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 San Diego County. 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, you will pay no copay for Tier 1 preferred generic drugs at preferred, standard, and standard mail-order pharmacies. For Tier 2 standard generics, copays range from $42 to $47, while Tier 3 preferred brands require 25% coinsurance and Tier 4 non-preferred drugs require 33% coinsurance. After your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase and pay nothing for covered Medicare Part D drugs. Additionally, individuals who qualify for the low-income subsidy, also known as Extra Help, will benefit from a reduced Part D premium of $0. This plan provides clear, structured cost-sharing to help you manage your prescription medication expenses.

Additional Benefits

The Anthem Prime (HMO-POS) plan offers comprehensive coverage with many essential services available at no copay and no coinsurance, including primary and specialist visits, preventive care, routine vision and hearing exams, and home health services. For inpatient hospital stays, members pay a $150 daily copay for the first six days and no copay for days 7 through 90, while outpatient hospital services range from no copay up to a $225 copay. Emergency care is accessible with a $150 copay, which is waived if admitted within 24 hours, and urgently needed services require a $35 copay. This plan also features strong supplemental benefits, such as preventive dental care with no copay and comprehensive dental services covered at a 25% coinsurance up to a $1,500 annual limit. Additionally, members benefit from up to 30 free one-way transportation trips per year to approved health-related locations, no copay for diabetic supplies, and durable medical equipment covered with coinsurance ranging from 0% to 20%. Diagnostic lab tests and X-rays are also fully covered with no copay or coinsurance, making this plan a highly cost-effective option for managing everyday healthcare needs.