Anthem Prime (HMO-POS)

Anthem Prime (HMO-POS) is a HMO-POS plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Riverside and San Bernardino Counties. This plan received an overall rating of 3 out of 5 stars in 2026.

It's important to know that Anthem Prime (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 Prime (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.

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:

Drug Coverage

The Anthem Prime (HMO-POS) Medicare plan offers an Enhanced Alternative drug benefit with no prescription drug deductible. During the initial coverage phase, members enjoy no copay for Tier 1 preferred generic drugs at preferred pharmacies, standard pharmacies, and through standard mail. Tier 2 standard generic drugs require a $42 copay at preferred pharmacies and standard mail, or a $47 copay at standard pharmacies. For higher-tier medications, members pay a 25% coinsurance for Tier 3 preferred brand drugs and a 33% coinsurance for Tier 4 non-preferred drugs. Once your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase and pay nothing for covered Part D prescriptions.

Additional Benefits

The Anthem Prime (HMO-POS) Medicare plan offers comprehensive coverage with no copay and no coinsurance for many essential services, including inpatient hospital stays, primary care visits, specialist consultations, and routine preventive care. Patients also benefit from no copays on home health services, routine eye and hearing exams, and outpatient surgical procedures. For urgent and emergency needs, the plan features a $25 copay for urgent care and a $150 copay for emergency room visits, which is waived if you are admitted. While many services require no cost-sharing, some specialized treatments involve copays or coinsurance, such as a 25% coinsurance for comprehensive dental services and a 20% coinsurance for dialysis and prosthetic devices. Prescription hearing aids, eyewear, and preventive dental are covered up to annual limits with no copay, while Part B chemotherapy and durable medical equipment carry coinsurance up to 20%. Additionally, skilled nursing facility stays are covered with no copay for the first 20 days, followed by a $218 daily copay for days 21 through 100.