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 2025, 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 out of 5 stars in 2025.
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 no drug deductible. Your prescription medication coverage will start immediately.
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 has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For example, a preferred generic drug has a $3 copay at a preferred pharmacy, while a standard generic drug has 20% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase and pay nothing for covered Part D drugs. If you qualify for the low-income subsidy, your Part D costs will be $0.
Additional Benefits
The Anthem Medicare Advantage (HMO-POS) plan offers comprehensive coverage with a focus on outpatient and preventive services. Many services like inpatient hospital stays, outpatient services, primary care visits, preventive services, hearing exams, vision exams, and dental services have no copay. You will also have access to a $3,000 annual maximum for prescription hearing aids and a $125 annual maximum for eyewear. Emergency care, including ambulance services, has a copay, as do certain mental health and substance abuse services. Diagnostic radiological services have a copay, and therapeutic radiological services have coinsurance. Skilled Nursing Facility (SNF) services are covered with no copay for the first 20 days, and a $125 copay per day for days 21-100.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with no copay for a Medicare-covered stay. Additional days for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric 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, including outpatient hospital services, observation services, ambulatory surgical center services, and outpatient blood services are covered, with no copay. Outpatient substance abuse services are also covered, with a copay of $30 for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the Anthem Medicare Advantage (HMO-POS) plan, with prior authorization required. There is no copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Anthem Medicare Advantage (HMO-POS) plan. Ground and air ambulance services have a $200 copay, with no coinsurance. Transportation services to a plan-approved health-related location are covered with no copay, and 72 one-way trips per year; transportation to any other health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are covered by the Anthem Medicare Advantage (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage have a $120 copay, while Urgently Needed Services has a $30 copay, and Worldwide Emergency Transportation has a $120 copay.
Primary Care See details
The Anthem Medicare Advantage (HMO-POS) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, chiropractic services, physician specialist services, physical therapy, speech-language pathology services, and additional telehealth benefits have no copay. Individual and group sessions for mental health specialty services, psychiatric services, and opioid treatment program services have a $30 copay.
Preventive Services See details
Preventive services include annual physical exams with no copay, and additional preventive services, kidney disease education services, and other preventive services, with no copay for some services. Health education, in-home safety assessments, and several other services are not covered.
Hearing Services See details
Hearing services with the Anthem Medicare Advantage (HMO-POS) plan include hearing exams with no copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a maximum benefit of $3,000 per year, and OTC hearing aids are covered with no copay up to $300 per year.
Vision Services See details
Vision services include coverage for eye exams and eyewear. Eye exams and eyewear have no copay, and eyewear has a combined maximum benefit of $125 every year.
Dental Services See details
Dental services are covered, with a $500 annual maximum. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services have no copay. Restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics have no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Anthem Medicare Advantage (HMO-POS) plan. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical equipment, including Durable Medical Equipment (DME), is covered with a coinsurance between 0% and 20%, but Durable Medical Equipment for use outside the home is not covered. Prosthetics and medical supplies have no coinsurance, and have a copay for Medicare-covered devices and supplies. Diabetic equipment is covered, with no copay for diabetic supplies or therapeutic shoes/inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services with no copay for diagnostic procedures, tests, and lab services, and coverage for all radiological services. Diagnostic Radiological Services have a copay of at most $105.00, while Therapeutic Radiological Services have a coinsurance of at most 20%, and Outpatient X-Ray Services have a $5 copay.
Home Health Services See details
Home Health Services are covered by the Anthem Medicare Advantage (HMO-POS) plan with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but specific services including Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Anthem Medicare Advantage (HMO-POS) plan with prior authorization required. You will have no copay for days 1-20, and a $125 copay per day for days 21-100.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) Items and Other 1, with no copay for OTC items and a doctor referral required for Other 1. Acupuncture, Meal Benefit, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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