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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 $19.00. 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 $250.00 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 $250 deductible for prescription drugs. After the deductible, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs, you'll pay a $5 copay at preferred pharmacies, $10 at standard pharmacies, and no copay via standard mail order. Standard generic drugs have a 20% coinsurance, while preferred and non-preferred brand drugs have 35% and 30% coinsurance respectively.
Additional Benefits
The Anthem Medicare Advantage 3 (HMO-POS) plan offers coverage for a wide range of services. This plan includes coverage for inpatient and outpatient hospital services, along with primary care, preventive services, hearing, vision, and dental. Many services have no copay, but some services like inpatient hospital stays, specialist visits, and hearing exams have copays. Additional benefits include ambulance and transportation services, emergency services, and home health services, all of which have no coinsurance. The plan also covers services like home infusion, dialysis, and medical equipment, with varying cost-sharing. This plan does not cover some services, such as additional hours of care, and personal care services.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, there is a $415 copay for days 1-6, and no copay for days 7-90. For Inpatient Hospital Psychiatric, there is a $415 copay for days 1-5, and no copay for days 6-90. Additional days for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are covered with no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including all 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 $415, and Observation Services have a copay of $415, while Ambulatory Surgical Center Services and Outpatient Blood Services have no copay. Individual and Group sessions for Outpatient Substance Abuse services each have a $40 copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Anthem Medicare Advantage 3 (HMO-POS) plan, with a $40 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with no coinsurance for any services. Ground and air ambulance services have a $270 copay, while transportation services to a plan-approved health-related location have no copay. 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. For emergency services, the copay is $140.00 with no coinsurance, while urgently needed services have a $50.00 copay with no coinsurance. Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $140.00 copay with no coinsurance.
Primary Care See details
Primary Care benefits include no copay for Primary Care Physician Services, a $20 copay for Chiropractic Services (routine care not covered), a $40 copay for Occupational Therapy Services, a $30 copay for Physician Specialist Services, and a $40 copay for both Individual and Group Sessions for Mental Health Specialty Services and Psychiatric Services. Physical Therapy and Speech-Language Pathology Services have a $40 copay, and Additional Telehealth Benefits have no copay. Opioid Treatment Program Services have a $40 copay.
Preventive Services See details
Preventive Services include no copay for an annual physical exam, and many other services with no copay, including Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. Other preventive services are covered but have a copay. Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, and Telemonitoring Services are not covered.
Hearing Services See details
The Anthem Medicare Advantage 3 (HMO-POS) plan covers hearing services, including hearing exams with a $30 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with no copay for all types, and OTC hearing aids are covered with no copay up to a maximum of $300 per year.
Vision Services See details
The Anthem Medicare Advantage 3 (HMO-POS) plan covers vision services including eye exams and eyewear. Eye exams have a copay of $0-$30, while routine eye exams have no copay. Eyewear, including contact lenses, eyeglasses, and eyeglass lenses and frames, has no copay, but upgrades are not covered, and there is a combined maximum of $250 per year for eyewear.
Dental Services See details
Dental services are covered under the Anthem Medicare Advantage 3 (HMO-POS) plan, including oral exams, dental x-rays, and other diagnostic services, with no copay. Other services, such as restorative services, endodontics, periodontics, and orthodontics, are covered with no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Insulin has a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Anthem Medicare Advantage 3 (HMO-POS) plan. You will pay 20% coinsurance for this service.
Medical Equipment See details
Medical Equipment is covered by Anthem Medicare Advantage 3 (HMO-POS), including Durable Medical Equipment (DME) with a 0-20% coinsurance and Prosthetics/Medical Supplies - Non-Medicare benefit and Medical Supplies with a 20% coinsurance. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay, and there is no copay for DME, but Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Anthem Medicare Advantage 3 (HMO-POS) plan, with a copay for diagnostic procedures/tests ranging from $0 to $100, and no copay for lab services. Diagnostic Radiological Services have a copay that ranges from $45 to $415, while Therapeutic Radiological Services have 20% coinsurance, and Outpatient X-Ray Services have a $45 copay.
Home Health Services See details
Home Health Services are covered with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered under this plan.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services. Prior authorization is required, and there is a copay for covered services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Anthem Medicare Advantage 3 (HMO-POS) with prior authorization required. There is no copay for days 1-20, and a $214 copay for days 21-100; additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items with no copay. Other services such as Acupuncture, Meal Benefit, Dual Eligible SNPs with Highly Integrated Services, 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.
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