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 $6500.00 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)
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Drug Coverage
The Anthem Medicare Advantage (HMO-POS) plan features an annual drug deductible of $275. You will pay no copay for Tier 1 preferred generic and Tier 6 select care drugs at both preferred and standard pharmacies, as well as through standard mail order. Tier 2 generic medications also have no copay at preferred pharmacies and standard mail order, while standard pharmacies charge a copay ranging from $5 to $15. For higher-tier medications, your costs are based on coinsurance percentages. Tier 3 preferred brands require a 25% coinsurance, and Tier 4 non-preferred drugs carry a 30% coinsurance at standard and preferred locations. Tier 5 specialty drugs require a 29% coinsurance for a one-month supply across all pharmacy and mail order options.
Additional Benefits
Anthem Medicare Advantage (HMO-POS) provides robust healthcare coverage featuring no copay for primary care visits, telehealth services, and preventive care. Specialist visits carry a $50 copay, while inpatient hospital stays require a daily copay for the first seven days with no coinsurance. Emergency room visits are covered with a $130 copay, and urgent care services require a $30 copay. This plan also includes valuable supplemental benefits with no copay for routine dental, vision, and hearing exams, alongside annual allowances for eyewear and hearing aids. While home health services and diabetic supplies have no copay, durable medical equipment and dialysis services require up to a 20% coinsurance. Comprehensive dental services are also available with no copay and a 25% coinsurance up to a $1,000 annual maximum.
Inpatient Hospital See details
Anthem Medicare Advantage (HMO-POS) partially covers inpatient hospital services with no coinsurance, requiring prior authorization and a daily copay of $437 for days 1-7 of acute stays and $310 for days 1-7 of psychiatric stays, with no copay for subsequent days. 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 ambulatory surgical center and outpatient blood services at no copay. Outpatient hospital and observation services require prior authorization with copays ranging from $0 to $437, while outpatient substance abuse sessions carry a $50 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 for this covered 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 and the copay is not waived upon hospital admission. Transportation services are not covered in practice, as trips to both plan-approved and general health-related locations are excluded.
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 transportation services are also covered up to a $100,000 maximum limit, with a $130 copay and no coinsurance for each service.
Primary Care See details
Anthem Medicare Advantage (HMO-POS) primary care benefits feature no copay and no coinsurance for primary care provider visits and telehealth services, though chiropractic services are not covered. Other covered services, including specialist visits, physical and occupational therapy, mental health, psychiatric, and opioid treatment services, carry a $50 copay and no coinsurance, while podiatry and other healthcare professional services range from no copay up to a $50 copay with no coinsurance.
Preventive Services See details
Anthem Medicare Advantage (HMO-POS) provides partial coverage for preventive services with no copay and no coinsurance for covered care, including annual physical exams, remote access technologies, and kidney disease education. However, several supplemental benefits are not covered, such as fitness benefits, health education, in-home safety assessments, and personal emergency response systems.
Hearing Services See details
Anthem Medicare Advantage (HMO-POS) covers Medicare-covered hearing exams with a $50 copay and no coinsurance, while routine exams and fittings have no copay and no coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to $2,000 annually, excluding inner ear, outer ear, and over-the-ear models, and over-the-counter (OTC) hearing aids are covered with no copay or coinsurance up to $300 per year.
Vision Services See details
Anthem Medicare Advantage (HMO-POS) offers partially covered vision services, which include one routine eye exam per year and eyewear with no copay, no coinsurance, and no deductible. A combined maximum benefit of $250 per year is available for covered eyeglasses and contact lenses, though eyewear upgrades and other eye exam services are not covered.
Dental Services See details
Anthem Medicare Advantage (HMO-POS) offers partially covered dental services with a $1,000 annual maximum, featuring no copay and no coinsurance for preventive care. Covered comprehensive services require no copay and a 25% coinsurance, though maxillofacial prosthetics, implant services, and orthodontics 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 and step therapy are required. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy and other Part B drugs require a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by Anthem Medicare Advantage (HMO-POS) with no copay and a 20% coinsurance.
Medical Equipment See details
Anthem Medicare Advantage (HMO-POS) covers medical equipment with no copays, though prior-authorized durable medical equipment (DME) carries a 0% to 20% coinsurance and prosthetics carry a 20% coinsurance. Diabetic supplies and therapeutic shoes from specified manufacturers are fully 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, featuring lab services with no copay or coinsurance and diagnostic tests with a $0 to $95 copay and no coinsurance. Diagnostic radiology requires a minimum $50 copay with no coinsurance, outpatient X-rays have a $90 copay, and therapeutic radiology requires a minimum 20% coinsurance with no copay.
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 not covered in practice under the Anthem Medicare Advantage (HMO-POS) plan. None of the associated sub-services, including standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) rehabilitation, are 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. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100; however, the benefit is only partially covered as additional days beyond the standard 100 days are not covered.
Other Services See details
Anthem Medicare Advantage (HMO-POS) partially covers other services, offering a chronic illness meal benefit and Medicare Community Resource Support with no copay and no coinsurance. Acupuncture and over-the-counter (OTC) items are not covered under this plan.
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