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 $275.00 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 $4775.00 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 a $275 drug deductible. For Tier 1 preferred generic and Tier 2 generic medications, members enjoy no copay for 1-month, 2-month, or 3-month supplies filled at preferred pharmacies or through standard mail order. If you choose a standard pharmacy, copays range from $5 to $15 for Tier 1 drugs and $10 to $30 for Tier 2 drugs, depending on the supply duration. For Tier 3 preferred brand and Tier 4 non-preferred drugs, you will pay a 25% coinsurance across preferred pharmacies, standard pharmacies, and standard mail order options. Specialty Tier 5 drugs require a 29% coinsurance for a 1-month supply. This straightforward cost-sharing structure helps you easily estimate your out-of-pocket prescription expenses.
Additional Benefits
The Anthem Medicare Advantage 3 (HMO-POS) plan offers comprehensive medical coverage with no copay and no coinsurance for primary care visits, telehealth, and home health services. For other medical needs, members pay a predictable $25 copay for specialist visits and a $130 copay for emergency room visits, with no coinsurance. Inpatient hospital stays require a $395 daily copay for the first several days, after which there is no copay. In addition to medical care, the plan features built-in dental, vision, and hearing benefits with no copays for routine exams and preventive care. Members also benefit from generous allowances, including up to $2,000 for preventive dental, $2,000 for prescription hearing aids, and $200 for eyewear, all with no copays. Additionally, the plan includes up to 24 free one-way trips to approved health locations and a $75 quarterly over-the-counter item allowance with no copay.
Inpatient Hospital See details
Anthem Medicare Advantage 3 (HMO-POS) covers inpatient acute and psychiatric hospital stays with no coinsurance, though prior authorization is required. You will pay a $395 daily copay for days 1 through 6 of an acute stay and days 1 through 5 of a psychiatric stay, with no copay for additional days, while upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Anthem Medicare Advantage 3 (HMO-POS) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services which also feature no copays. Outpatient hospital services carry a copay of $0 to $395, observation services cost a $395 copay per stay, and outpatient substance abuse sessions require a $25 copay.
Partial Hospitalization See details
Anthem Medicare Advantage 3 (HMO-POS) covers partial hospitalization services with a $40.00 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Anthem Medicare Advantage 3 (HMO-POS), with ground and air ambulance services requiring prior authorization and a $255 copay with no coinsurance. Transportation services are partially covered with no copay or coinsurance for up to 24 one-way trips per year to plan-approved health-related locations, but trips to any health-related location are not covered.
Emergency Services See details
Emergency services are covered by Anthem Medicare Advantage 3 (HMO-POS) with a $130 copay and no coinsurance, while urgently needed services require a $50 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $100,000 maximum benefit with a $130 copay and no coinsurance.
Primary Care See details
Anthem Medicare Advantage 3 (HMO-POS) covers primary care and telehealth visits with no copay and no coinsurance, while specialist visits, therapy services, and mental health sessions require a $25 copay and no coinsurance. Chiropractic and podiatry services are not covered under this plan.
Preventive Services See details
Preventive services are partially covered by Anthem Medicare Advantage 3 (HMO-POS) with no copay and no coinsurance for annual physicals, kidney disease education, remote access technologies, and select screenings. However, several supplemental benefits are not covered, including fitness benefits, health education, in-home safety assessments, nutritional therapy, and personal emergency response systems.
Hearing Services See details
Anthem Medicare Advantage 3 (HMO-POS) hearing services feature a $25 copay and no coinsurance for Medicare-covered exams, while annual 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, though inner ear, outer ear, and over the ear models are not covered. OTC hearing aids are covered with no copay or coinsurance up to a $300 yearly maximum.
Vision Services See details
Anthem Medicare Advantage 3 (HMO-POS) provides partially covered vision services with no coinsurance and no copays for one annual routine eye exam and eligible eyewear, which features a $200 yearly limit. Other eye exam services and eyewear upgrades are not covered under this plan.
Dental Services See details
Anthem Medicare Advantage 3 (HMO-POS) covers preventive dental services with no copay and no coinsurance up to a $2,000 annual maximum. Comprehensive dental services are partially covered with no copay and a 25% coinsurance, though maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Anthem Medicare Advantage 3 (HMO-POS) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while Part B chemotherapy, radiation, and other drugs require 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by Anthem Medicare Advantage 3 (HMO-POS) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Anthem Medicare Advantage 3 (HMO-POS) with no copays for durable medical equipment (DME), prosthetics, and diabetic supplies. DME requires 0% to 20% coinsurance, prosthetics and medical supplies carry a 20% coinsurance, and diabetic equipment features no coinsurance.
Diagnostic and Radiological Services See details
Anthem Medicare Advantage 3 (HMO-POS) covers diagnostic services with no coinsurance, offering lab services with no copay and diagnostic procedures with a $0 to $100 copay. Radiological services are also covered, requiring a $45 copay for outpatient X-rays, a minimum $45 copay for diagnostic radiological services, and a minimum 20% coinsurance for therapeutic radiological services.
Home Health Services See details
Anthem Medicare Advantage 3 (HMO-POS) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Anthem Medicare Advantage 3 (HMO-POS) does not cover Cardiac Rehabilitation Services, as standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) rehabilitation services are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Anthem Medicare Advantage 3 (HMO-POS) with no coinsurance, requiring prior authorization and no prior three-day inpatient hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Anthem Medicare Advantage 3 (HMO-POS) partially covers other services, providing over-the-counter (OTC) items with no copay and no coinsurance up to a maximum of $75 every three months. Acupuncture, meal benefits, and dual-eligible SNP services are not covered under this plan.
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