, and annual routine exams and fittings with no copay or coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to a $2,000 annual limit, excluding inner ear, outer ear, and over the ear types. OTC hearing aids are also covered with no copay or coinsurance up to a $300 annual limit.
Vision Services See details
Anthem Medicare Advantage 3 (HMO-POS) provides partially covered vision services with no deductibles, no coinsurance, and no copays for routine eye exams and covered eyewear. Covered eyewear, including contact lenses and eyeglasses, has a $125 annual maximum benefit, while upgrades and other eye exam services are not covered.
Dental Services See details
Anthem Medicare Advantage 3 (HMO-POS) provides partially covered dental services with an annual benefit maximum of $2,500. Preventive dental care features no copay and no coinsurance, while covered comprehensive services require no copay and a 25% coinsurance, excluding maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Anthem Medicare Advantage 3 (HMO-POS) with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin features a $35 copay with no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Anthem Medicare Advantage 3 (HMO-POS) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Anthem Medicare Advantage 3 (HMO-POS) covers medical equipment with no copays, featuring a 0% to 20% coinsurance for durable medical equipment (DME) and a 20% coinsurance for prosthetics and medical supplies. Diabetic equipment, supplies, and therapeutic shoes are fully covered with no copays and no coinsurance.
Diagnostic and Radiological Services See details
Anthem Medicare Advantage 3 (HMO-POS) covers diagnostic and radiological services, which require prior authorization. Diagnostic tests and procedures have no coinsurance and a copay ranging from $0 to $100, while lab services have no copay. Outpatient X-rays and diagnostic radiological services require a $45 copay (minimum for diagnostic radiological), while therapeutic radiological services carry a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered by Anthem Medicare Advantage 3 (HMO-POS) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Anthem Medicare Advantage 3 (HMO-POS) with no copay and no coinsurance, but prior authorization is required. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and carry a $10 copay.
Skilled Nursing Facility (SNF) See details
Anthem Medicare Advantage 3 (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 3 (HMO-POS) partially covers other services, offering over-the-counter (OTC) items with no copay and no coinsurance up to a maximum of $32 every three months, though acupuncture and meal benefits are not covered.
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