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 2026, 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 Select counties in OH. This plan received an overall rating of 4 out of 5 stars in 2026.
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 $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 $275.00 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 $9250.00 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 features an annual drug deductible of $275. Under this plan, you will pay no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs at standard and preferred pharmacies. Tier 2 generic drugs also feature no copay at preferred pharmacies and standard mail order, while standard pharmacies charge a small copay starting at $5 for a one-month supply. For higher-tier medications, costs are structured as coinsurance rather than flat copayments. Tier 3 preferred brand drugs require a 25% coinsurance, and Tier 4 non-preferred drugs carry a 30% coinsurance at both preferred and standard locations. Specialty medications in Tier 5 are covered with a 29% coinsurance for a one-month supply.
Additional Benefits
The Anthem Medicare Advantage (HMO-POS) plan offers comprehensive medical coverage with no copay for primary care visits, preventive services, and home health care. For specialist visits, urgent care, and emergency services, members pay fixed copays of $45, $30, and $115 respectively, with no coinsurance. Inpatient hospital stays require a daily copay of $470 for the first five days of acute stays, while outpatient services feature no coinsurance and copays ranging from no copay up to $470. This plan also features valuable supplemental benefits, including routine dental, vision, and hearing services with no copay for routine exams alongside annual allowances for eyewear and hearing aids. Additionally, there is no copay for the first 20 days of skilled nursing facility stays and no copay for diabetic supplies. Members can also take advantage of a $35 quarterly over-the-counter item allowance to help manage everyday health needs.
Inpatient Hospital See details
Anthem Medicare Advantage (HMO-POS) covers inpatient hospital services with no coinsurance, requiring prior authorization. For acute stays, there is a $470 copay per day for days 1 through 5, and psychiatric stays require a $395 copay per day for days 1 through 5, with no copay for additional days; however, upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Anthem Medicare Advantage (HMO-POS) covers outpatient services with no coinsurance, including outpatient blood services and ambulatory surgical center services with no copay. Outpatient hospital services have a copay ranging from $0 to $470, observation services require a $470 copay per stay, and outpatient substance abuse group and individual sessions have a $45 copay.
Partial Hospitalization See details
Anthem Medicare Advantage (HMO-POS) covers partial hospitalization benefits with a $40.00 copay and no coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
Anthem Medicare Advantage (HMO-POS) covers ground and air ambulance services with a $260.00 copay and no coinsurance, though prior authorization is required. Transportation services to plan-approved or any other health-related locations are not covered under this plan.
Emergency Services See details
Anthem Medicare Advantage (HMO-POS) covers emergency services with a $115 copay and urgently needed services with a $30 copay, both featuring no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $100,000 maximum limit with a $115 copay and no coinsurance per service.
Primary Care See details
Anthem Medicare Advantage (HMO-POS) covers primary care and telehealth services with no copay and no coinsurance, while specialist, mental health, and psychiatric visits require a $45 copay and no coinsurance. Physical and occupational therapy are covered with a $35 copay and no coinsurance, though chiropractic services are not covered.
Preventive Services See details
Anthem Medicare Advantage (HMO-POS) offers partial coverage for preventive services with no copay and no coinsurance for covered care such as annual physical exams, kidney disease education, and remote access technologies. Supplemental services not covered under this plan include fitness benefits, health education, in-home safety assessments, personal emergency response systems, weight management programs, and therapeutic massages.
Hearing Services See details
Anthem Medicare Advantage (HMO-POS) covers hearing services with no deductible and no coinsurance, featuring routine exams and fitting evaluations for no copay, and Medicare-covered exams for a $45 copay. Prescription hearing aids are partially covered up to $2,000 yearly with no copay or coinsurance (excluding inner ear, outer ear, and over the ear types), while OTC hearing aids are covered up to $300 yearly with no copay or coinsurance.
Vision Services See details
Anthem Medicare Advantage (HMO-POS) offers partially covered vision services, which include one routine eye exam per year and eyewear up to a $175 annual limit with no copay and no coinsurance. Other eye exam services and eyewear upgrades are not covered by the plan.
Dental Services See details
Anthem Medicare Advantage (HMO-POS) partially covers dental services up to a $1,000 annual limit, offering preventive care with no copay and no coinsurance, and comprehensive services with no copay and 25% coinsurance. Under this plan, implant services, orthodontics, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Anthem Medicare Advantage (HMO-POS) with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and 0% to 20% coinsurance.
Dialysis Services See details
Anthem Medicare Advantage (HMO-POS) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
Anthem Medicare Advantage (HMO-POS) covers durable medical equipment and prosthetics with no copay and 0% to 20% coinsurance, subject to prior authorization. Diabetic supplies and therapeutic shoes are also covered with no copay and no coinsurance, though brand limitations may apply.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Anthem Medicare Advantage (HMO-POS), with prior authorization required. Diagnostic lab services have no copay and no coinsurance, while other diagnostic procedures and tests range from a $0 to $95 copay with no coinsurance. Radiological services require a $90 copay for X-rays, a minimum $50 copay for diagnostic radiology, and a 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home health services are covered under the Anthem Medicare Advantage (HMO-POS) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Anthem Medicare Advantage (HMO-POS) plan with no coinsurance and prior authorization required, though only some services are covered as cardiac, intensive cardiac, pulmonary, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Anthem Medicare Advantage (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. Patients pay no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, with no coverage provided for additional days.
Other Services See details
Anthem Medicare Advantage (HMO-POS) offers partial coverage for other services with no copay and no coinsurance, including chronic illness meals, community resource support, and a $35 quarterly over-the-counter item allowance. Acupuncture is not covered under this benefit.
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