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 $24.00. 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 $6300.00 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) prescription drug plan has an annual drug deductible of $250. For Tier 1 preferred generic and Tier 2 generic medications, there is no copay when using a preferred pharmacy or standard mail order. If you utilize a standard pharmacy, copays start at $5 for Tier 1 drugs and $10 for Tier 2 drugs for a one-month supply. For higher-tier medications, costs are based on coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 25% coinsurance, while Tier 4 non-preferred drugs require a 30% coinsurance. Tier 5 specialty drugs also have a 30% coinsurance and are limited to a one-month supply.
Additional Benefits
The Anthem Medicare Advantage 3 (HMO-POS) plan offers comprehensive medical coverage with no copay for primary care visits, telehealth, and preventive care. For specialized care, members pay a $30 copay for specialist visits and outpatient therapies, while emergency room visits carry a $130 copay. Inpatient hospital stays require a $389 daily copay for the first few days with no coinsurance, after which there is no copay. This plan also includes essential supplemental benefits, featuring no copay or coinsurance for routine dental, vision, and hearing exams, alongside allowances for eyewear and hearing aids. Skilled nursing facility stays have no copay for the first 20 days, and home health services are covered with no copay or coinsurance. Additionally, members receive up to 24 one-way transportation trips per year and a $50 quarterly allowance for over-the-counter items with no copay.
Inpatient Hospital See details
Anthem Medicare Advantage 3 (HMO-POS) partially covers inpatient hospital services with no coinsurance, requiring a $389 daily copay for days 1 through 6 of acute stays and days 1 through 5 of psychiatric stays, with no copay for subsequent days. Prior authorization is required, and non-Medicare-covered stays and room upgrades are not covered.
Outpatient Services See details
Outpatient services are covered by Anthem Medicare Advantage 3 (HMO-POS) with no coinsurance, featuring a $0 to $415 copay for outpatient hospital services and a $415 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $30 copay and no coinsurance.
Partial Hospitalization See details
Anthem Medicare Advantage 3 (HMO-POS) covers partial hospitalization services with a $40.00 copay and no coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
Anthem Medicare Advantage 3 (HMO-POS) covers ground and air ambulance services with a $265 copay per trip and no coinsurance. Transportation services are partially covered with no copay or coinsurance for up to 24 one-way trips per year to plan-approved locations, while transportation to any health-related location is 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 benefit with a $130 copay and no coinsurance per service.
Primary Care See details
Anthem Medicare Advantage 3 (HMO-POS) offers primary care and telehealth services with no copay and no coinsurance, while specialists, physical, occupational, speech, mental health, psychiatric, and opioid treatment services require a $30 copay and no coinsurance. Other healthcare professional services have a copay of $0 to $15 with no coinsurance, podiatry is not covered, and though some chiropractic services are covered, routine and other chiropractic services are not covered.
Preventive Services See details
Preventive services are covered by Anthem Medicare Advantage 3 (HMO-POS) with no copay and no coinsurance for annual physical exams, kidney disease education, remote access technologies, and select screenings. This benefit is partially covered, as health education, fitness benefits, in-home safety assessments, personal emergency response systems, nutritional/dietary benefits, and alternative therapies are not covered.
Hearing Services See details
Anthem Medicare Advantage 3 (HMO-POS) covers hearing services, offering routine exams and fitting evaluations with no copay or coinsurance, and Medicare-covered exams for a $30 copay and no coinsurance. Prescription hearing aids are partially covered up to $2,000 annually and over-the-counter hearing aids up to $300 annually, both with no copay or coinsurance, though inner, outer, and over-the-ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by Anthem Medicare Advantage 3 (HMO-POS), offering one annual routine eye exam and eyewear like contacts and eyeglasses with no copay and no coinsurance, up to a $200 yearly limit. Other eye exam services and eyewear upgrades are not covered by the plan.
Dental Services See details
Anthem Medicare Advantage 3 (HMO-POS) partially covers dental services, offering preventive care with no copay and no coinsurance up to a $1,200 annual maximum. Comprehensive treatments like restorative and endodontic services are covered with no copay and 25% coinsurance, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Anthem Medicare Advantage 3 (HMO-POS) 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 require no coinsurance 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
Anthem Medicare Advantage 3 (HMO-POS) covers medical equipment with no copays for durable medical equipment (DME), prosthetics, medical supplies, and diabetic equipment. Members will pay a 0% to 20% coinsurance for DME, a 20% coinsurance for prosthetics and medical supplies, and no coinsurance for diabetic supplies and therapeutic shoes.
Diagnostic and Radiological Services See details
Anthem Medicare Advantage 3 (HMO-POS) covers diagnostic services with no coinsurance, featuring no copay for lab services and copays up to $100 for diagnostic tests. Radiological services require prior authorization and include 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. Prior authorization is required to receive this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Anthem Medicare Advantage 3 (HMO-POS) plan. This includes intensive cardiac, pulmonary, and supervised exercise therapy (SET) rehabilitation services, which are all excluded from coverage.
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 allowing admission without a prior three-day inpatient hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, though 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 benefit of $50 every three months. Acupuncture, meal benefits, and other additional services are not covered.
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