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Anthem Medicare Advantage 2 (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem Medicare Advantage 2 (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 2 (HMO-POS) in 2025, please refer to our full plan details page.
Anthem Medicare Advantage 2 (HMO-POS) is a HMO-POS plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Select counties in MO. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Anthem Medicare Advantage 2 (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 2 (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 2 (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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3200.00 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 2 (HMO-POS) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay varying costs depending on the drug tier and pharmacy type. For example, preferred generic drugs have no copay at preferred and standard pharmacies, while standard generic drugs have 20% coinsurance at preferred pharmacies and 25% coinsurance at standard pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs. However, you may still have to pay a share of the costs for excluded drugs covered under any enhanced benefit. This plan also has a Part D premium reduction for those who qualify for the low-income subsidy.
Additional Benefits
The Anthem Medicare Advantage 2 (HMO-POS) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a copay of $295 per day for the first 6 days, and then no copay for the remaining days. Outpatient services, primary care, and preventive services generally have no copay, but some services like specialist visits and certain therapies have a $30 copay. The plan also covers hearing, vision, and dental services, with hearing exams costing $30 and prescription hearing aids covered up to $3,000 annually. Vision and dental services have no copay, with a $350 annual maximum for eyewear. Emergency, ambulance, and transportation services are included with copays ranging from $30 to $295.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, both requiring prior authorization. For the first 6 days of an inpatient stay, there is a $295 copay per day, and days 7-90 have no copay; additional days for both acute and psychiatric services are covered with no copay. Non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient services are covered, including outpatient hospital services with a copay between $0 and $295, observation services with a $295 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services, including individual and group sessions, have a copay of $30, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by Anthem Medicare Advantage 2 (HMO-POS) with a $40 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Anthem Medicare Advantage 2 (HMO-POS) plan. Ground and air ambulance services have a copay of $295, and transportation services to a plan-approved health-related location have no copay for up to 30 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Anthem Medicare Advantage 2 (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage have a $140 copay, while Urgently Needed Services have a $30 copay; all services have no coinsurance.
Primary Care See details
Under the Anthem Medicare Advantage 2 (HMO-POS) plan, primary care physician services are covered with no copay, while chiropractic services have a $20 copay. Occupational therapy services have a $30 copay, and physician specialist services have a $30 copay. Mental health specialty services, psychiatric services, and opioid treatment program services all have a $30 copay, while physical therapy and speech-language pathology services have a $30 copay. Podiatry services and other health care professional services have copays ranging from $0 to $30. Additional telehealth benefits are covered with no copay.
Preventive Services See details
Preventive Services, including Medicare-covered services, the Annual Physical Exam, and other preventive services, are covered by the Anthem Medicare Advantage 2 (HMO-POS) plan. The Annual Physical Exam has no copay, and additional preventive services may have a copay. Other services like Health Education, In-Home Safety Assessment, and others are not covered.
Hearing Services See details
The Anthem Medicare Advantage 2 (HMO-POS) plan covers hearing exams with a $30 copay, routine hearing exams with no copay, fitting/evaluation for hearing aids with no copay, and OTC hearing aids with no copay. Prescription hearing aids are covered with a maximum plan benefit of $3000 per year, while prescription hearing aids for inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision services include eye exams, routine eye exams, eyewear, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. Eye exams have a copay of $0-$30, routine eye exams have no copay, and eyewear, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades have no copay. Eyewear has a combined maximum benefit of $350 per year.
Dental Services See details
Dental services are covered, including oral exams, dental x-rays, other diagnostic services, cleanings, fluoride treatments, and other preventive services with no copay, and other services including restorative, endodontics, periodontics, prosthodontics (removable and fixed), oral and maxillofacial surgery, and orthodontics with no copay. This plan has a $2,500 annual maximum for other dental services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, requiring prior authorization. Medicare Part B Insulin Drugs have a $35 copay, while 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 under the Anthem Medicare Advantage 2 (HMO-POS) plan. The plan has a coinsurance of 20% for dialysis services.
Medical Equipment See details
Medical equipment is covered under the Anthem Medicare Advantage 2 (HMO-POS) plan. Durable Medical Equipment (DME) has no copay, with 0-20% coinsurance, and requires prior authorization. Prosthetics/Medical Supplies - Non-Medicare benefit and Medical Supplies have no copay and 20% coinsurance. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a copay between $0 and $95, lab services with no copay, and outpatient X-ray services with a $75 copay. Therapeutic radiological services have a coinsurance of at least 20%, and diagnostic radiological services have a copay up to $195.
Home Health Services See details
Home Health Services are covered by the Anthem Medicare Advantage 2 (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 by the Anthem Medicare Advantage 2 (HMO-POS) plan, but the specific services are not covered. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Anthem Medicare Advantage 2 (HMO-POS), but require prior authorization. For days 1-20, the copay is $20, and for days 21-100, the copay is $214; there is no coinsurance. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Anthem Medicare Advantage 2 (HMO-POS) plan covers over-the-counter items and meal benefits with no copay. Other services like acupuncture, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and many more are not covered.
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