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 2025, 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 out of 5 stars in 2025.
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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9350.00 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) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay or coinsurance for your prescriptions, depending on the drug tier and pharmacy you use. For example, you will pay a $4 copay for preferred generic drugs at a preferred pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for your Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Anthem Medicare Advantage (HMO) plan offers comprehensive coverage for various healthcare needs. Inpatient hospital stays have a copay, with acute care starting at $299 and psychiatric care at $355, but some days have no copay. Outpatient services, including doctor visits and lab services, often have no copay, while emergency services and specialist visits have copays. This plan also covers preventive services, hearing, and vision, with varying copays. Additionally, you'll find coverage for home health, skilled nursing, and ambulance services. Dental services are partially covered, and there's coverage for medical equipment, diagnostic, and radiological services.
Inpatient Hospital See details
Inpatient Hospital benefits cover acute and psychiatric services. For Inpatient Hospital-Acute, you pay a $299 copay for days 1-6, and no copay for days 7-90; Additional Days are covered with no copay. For Inpatient Hospital Psychiatric, you pay a $355 copay for days 1-5, and no copay for days 6-90; Additional Days are covered with no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services have a copay of $0-$325, Observation Services have a copay of $325 per stay, ASC Services have no copay, Individual and Group Sessions for Outpatient Substance Abuse have a copay of $40, and Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Anthem Medicare Advantage (HMO) plan with a $40 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Anthem Medicare Advantage (HMO). Ground ambulance services have a $250 copay, while air ambulance services have 20% coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by Anthem Medicare Advantage (HMO). Emergency Services have a $90 copay, and Urgently Needed Services have a $35 copay, while Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $90 copay, with a maximum plan benefit coverage of $100,000.
Primary Care See details
The Anthem Medicare Advantage (HMO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, and occupational therapy services with a $35 copay. The plan also covers physician specialist services and physical therapy and speech-language pathology services with a $35 copay, as well as mental health specialty services, psychiatric services, and opioid treatment program services with a $40 copay for individual and group sessions. Additional telehealth benefits have no copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive services, including annual physical exams, are covered by this plan. Annual physical exams have no copay, while other preventive services have a copay. Some services like health education, in-home safety assessments, and others are not covered.
Hearing Services See details
Hearing exams have a $35 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered with a maximum benefit of $500 per year, and OTC hearing aids are covered with no copay and a maximum benefit of $300 per year. Prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Anthem Medicare Advantage (HMO) covers vision services, including eye exams with a copay of $0-$35. Eyewear benefits are covered with a $0 copay, and a combined maximum benefit of $100 per year for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames; however, upgrades are not covered.
Dental Services See details
Dental services are partially covered under Anthem Medicare Advantage (HMO). Medicare Dental Services are covered with no copay, while orthodontic services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics, maxillofacial prosthetics, implant services, prosthodontics, fixed, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Anthem Medicare Advantage (HMO) plan and require prior authorization. The plan covers Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by Anthem Medicare Advantage (HMO) with a coinsurance of 20%.
Medical Equipment See details
Medical equipment benefits include Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, Prosthetic Devices with a 20% coinsurance, Medical Supplies with a 20% coinsurance, and Diabetic Equipment with no copay for Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, with copays ranging from $0 to $145, and lab services with no copay. Diagnostic Radiological Services have a copay up to $300, and Therapeutic Radiological Services have a 20% coinsurance. Outpatient X-Ray Services have a $5 copay.
Home Health Services See details
Home Health Services are covered by the Anthem Medicare Advantage (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Anthem Medicare Advantage (HMO) plan. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Anthem Medicare Advantage (HMO), but require prior authorization. For days 1-20, there is no copay, and for days 21-100, there is a $196 copay.
Other Services See details
The Anthem Medicare Advantage (HMO) plan covers Over-the-Counter (OTC) Items and "Other 1" services with no copay. Acupuncture, meal benefits, and a variety of other services are not covered.
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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.
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