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 $220.00 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 $4900.00 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 an annual drug deductible of $220. Tier 1 preferred generic drugs have no copay for one, two, or three-month supplies at preferred pharmacies, standard pharmacies, and standard mail order. Tier 2 generic drugs also feature no copay at preferred pharmacies and standard mail order, while standard pharmacies charge a copay of $5 for a one-month supply, $10 for two months, and $15 for three months. For brand-name and specialty medications, costs are based on coinsurance. Tier 3 preferred brand drugs require a 25% coinsurance at preferred pharmacies, standard pharmacies, and standard mail order. Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 30% coinsurance, with specialty prescriptions limited to a one-month supply.
Additional Benefits
Anthem Medicare Advantage 3 (HMO-POS) offers comprehensive medical coverage with no copay for primary care visits, telehealth, and home health services. Specialist visits require a $30 copay, while inpatient hospital stays incur a daily copay of $395 for the first five to six days before transitioning to no copay. Emergency room visits carry a $130 copay, and the plan includes up to 24 one-way routine transportation trips with no copay alongside a $250 copay for ambulance services. The plan also features robust supplemental benefits, including no copay for preventive dental care, routine eye exams, and routine hearing exams, with annual allowances of $300 for eyewear and $2,000 for prescription hearing aids. Additionally, members pay no copay for diabetic supplies and receive a $68 quarterly allowance for over-the-counter items, while durable medical equipment and dialysis services require a 0% to 20% coinsurance.
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. For acute stays, you pay a $395 daily copay for days 1-6 and no copay for day 7 and beyond, while psychiatric stays require a $395 daily copay for days 1-5 and no copay thereafter; 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, featuring no copay for ambulatory surgical center and blood services. Outpatient hospital and observation services require a copay ranging from $0.00 to $395.00, while outpatient substance abuse sessions have a $30.00 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 coverage for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Anthem Medicare Advantage 3 (HMO-POS), which charges a $250 copay and no coinsurance for ground or air ambulance services. Additionally, the plan provides up to 24 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, though transportation to other health-related locations 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 limit, with a $130 copay and no coinsurance per service.
Primary Care See details
Anthem Medicare Advantage 3 (HMO-POS) covers primary care and telehealth services with no copay and no coinsurance, while specialist visits, therapies, mental health, psychiatric, and opioid treatment services require a $30 copay and no coinsurance. Other healthcare professionals have a $0 to $15 copay with no coinsurance, whereas chiropractic and podiatry 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. However, additional supplemental preventive services are only partially covered, excluding benefits such as fitness programs, health education, in-home safety assessments, and personal emergency response systems.
Hearing Services See details
Hearing services are covered by Anthem Medicare Advantage 3 (HMO-POS), with Medicare-covered exams requiring a $30 copay and no coinsurance, while routine exams and fittings have no copay or coinsurance. Prescription and OTC hearing aids are covered with no copay or coinsurance up to annual limits of $2,000 and $300 respectively, though prescription hearing aids are only partially covered because inner ear, outer ear, and over the ear models are not covered.
Vision Services See details
Vision services are partially covered by Anthem Medicare Advantage 3 (HMO-POS), featuring no copay and no coinsurance for one routine eye exam per year and up to a $300 annual limit for covered eyewear like contacts and eyeglasses. Other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Dental services under Anthem Medicare Advantage 3 (HMO-POS) are partially covered, with maxillofacial prosthetics, implant services, and orthodontics not covered. Covered preventive services feature no copay and no coinsurance up to a $1,750 annual maximum, while covered comprehensive services require no copay and a 25% coinsurance.
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 is covered with a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require no copay and a 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 across all categories, requiring a 0% to 20% coinsurance for durable medical equipment and a 20% coinsurance for prosthetics and medical supplies. Diabetic equipment, including supplies and therapeutic shoes or inserts, is covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Anthem Medicare Advantage 3 (HMO-POS) covers diagnostic and radiological services with prior authorization required. Diagnostic tests have a $0 to $100 copay and no coinsurance, lab services have no copay and no coinsurance, while radiological services feature a $45 copay for X-rays, a $45 minimum copay for diagnostic radiology, and a 20% coinsurance for therapeutic radiology.
Home Health Services See details
Anthem Medicare Advantage 3 (HMO-POS) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are not covered under the Anthem Medicare Advantage 3 (HMO-POS) plan, including intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) care is covered by Anthem Medicare Advantage 3 (HMO-POS) with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. You will pay no copay for days 1 through 20 and 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 $68 every three months. Acupuncture, meal benefits, and other additional services are not covered under this plan.
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