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 Clark County. 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-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 $50.00 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 $1250.00 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 a low $50 annual drug deductible, making prescription coverage highly affordable from the start. For generic medications, members pay no copay for Tier 1 preferred generics at preferred and standard pharmacies, as well as through standard mail order. Tier 2 generic drugs also feature no copay at preferred pharmacies and through standard mail order, though standard retail pharmacies charge a $10 copay for a one-month supply. For brand-name and specialty medications, costs are structured as coinsurance during the initial coverage phase. Tier 3 preferred brands require a 25% coinsurance, while Tier 4 non-preferred drugs have a 30% coinsurance across preferred, standard, and standard mail-order options. Tier 5 specialty drugs carry a 32% coinsurance for a one-month supply at preferred, standard, and standard mail-order pharmacies.
Additional Benefits
The Anthem Medicare Advantage (HMO-POS) plan offers robust coverage with no copay and no coinsurance for many essential services, including inpatient hospital stays, primary care visits, specialist consultations, and preventive care. Outpatient hospital services, home health care, and diagnostic lab tests are also covered with no copay or coinsurance. For urgent and emergency needs, the plan features a $30 copay for urgent care and a $150 copay for emergency room visits, which is waived if you are admitted. Routine hearing, vision, and preventive dental services are also covered with no copay or coinsurance, although annual benefit limits apply for eyewear, hearing aids, and dental care. For recovery and specialized care, skilled nursing facility stays feature no copay for the first 20 days, followed by a $218 daily copay for days 21 through 100. Additionally, while durable medical equipment features no copay, it may require a coinsurance ranging from 0% to 20%.
Inpatient Hospital See details
Anthem Medicare Advantage (HMO-POS) partially covers inpatient hospital benefits, offering Medicare-covered acute and psychiatric stays with no copay and no coinsurance. Prior authorization is required, and non-Medicare-covered stays and hospital upgrades are not covered.
Outpatient Services See details
Anthem Medicare Advantage (HMO-POS) covers outpatient hospital, observation, ambulatory surgical center, and blood services with no copay and no coinsurance. Outpatient substance abuse services, including individual and group sessions, are covered with a $30 copay and no coinsurance.
Partial Hospitalization See details
Anthem Medicare Advantage (HMO-POS) covers partial hospitalization services with no copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Anthem Medicare Advantage (HMO-POS) covers ground and air ambulance services with a $250 copay and no coinsurance, though prior authorization is required. Transportation services, including trips to plan-approved or any health-related locations, are not covered.
Emergency Services See details
Anthem Medicare Advantage (HMO-POS) covers emergency services with a $150 copay (waived if admitted to the hospital within 24 hours) and no coinsurance, and urgently needed services with a $30 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $100,000 maximum benefit limit with a $150 copay and no coinsurance.
Primary Care See details
Primary care benefits under the Anthem Medicare Advantage (HMO-POS) plan feature no copays and no coinsurance for primary care visits, specialists, physical and occupational therapy, telehealth, and podiatry, though chiropractic services are not covered. Mental health, psychiatric, and opioid treatment services require a $30 copay and no coinsurance, while other healthcare professionals have a copay ranging from $0 to $20 and no coinsurance.
Preventive Services See details
Anthem Medicare Advantage (HMO-POS) covers preventive services, including annual physical exams, kidney disease education, and remote access technologies, with no copay and no coinsurance. This benefit is partially covered, as several supplemental services such as fitness benefits, health education, personal emergency response systems, and weight management programs are not covered.
Hearing Services See details
Anthem Medicare Advantage (HMO-POS) covers hearing services with no copays and no coinsurance, including annual routine exams and fitting evaluations. Prescription hearing aids are partially covered with a $1,500 annual limit (excluding inner ear, outer ear, and over-the-ear types), and over-the-counter hearing aids are covered up to $300 annually.
Vision Services See details
Anthem Medicare Advantage (HMO-POS) offers partially covered vision services with no copay, no coinsurance, and no deductible. This includes one routine eye exam per year and a $175 annual maximum for eyewear like contacts and eyeglasses, though upgrades and other eye exam services are not covered.
Dental Services See details
Anthem Medicare Advantage (HMO-POS) partially covers dental services, offering preventive and diagnostic care with no copay and no coinsurance up to a $500 annual limit. Comprehensive dental services are covered with no copay and a 25% coinsurance, but 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 and step therapy are required. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy and other Part B drugs carry a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Anthem Medicare Advantage (HMO-POS) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Anthem Medicare Advantage (HMO-POS) covers medical equipment with no copay for all services, including durable medical equipment (DME), prosthetics, and diabetic supplies. DME has a coinsurance of 0% to 20%, while prosthetics, medical supplies, and diabetic equipment carry no coinsurance.
Diagnostic and Radiological Services See details
Anthem Medicare Advantage (HMO-POS) covers diagnostic and radiological services with prior authorization and referrals required. Diagnostic tests, procedures, and lab services are covered with no copay and no coinsurance, while outpatient X-rays and diagnostic radiological services require a copay starting at $5, and therapeutic radiological services have a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered by Anthem Medicare Advantage (HMO-POS) with no copay and no coinsurance, although prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Anthem Medicare Advantage (HMO-POS) with no copay and no coinsurance, though prior authorization is required. However, the plan does not cover cardiac, intensive cardiac, pulmonary, or SET for PAD rehabilitation sub-services in practice.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Anthem Medicare Advantage (HMO-POS) with no coinsurance and no prior three-day hospital stay required, though prior authorization is necessary. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100; additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by Anthem Medicare Advantage (HMO-POS), as acupuncture, over-the-counter (OTC) items, and meal benefits are not covered. The plan does cover Medicare Community Resource Support with no copay and no coinsurance, although a referral is required.
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