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 $6750.00 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:
Sign up for Anthem Medicare Advantage (HMO-POS)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Anthem Medicare Advantage (HMO-POS) plan features an annual prescription drug deductible of $275. Under this plan, you will pay no copay for Tier 1 (Preferred Generic) and Tier 6 (Select Care) drugs at preferred or standard pharmacies, as well as through standard mail order. Tier 2 (Generic) drugs also feature no copay at preferred pharmacies and standard mail order, while standard pharmacies require a copay ranging from $5 to $15 depending on the supply. For brand-name and specialty medications, your costs are determined by coinsurance rather than flat copays. Tier 3 (Preferred Brand) drugs require a 25% coinsurance, and Tier 4 (Non-Preferred) drugs carry a 30% coinsurance at both preferred and standard pharmacies. Tier 5 (Specialty) drugs require 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 provider visits, telehealth, annual physicals, and home health services. For specialized care, members pay a $40 copay for specialists and physical therapy, while inpatient hospital stays require daily copays starting at $400 for the first five days. Emergency room visits have a $130 copay, and urgent care is available for a $30 copay, both with no coinsurance. Additional benefits include routine vision, hearing, and preventive dental care with no copay or coinsurance, alongside annual allowances for eyewear, hearing aids, and over-the-counter items. Comprehensive dental services are covered with no copay and a 25% coinsurance up to a $1,500 annual limit. Skilled nursing facility care features no copay for the first 20 days, followed by a $218 daily copay for days 21 through 100.
Inpatient Hospital See details
Anthem Medicare Advantage (HMO-POS) inpatient hospital benefits are partially covered with no coinsurance, as upgrades and non-Medicare-covered stays are not covered. Under this plan, acute care requires a $400 daily copay for days 1 through 5, while psychiatric care requires a $310 daily copay for days 1 through 7, with no copays for any additional days.
Outpatient Services See details
Anthem Medicare Advantage (HMO-POS) covers outpatient services with no coinsurance, including no copay for ambulatory surgical center and blood services. Outpatient hospital services require a copay ranging from no copay to $400 (with a $400 copay per stay for observation services), while outpatient substance abuse sessions have a $40 copay.
Partial Hospitalization See details
Anthem Medicare Advantage (HMO-POS) covers partial hospitalization services with a $40.00 copay and no coinsurance. Prior authorization is required to receive coverage for this benefit.
Ambulance and Transportation Services See details
Anthem Medicare Advantage (HMO-POS) covers ground and air ambulance services with a $260 copay and no coinsurance, though prior authorization is required. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Anthem Medicare Advantage (HMO-POS) covers emergency services with a $130 copay and no coinsurance, and urgently needed services with a $30 copay and no coinsurance. Worldwide emergency, urgent, and emergency transportation services are also covered up to a $100,000 maximum benefit with a $130 copay and no coinsurance.
Primary Care See details
Anthem Medicare Advantage (HMO-POS) offers primary care benefits that are partially covered, as chiropractic services are not covered. Covered services feature no coinsurance, with no copay for primary care provider visits and telehealth, and a $40 copay for specialists, physical therapy, and mental health services.
Preventive Services See details
Preventive services are covered by Anthem Medicare Advantage (HMO-POS) with no copay and no coinsurance for annual physical exams, kidney disease education, remote access technologies, and screenings for glaucoma and diabetes. However, the benefit is only partially covered, as services like health education, fitness benefits, personal emergency response systems, in-home safety assessments, and weight management programs are not covered.
Hearing Services See details
Anthem Medicare Advantage (HMO-POS) covers hearing exams with a $40 copay for Medicare-covered exams and no copay or coinsurance for routine annual exams and fittings. Prescription hearing aids are partially covered up to $3,000 annually with no copay or coinsurance, though inner ear, outer ear, and over-the-ear models are not covered. Over-the-counter hearing aids are also covered up to $300 per year with no copay or coinsurance, with prior authorization required for all services.
Vision Services See details
Vision services are partially covered by Anthem Medicare Advantage (HMO-POS), offering routine eye exams and eyewear with no copay and no coinsurance. Covered eyewear includes contacts and eyeglasses up to a $200 annual maximum, while other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Anthem Medicare Advantage (HMO-POS) provides partially covered dental services up to a $1,500 annual maximum, offering preventive care with no copay and no coinsurance. Comprehensive services are covered with no copay and a 25% coinsurance, though maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Anthem Medicare Advantage (HMO-POS) covers home infusion bundled services with no copay, though prior authorization is required. Covered Part B insulin drugs have a $35 copay and no coinsurance, while Part B chemotherapy, radiation, and other drugs require no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Anthem Medicare Advantage (HMO-POS) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Anthem Medicare Advantage (HMO-POS) with no copays, featuring 0% to 20% coinsurance for durable medical equipment and 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 (HMO-POS) covers diagnostic and radiological services, with prior authorization required for all services. Diagnostic tests have a $0 to $95 copay and no coinsurance, lab services have no copay or coinsurance, and radiological services require a $90 copay plus coinsurance for X-rays, a copay starting at $50 with no coinsurance for diagnostic radiology, or a minimum 20% coinsurance with no copay for therapeutic radiology.
Home Health Services See details
Home health services are covered by Anthem Medicare Advantage (HMO-POS) with no copay and no coinsurance, though 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 required prior authorization. Although some services are covered, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered, with copays for these services ranging from $15 to $35.
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. 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 (HMO-POS) partially covers other services with no copay and no coinsurance, which includes chronic illness meal benefits, Medicare Community Resource Support, and up to $30 every three months for over-the-counter items. Acupuncture is not covered under this benefit.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved