A non-government entity
Anthem Medicare Advantage (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Anthem Medicare Advantage (HMO). 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) in 2026, please refer to our full plan details page.
Anthem Medicare Advantage (HMO) is a HMO plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Denver Metro Area. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Anthem Medicare Advantage (HMO) 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).
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), 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 $325.00 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 $9250.00 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) prescription drug plan features an annual drug deductible of $325 and provides cost-effective coverage for generic medications. There is no copay for Tier 1 preferred generics and Tier 6 select care drugs at preferred, standard, and standard mail-order pharmacies. Additionally, Tier 2 generic drugs have no copay at preferred pharmacies and standard mail-order, while standard retail pharmacies require a $10 to $30 copay depending on the supply. For higher-tier medications, costs are calculated as a coinsurance percentage instead of a flat copayment. Tier 3 preferred brand drugs require a 20% coinsurance at preferred and standard mail-order pharmacies, which rises to 25% at standard pharmacies. Tier 4 non-preferred drugs require a 30% coinsurance, and Tier 5 specialty drugs require a 29% coinsurance for a one-month supply across all available pharmacy networks.
Additional Benefits
The Anthem Medicare Advantage (HMO) plan offers affordable healthcare coverage featuring no copay and no coinsurance for primary care and telehealth visits. For hospital stays, members pay a $325 daily copay for the first six days of acute inpatient care with no copay thereafter, while emergency room visits carry a $115 copay that is waived if admitted within 24 hours. Outpatient hospital services require a copay of up to $350 with no coinsurance, and diagnostic lab tests are available with no copay. Specialist visits and mental health services require copays between $20 and $40, while routine hearing and vision exams are covered with no copay. The plan also provides no-copay home health services, a $35 quarterly over-the-counter allowance, and up to $300 annually for eyewear and $500 for prescription hearing aids. Skilled nursing facility care features no copay for the first 20 days, followed by a $218 daily copay, though routine dental services are not covered under this plan.
Inpatient Hospital See details
Anthem Medicare Advantage (HMO) covers inpatient hospital services with no coinsurance, though prior authorization is required. For acute stays, there is a $325 daily copay for days 1 through 6 and no copay for additional days, while psychiatric stays require a $355 daily copay for days 1 through 5 and no copay thereafter. This benefit is partially covered, as upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Anthem Medicare Advantage (HMO) covers outpatient services with no coinsurance, featuring a copay of $0 to $350 for outpatient hospital services and a $350 copay per stay for observation services. Ambulatory surgical center and blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $40 copay.
Partial Hospitalization See details
Anthem Medicare Advantage (HMO) 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) covers ground and air ambulance services with a $275 copay per service and no coinsurance, though prior authorization is required. Transportation services to plan-approved or health-related locations are not covered under this plan.
Emergency Services See details
Anthem Medicare Advantage (HMO) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services have a $35 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $100,000 limit with a $115 copay and no coinsurance.
Primary Care See details
Anthem Medicare Advantage (HMO) covers primary care and telehealth services with no copay and no coinsurance. Specialist visits, physical, occupational, and speech therapies, and mental health services are covered with no coinsurance and copays ranging from $20 to $40, while chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered under the Anthem Medicare Advantage (HMO) plan with no copay and no coinsurance for covered services, which include annual physical exams, kidney disease education, remote access technologies, and diabetes self-management training. However, the plan does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, fitness benefits, enhanced disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Hearing services are covered by Anthem Medicare Advantage (HMO), offering Medicare-covered exams for a $35 copay and no coinsurance, alongside routine exams and fittings with no copay and no coinsurance. Prescription hearing aids are partially covered up to $500 annually with no copay and no 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 annually with no copay and no coinsurance.
Vision Services See details
Vision services are partially covered by Anthem Medicare Advantage (HMO) with no deductible, featuring eye exams for a $0 to $35 copay and eyewear up to a $300 yearly limit with no copay or coinsurance. While routine eye exams and standard eyewear are covered, other eye exam services and upgrades are not covered.
Dental Services See details
Anthem Medicare Advantage (HMO) partially covers dental services, offering Medicare-covered dental care with no copay and no coinsurance, though prior authorization is required. Routine preventive and comprehensive dental services—including oral exams, cleanings, x-rays, restorative care, and orthodontics—are not covered.
Home Infusion bundled Services See details
Anthem Medicare Advantage (HMO) covers home infusion bundled services with no copay, although prior authorization and step therapy are required. Under this benefit, Part B chemotherapy and other Part B drugs have 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 by Anthem Medicare Advantage (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Anthem Medicare Advantage (HMO) covers durable medical equipment with no copay and 0% to 20% coinsurance, and prosthetic devices and medical supplies with no copay and 20% coinsurance. Diabetic equipment, including supplies and therapeutic shoes or inserts, is covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the Anthem Medicare Advantage (HMO) with prior authorization required. Diagnostic services feature no coinsurance, with no copay for lab services and a $0 to $145 copay for procedures and tests, while radiological services require a $5 copay for X-rays, a minimum $5 copay for diagnostic radiology, and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Anthem Medicare Advantage (HMO) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under Anthem Medicare Advantage (HMO) with no copay and no coinsurance, meaning some services are covered but standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Anthem Medicare Advantage (HMO) covers skilled nursing facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day 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) partially covers other services, offering over-the-counter (OTC) items with a $35 quarterly allowance and Medicare Community Resource Support, both with no copay and no coinsurance. Acupuncture, meal benefits, and other additional services under this benefit are not covered.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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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.
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