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 2025, 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 2025.
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 $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 $3900.00 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 has a $150 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs, you'll pay a $5 copay at a preferred pharmacy, $10 at a standard pharmacy, and no copay for standard mail order. Standard generic drugs have a 20% coinsurance, while preferred brand drugs have a 35% coinsurance. Non-preferred drugs have a 31% coinsurance. After your yearly out-of-pocket drug costs reach $2000, you will pay nothing for covered drugs.
Additional Benefits
The Anthem Medicare Advantage 3 (HMO-POS) plan offers a variety of health benefits with varying cost-sharing. It covers inpatient hospital stays with a copay, and outpatient services, including primary care, with copays between $0 and $40. The plan also includes coverage for emergency services, hearing, vision, and dental services, often with no copay or low copays, along with coverage for home health services. This plan offers additional benefits such as ambulance and transportation services, with copays ranging from $0-$270. Other services like home infusion, medical equipment, and skilled nursing facilities are covered, but may have coinsurance or copays. The plan also covers preventive services with no copay, but certain services like health education and in-home safety assessments are not covered.
Inpatient Hospital See details
Inpatient hospital services are covered, including acute and psychiatric care, with prior authorization required. For acute care, you will pay a $395 copay for days 1-6, and no copay for days 7-90; for psychiatric care, the copay is $395 for days 1-5, and no copay for days 6-90. Additional days for both acute and psychiatric care are covered with no copay, while non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services are covered. Outpatient Hospital Services have a copay between $0 and $395, Observation Services have a $395 copay, Outpatient Substance Abuse services have a $40 copay, and Ambulatory Surgical Center Services and Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by Anthem Medicare Advantage 3 (HMO-POS), with a $40 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Anthem Medicare Advantage 3 (HMO-POS) plan, with a $270 copay for both ground and air ambulance services and no coinsurance. Transportation Services to a plan-approved health-related location are covered with no copay, but are limited to 24 one-way trips per year, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Anthem Medicare Advantage 3 (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage have a $140 copay, while Urgently Needed Services has a $50 copay. Worldwide Emergency Services has a maximum plan benefit coverage of $100,000. There is no coinsurance for any of these services.
Primary Care See details
Primary Care benefits include no copay for Primary Care Physician Services, a $20 copay for Chiropractic Services (with routine care not covered), and a $40 copay for Occupational Therapy Services. Physician Specialist Services have a $25 copay, while Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services have a $40 copay for individual and group sessions. Physical Therapy and Speech-Language Pathology Services have a $40 copay, and Additional Telehealth Benefits have no copay.
Preventive Services See details
Preventive Services include annual physical exams with no copay, and other services like Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay. Some services like Health Education, In-Home Safety Assessment, and others are not covered.
Hearing Services See details
Hearing exams have a $25 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids have a maximum benefit of $2,000 per year, and OTC hearing aids have no copay with a maximum benefit of $300 per year.
Vision Services See details
Vision services include eye exams with a copay of $0-$25, and eyewear with no copay, including contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames with no copay, and an allowance of $200 per year. Upgrades are not covered.
Dental Services See details
Dental services are covered, including oral exams, dental x-rays, and other diagnostic services, with no copay. Other covered services include prophylaxis (cleaning), fluoride treatment, and orthodontic services, also with no copay, up to a maximum of $2000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B insulin drugs, there is a $35 copay. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, coinsurance ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the Anthem Medicare Advantage 3 (HMO-POS) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment benefits are covered under the Anthem Medicare Advantage 3 (HMO-POS) plan. Durable Medical Equipment (DME) has a coinsurance of 0-20% and no copay, while Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay. Prosthetic Devices and Medical Supplies are covered with a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, are covered, with copays ranging from $0 to $100 for diagnostic procedures/tests and no copay for lab services. Diagnostic radiological services have a copay of at most $395, with a minimum copay of $45, while therapeutic radiological services have a coinsurance of at least 20%. Outpatient X-Ray services have a copay of $45.
Home Health Services See details
Home Health Services are covered by the Anthem Medicare Advantage 3 (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, but Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required for Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Anthem Medicare Advantage 3 (HMO-POS) plan, but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100, but additional days beyond Medicare coverage and non-Medicare-covered stays are not covered.
Other Services See details
Other Services are covered by the Anthem Medicare Advantage 3 (HMO-POS) plan, but acupuncture, meal benefits, dual eligible SNPs, 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. Over-the-counter (OTC) items are covered with no copay.
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