A non-government entity
Anthem Medicare Advantage (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem Medicare Advantage (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 (HMO-POS) in 2025, please refer to our full plan details page.
Anthem Medicare Advantage (HMO-POS) is a HMO-POS plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in State of New Hampshire. This plan received an overall rating of 2.5 out of 5 stars in 2025.
It's important to know that Anthem Medicare Advantage (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 (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 (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $26.00. 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 $350.00 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 $6800.00 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 (HMO-POS) plan has a $350 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and pharmacy. For example, in the initial coverage phase, preferred generic drugs have a $1 copay at preferred pharmacies, while standard mail orders have no copay. Specialty tier drugs have no copay at any pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Anthem Medicare Advantage (HMO-POS) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services may have coinsurance or copays depending on the service. Emergency services and ambulance services are covered with copays. This plan includes coverage for primary care with no copay, and specialist visits with a copay. Preventive services and routine hearing exams have no copay, while hearing aids have a maximum annual benefit. Vision and dental services are also covered, and many other services such as home health and medical equipment have no copays.
Inpatient Hospital See details
Inpatient hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you pay a $415 copay for days 1-5, and no copay for days 6-90. For Inpatient Hospital Psychiatric, you pay a $415 copay for days 1-4, and no copay for days 5-90. 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 include all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services have a 30% coinsurance and no copay, while Observation Services have a 30% coinsurance. Ambulatory Surgical Center (ASC) Services have a 25% coinsurance and no copay. Individual and Group Sessions for Outpatient Substance Abuse have a $40 copay. Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Anthem Medicare Advantage (HMO-POS) plan, but requires prior authorization. The copay for this benefit is $50.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground and air ambulance services have a copay of $330, and there is no coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are covered by the Anthem Medicare Advantage (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, Urgently Needed Services has a $45 copay, and Worldwide Urgent Coverage and Worldwide Emergency Transportation each have a $110 copay.
Primary Care See details
Primary Care Physician Services have no copay, Chiropractic Services have a $15 copay, Occupational Therapy Services have a $35 copay, Physician Specialist Services have a $45 copay, and Physical Therapy and Speech-Language Pathology Services have a $40 copay. Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services have a $40 copay for individual and group sessions, while Podiatry Services have a copay between $0 and $45 and Other Health Care Professional services have a copay between $0 and $20. Additional Telehealth Benefits have no copay.
Preventive Services See details
The Anthem Medicare Advantage (HMO-POS) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services are covered, but specific services like Health Education, In-Home Safety Assessment, and others are not covered.
Hearing Services See details
Hearing exams are covered with a $45 copay, and routine hearing exams have no copay. Fitting/evaluation for hearing aids has no copay. Prescription hearing aids are covered, with a maximum benefit of $1,000 every year and no copay for all types of prescription hearing aids. OTC hearing aids are covered with no copay, with a maximum benefit of $300 per year for both ears combined.
Vision Services See details
The Anthem Medicare Advantage (HMO-POS) plan covers vision services, including routine eye exams with a copay of $0-$45, and eyewear with no copay. Eyewear includes contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames, with a combined maximum plan benefit of $125 per year.
Dental Services See details
Dental services are covered, including oral exams, dental x-rays, and other diagnostic dental services with no copay. Other preventive dental services, including prophylaxis (cleaning) and fluoride treatment, are covered with no copay, and there is a $1,750 annual maximum plan benefit.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Anthem Medicare Advantage (HMO-POS) plan, with prior authorization required. Medicare Part B insulin drugs have a $35 copay, while 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 (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has no copay, and a 0-20% coinsurance, with prior authorization required and preferred vendors. Prosthetic Devices and Medical Supplies have no copay, with 20% coinsurance for Medicare-covered services. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
The Anthem Medicare Advantage (HMO-POS) plan covers diagnostic and radiological services. Diagnostic Procedures/Tests have a copay between $0 and $100, and Lab Services have no copay. Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Anthem Medicare Advantage (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 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, or Additional Cardiac Rehabilitation Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Anthem Medicare Advantage (HMO-POS) with prior authorization required. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
Other Services include Over-the-Counter (OTC) Items with no copay, but Acupuncture, Meal Benefits, 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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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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