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 $5000.00 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. For cost-effective options, there is no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs across preferred, standard, and standard mail order pharmacies. Tier 2 generic drugs also offer no copay at preferred pharmacies and standard mail order, while standard pharmacies charge a copay ranging from $5 to $15 depending on the supply. For brand-name and specialty medications, costs are determined by coinsurance percentages. Tier 3 preferred brand drugs require a 25% coinsurance, and Tier 4 non-preferred drugs carry a 30% coinsurance across all pharmacy options. Tier 5 specialty medications require a 29% coinsurance for a one-month supply at preferred, standard, and standard mail order pharmacies.
Additional Benefits
The Anthem Medicare Advantage (HMO-POS) plan offers affordable medical coverage with no copay and no coinsurance for primary care doctor visits, preventive care, and home health services. Specialist visits require a thirty-five dollar copay, while inpatient hospital stays charge a daily copay for the first seven days with no coinsurance. Emergency and urgent care services are also covered under flat copayments with no coinsurance. For extra wellness needs, this plan features no copay for routine vision and hearing exams, alongside allowances of up to three hundred dollars for eyewear and three thousand dollars for prescription hearing aids. Preventive dental care has no copay, whereas comprehensive dental services require a twenty-five percent coinsurance up to a two thousand dollar annual maximum. Members also receive a thirty-five dollar quarterly allowance for over-the-counter items and worldwide emergency coverage.
Inpatient Hospital See details
Anthem Medicare Advantage (HMO-POS) covers inpatient hospital services with no coinsurance, requiring a daily copay of $375 for days 1 to 7 of acute stays and $310 for days 1 to 7 of psychiatric stays, with no copay for subsequent days. Non-Medicare-covered stays and upgrades are not covered under this benefit.
Outpatient Services See details
Anthem Medicare Advantage (HMO-POS) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services with no copay. Outpatient hospital services carry a copay of $0 to $375, observation services require a $375 copay per stay, and outpatient substance abuse sessions have a $35 copay, with prior authorization required for most benefits.
Partial Hospitalization See details
Partial hospitalization is covered under the Anthem Medicare Advantage (HMO-POS) plan with a $40.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Anthem Medicare Advantage (HMO-POS) covers ground and air ambulance services with a $260 copay and no coinsurance, although prior authorization is required. Transportation services to plan-approved or any health-related locations are not covered under this plan.
Emergency Services See details
Emergency services are covered by Anthem Medicare Advantage (HMO-POS) with a $130 copay and no coinsurance, while urgently needed services require a $30 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with a $130 copay and no coinsurance, up to a maximum plan benefit of $100,000.
Primary Care See details
Anthem Medicare Advantage (HMO-POS) offers primary care physician visits and telehealth services with no copay and no coinsurance. Most specialist, therapy, mental health, psychiatric, and opioid treatment services require a $35 copay and no coinsurance, while chiropractic services are not covered. Podiatry and other health professional services range from a $0 to $35 copay with no coinsurance.
Preventive Services See details
Preventive services are partially covered by Anthem Medicare Advantage (HMO-POS) with no copay and no coinsurance for covered care such as annual physical exams, kidney disease education, and remote access technologies. However, several sub-services are not covered, including fitness benefits, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, smoking cessation, enhanced disease management, telemonitoring, counseling, and home modifications.
Hearing Services See details
Anthem Medicare Advantage (HMO-POS) covers hearing services, featuring Medicare-covered exams for a $35 copay and no coinsurance, alongside routine annual exams and fittings with no copay and no coinsurance. Prescription hearing aids up to $3,000 annually and OTC hearing aids up to $300 annually are available with no copay and no coinsurance, although inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
Anthem Medicare Advantage (HMO-POS) vision services are partially covered, offering no copay and no coinsurance for one routine eye exam per year and eyewear, which has a $300 annual limit. Other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Anthem Medicare Advantage (HMO-POS) offers partially covered dental services with an annual maximum benefit of $2,000. Preventive dental care has no copay and no coinsurance, while covered comprehensive dental services have 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. Under this plan, Medicare Part B chemotherapy and other Part B drugs require no copay and 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and no 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
Anthem Medicare Advantage (HMO-POS) covers medical equipment with no copays for durable medical equipment (DME), prosthetics, medical supplies, and diabetic equipment. Coinsurance ranges from 0% to 20% for DME, is 20% for prosthetics and medical supplies, and there is no coinsurance for diabetic supplies and therapeutic shoes or inserts.
Diagnostic and Radiological Services See details
Anthem Medicare Advantage (HMO-POS) covers diagnostic services with no coinsurance, offering no copay for lab services and a $0 to $95 copay for diagnostic procedures. Radiological services require prior authorization and include diagnostic radiology starting at a $50 copay with no coinsurance, outpatient X-rays at a $90 copay plus coinsurance, and therapeutic radiology with a 20% minimum coinsurance and a copay.
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, but in practice, some services are covered while cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Anthem Medicare Advantage (HMO-POS) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, though prior authorization is required and additional days beyond the Medicare-covered limit are not covered. There is no copay for days 1 through 20, followed by a $218 copay for days 21 through 100, with no prior three-day inpatient hospital stay required.
Other Services See details
Anthem Medicare Advantage (HMO-POS) partially covers other services with no copay and no coinsurance, including chronic illness meal benefits, Medicare Community Resource Support, and a $35 quarterly over-the-counter item allowance. Acupuncture is not covered under this benefit.
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